The Mediterranean Diet: An Evidence-Based Approach

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The Mediterranean Diet:
An Evidence-Based Approach
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Contents
Contributors
Acknowledgments
Section A: The Mediterranean diet: Concepts and overviews
1
The Mediterranean diet: History, concepts and elements
	Origins of the Mediterranean diet
	Definition of the Mediterranean diet
	Nutritional characteristics of the Mediterranean diet
	The Mediterranean diet: Fresh, seasonal and local ingredients
	Other characteristics of the Mediterranean diet (variety, frugality and palatability)
	Are we abandoning the Mediterranean diet?
	The Mediterranean diet pyramid
	The Mediterranean diet: UNESCO intangible cultural heritage of humanity
	The Mediterranean diet is good for health: Origins
	References
2
Mediterranean diet: A long journey toward intangible cultural heritage and sustainability
	Introduction
	Mediterranean diet: An intangible cultural heritage
	Mediterranean diet and health
	Mediterranean diet and sustainable environment
		Mediterranean diet 4.0: Pursuing a sustainable model for the Mediterranean area
	The new Mediterranean diet pyramid
		Cultural and lifestyle aspects
		Moderation
		Conviviality
		Culinary activities
		Physical activity
	Final considerations
	Summary points
	References
	Further reading
3
Mediterranean diet in children and adolescents
	Child nutrition overview
	Mediterranean diet and nutritional adequacy
	Mediterranean diet adherence and weight status: A potential link to the childhood obesity epidemic
	Mediterranean diet and asthma in children and adolescents
	Mediterranean diet and cardiometabolic risk factors in children and adolescents
	Associations of the Mediterranean diet with other health indices
	Mediterranean diet adherence among children and adolescents
	Mediterranean diet and physical activity
	Mediterranean diet during the economic crisis: An excuse or a reality?
	Concluding remarks
	References
4
The Mediterranean diet and cardiovascular disease: An overview
	Mediterranean diet: A brief description
	Mediterranean dietary patterns: A method to assess adherence for further evaluation
	Mediterranean diet and CVD: What is the evidence?
		Epidemiological studies
			Randomized clinical trials
	Heart failure
	Concluding remarks
	References
5
Socioeconomic factors for the adherence to the Mediterranean diet in North Africa: The shift from 1990 to 2019
	Introduction
	Objective
	Sociodemographic data in North African countries 1980–1919
	Socioeconomic status in North African countries
		Nutritional transition in North Africa
	How does socioeconomic and demographic status affect the nutrition transition and adherence to Mediterranean diet in North ...
		Physical activity and sedentary behavior
		Obesity
		Nutritional behavior
	Conclusion
	Summary points
	References
6
Mediterranean lifestyle: Linking social life and behaviors, residential environment, and cardiovascular disease prevention
	The definition of Mediterranean diet and its evolution
	Mediterranean lifestyle: Conceptualizing beyond diet
	Mediterranean lifestyle and cardiovascular disease prevention
	The role of socialization and behaviors
	The role of residential environment
	Is Mediterranean diet transferable?
	Summary points
	References
7
Orthodox religious fasting: A vital subset of the Mediterranean diet
	Introduction
	Christian Orthodox fasting: The concept
	Dietary analysis of Orthodox fasting
	Effects on human health
	The Athonian fasting
	Conclusions
	Summary points
	References
8
Food security and adherence to the Mediterranean diet: An interplay of socio-demographic characteristics
	Introduction
	Food insecurity in the Mediterranean countries
	Food security and Mediterranean diet: Friends or foes?
	Nutrition transition: Abandoning the traditional dietary pattern
	Financial costs associated with the adoption of a healthy diet
	Economic laws governing food consumption
	We do need more education: Another brick in the wall of health literacy
	Caveats of the Mediterranean diet concept
	Mediterranean food for thought and sustainable development
	References
9
Mediterranean diet, nutrition transition, and cardiovascular risk factor in children and adolescents
	Introduction
	Factors influencing food choices in childhood
	Healthy food education models
		MD adherence in school children and adolescents
	Mediterranean-style diet and cardiovascular risk factors in children and adolescents
	Conclusions
	References
10
Precision nutrition: Mediterranean diet and genetic susceptibility
	Precision nutrition: Mediterranean diet and genetic susceptibility
		Understanding the human genome
		Modern human diversity: Genetic variations among individuals
		Significance of human genetic variations
		The Mediterranean diet and genetic susceptibility
		Conclusion
	References
11
Mediterranean food and environmental impacts
	Introduction
	Water footprint
	Land use
	Carbon footprint and climate change
	Biodiversity
	Food wastage
	Conclusions
	References
12
Mediterranean adequacy index: Features and applications
	Introduction
	The seven countries study and the Mediterranean diet
	The origin of the Mediterranean adequacy index (MAI)
	Structure of the MAI
	Application of the MAI
		MAI versus 25-year CHD mortality in the SCS
		MAI versus 50-year CHD mortality in the SCS areas
		MAI versus 50-year all-cause mortality in the SCS
		MAI versus 40-year CHD mortality in the Italian Rural Areas of the SCS
		MAI versus other dietary scores as associated with 40-year CHD mortality in the Italian Rural Areas of the SCS
		MAI compared with two other dietary scores predicting all-cause mortality in the elderly
		Further applications of the MAI to other populations
	Limits of the MAI
	Strength of the MAI
	Conclusions
	References
13
Nutritional adequacy of the Mediterranean diet
	Introduction
	Nutritional adequacy assessment methods
	Nutritional adequacy and public health
	Mediterranean diet, Western diet, and nutritional adequacy
	Mediterranean diet in children and nutritional adequacy
	Summary points
	References
14
Toward a Mediterranean-style diet beyond the Mediterranean countries: Evidence of implementation and adherence
	Introduction
	Adherence to MD worldwide
	Implementation of the MD in non-Mediterranean populations
	Effects on CVD risk factors and cognition
		Blood pressure
		Other CVD outcomes
		Endothelial function markers
		Mood and cognitive function
		Discussion
		Barriers to following the MD outside the Mediterranean region
	References
Section B: Components of the Mediterranean diet
15
Contribution of nuts to the Mediterranean diet
	Introduction
	Nuts in the Mediterranean diet
	Nutrient content of Mediterranean nuts
	Nut consumption and health outcomes
		Epidemiological studies
		Randomized clinical trials
		Health effects of Mediterranean nuts in the PREDIMED trial
	Conclusion
	Summary points
	Acknowledgments
	References
16
The Mediterranean diet and mineral composition
	Introduction
	Mineral intake in the MD
		Calcium
		Phosphorus
		Magnesium
		Iron
		Zinc
		Sodium/Potassium
		Other micronutrients
	Mineral content in typical Mediterranean menus
	Mineral bioavailability
	Conclusions
	References
17
Hydroxytyrosol as a component in the Mediterranean diet and its role in disease prevention
	Introduction
	Which is the origin of HT?
	Hydroxytyrosol through the body: Which are its ADME processes?
		Chemical characteristics
		From food to blood: The absorption process
		Transport in the body: The distribution process
		Transformations. How are the metabolism processes?
		Elimination
	Does HT have side effects?
		Acute/subchronic toxicity
		Dose establishment
	Role of HT in different diseases: HT against them and as protector of life
		Neuroprotective effects
		Antimicrobial effect of HT
		How can HT protect the skin?
		Antiatherogenic and cardioprotector
		Has got HT antiinflammatory and antiplatelet actions?
		Cancer studies
	Summary points
	References
	Further reading
18
Light, regular red wine consumption at main meals: A key cardioprotective element of traditional Mediterranean diet
	Introduction
	Grape and wine chemistry
	Melatonin
	Mediterranean diet, wine, and cardiovascular disease: Systematic reviews and meta-analyses
	Clinical trials
	Wine and other chronic degenerative diseases: Focus on cancer
	Conclusions and future perspectives
	References
19
Frying a cultural way of cooking in the Mediterranean diet and how to obtain improved fried foods
	Cultural and gastronomic importance of frying in the Mediterranean diet
	Culinary oils: Frying procedure
		Oil types, selection, and uses
		Frying technique
	Changes occurring during frying
		Advantages and disadvantages of frying versus other cooking procedures
		Alternate frying technologies: Searching for an optimal deep-frying technique
		Frying to obtain functional foods: Advantages of frying with olive oils
			Oil composition
			Frying temperature
			Crust formation
			Resistance to thermal oxidation of olive oil during frying or at frying temperatures
		Obtaining healthier fried food
		Fried-food consumption and health
			Effects on body weight
			Effects on mortality and degenerative diseases
	Future remarks
	Summary points
	Acknowledgments
	References
20
Wild greens used in the Mediterranean diet
	Introduction
	Common wild greens used in the Mediterranean diet
		Wild greens used in Greece
		Wild greens used in Italy
		Wild greens used in Portugal
	Current trends in commercial exploitation of wild greens
	Conclusion remarks and future perspectives
	References
21
Raisins and the other dried fruits: Chemical profile and health benefits
	Introduction
	Chemical components of raisins and other dried fruits
	Quality control of raisins and other dried fruits
	Antioxidant properties of raisins and other dried fruits
	Health effects of raisin consumption
	Summary
	References
22
Date palm fruit (Phoenix dactylifera): Nutritional values and potential benefits on health
	Introduction
	Phytoconstituents in date palm fruits of Phoenix dactylifera
		Sugars
		Protein
		Lipids
		Aroma and volatile compounds
		Pigments
		Vitamins
		Mineral elements
		Fiber
		Polyphenols
			Flavonoids
			Phenolic acid
			Condensed tannins
			Anthocyanins
		Phytosterols
	Biological activities
		Antioxidant activity
		Antiinflammatory activity
		Antihypercholesterolemic activity
		Antibacterial and antifungal activities
		Antihemolytic activity
		Gastrointestinal protective activity
		Fibers and pectins: Potential applications
	Conclusion
	References
	Further reading
23
Dietary fiber intake and the Mediterranean population
	Introduction
	What is fiber? Definition changes over time
	What is Mediterranean diet and which components are rich in fiber
	Dietary fiber and mortality
	Dietary fiber and cardiovascular disease incidence
	Dietary fiber and type 2 diabetes incidence
	Dietary fiber and weight gain/obesity
	Dietary fiber and breast cancer incidence
	Dietary fiber and colorectal cancer incidence
	Dietary fiber and prostate cancer incidence
	Conclusion
	References
24
Oleic acid and implications for the Mediterranean diet
	Introduction
	Content of oleic acid in plasma/serum and erythrocytes phospholipids in Mediterranean and non-Mediterranean populations
		Content of oleic acid in sport players
		Content of oleic acid in noncommunicable disease
	Oleic acid and cardiovascular diseases
	Oleic acid and cancer
	Conclusion
	Acknowledgment
	References
25
Fish in the Mediterranean diet
	Introduction
	Nutritional value of fish
		Proteins
		Lipids and fatty acids
		Vitamins and minerals
	Potential risks associated with fish consumption
		Metals and metalloids
		Other risks
	Conclusions
	References
26
The Mediterranean diet and its individual components: Linking with obesity in Italy
	Introduction
	Evolution of the Mediterranean diet in Italy
	Trends in obesity prevalence in Italy
	Obesity and linking with the Mediterranean diet and its components
	Conclusions
	References
	Further reading
27
Bioactive compounds in oranges from the Mediterranean climate area
	Introduction: Mediterranean citrus origin and phylogenetic
		Citrus Mediterranean origin
		Citrus phylogenetic
	Nutritional value and bioactive compounds in citrus fruits
		Dietary fiber
		Vitamins
			Vitamin C
			Provitamin A ( Carotenoids)
			Vitamin E ( tocopherols)
		Limonoids
		Phenolic compounds
			Flavonoids
			Phenolic acids
	Bioactivity of citrus fruits in relation to human health
	References
	Further reading
Section C: Medical, health, and nutritional aspects of the Mediterranean diet
28
Gestational diabetes mellitus and Mediterranean diet principles
	Introduction
	Gestational diabetes mellitus: Concept and diagnosis
	Scientific evidence: Can the Mediterranean diet prevent GDM?
		Epidemiological studies
		Randomized clinical studies
	Treatment of GDM
	What are the mechanisms involved?
		Insulin sensitivity
		Antiinflammatory and antioxidant
		Weight control
	Pistachios, walnuts, almonds, peanuts…does it matter?
	Conclusion
	Summary points
	Acknowledgments
	Conflict of interest
	References
29
The Mediterranean diet and asthma
	Introduction
	Pathophysiology
	Gut microbiota and asthma
	Nutrients and asthma
		Fruits and vegetables
		Micronutrients
			Vitamins
			Vitamin A
			Vitamin C
			Vitamin D
			Vitamin E
	Minerals
		Macronutrients
			Fatty acids
	Mediterranean diet and asthma control
	Mediterranean diet and lung function
	Prevention of asthma
	Conclusion
	References
30
The Mediterranean diet, dietary inflammatory index, and adiposity
	Introduction
	Mediterranean diet, dietary inflammatory index, and adiposity
		Cross-sectional studies
		Prospective cohort studies
	Conclusion
	References
31
Microglia-mediated neuroinflammation and Mediterranean diet
	Introduction
	Microglia
	MD food components in mitigating microglia-mediated neuroinflammation
		Nutrients
			Lipids: Unsaturated fats (monounsaturated and polyunsaturated fatty acids)
		Polyphenols
			Olive oil polyphenols: Secoiridoids
			Stilbenes
			Flavonoids: Anthocyanins, catechin, epicatechin, quercetin
	Conclusion
	References
32
Mediterranean diet, inflammation, and telomere length maintenance
	Introduction
	Telomere, inflammation, and lifestyle factors
		Telomere length and lifestyle choices
		Telomere length and bioactive food compounds
	Mediterranean diet, telomere maintenance, and inflammation
		Human studies
	Conclusions
	References
33
Olive oil nutraceuticals and chronic disease prevention: More than an offshoot of the Mediterranean diet
	Overview
	Bio-nutraceuticals within olive oil and associated health benefits
	Recommended dosage and intake of OO
	Role of OO and its nutraceuticals in health and disease
		Cardiovascular disease
		OO and cancer
		OO and diabetes
	Innovative applications of OO in health and lifestyle
	Conclusion
	References
34
The Mediterranean diet and metabolic syndrome
	Introduction
	Definition of the metabolic syndrome
	Pathophysiology of MetS
	Definition of Mediterranean diet
	Mediterranean diet and metabolic syndrome
	Recommendations
	Conclusions
	References
35
The Mediterranean diet and breast cancer risk
	Introduction
	The Mediterranean dietary pattern
	The Mediterranean dietary pattern and breast cancer risk: Epidemiological evidence
	The protective effect of the Mediterranean diet: Mechanistic evidence
	Nutrigenetics and metabolic studies on the relationship between the Mediterranean diet and breast cancer
	Investigating the Mediterranean diet: Concepts, challenges, and benefits
	Conclusions
	Summary points
	References
36
The Mediterranean diet and arthritis
	Introduction
	The inflammatory process and comorbidities in arthritis
	The role of diet in the pathogenesis of arthritis
	Characteristics of the traditional Mediterranean dietary lifestyle
	Effects of nutritive and bioactive components of the Mediterranean diet in the modulation of inflammation
		Findings from clinical studies
	Immunomodulatory effect of Mediterranean dietary components
	Mediterranean diet and gut microbiota
	Influence of the Mediterranean diet on epigenetic modifications
	Clinical trials on the Mediterranean diet interventions in arthritis patients
	Clinical trial on Mediterranean diet components supplementation in arthritis
	Conclusion
	Summary points
	Acknowledgment
	References
37
Mediterranean diet and pregnancy
	Introduction
	Nutrition during gestation
	General nutrition remarks during pregnancy
	Mediterranean dietary pattern
	Mediterranean diet, a dietary way for decreasing malnutrition or subnutrition during gestation?
	Mediterranean diet and gestational diabetes and gestational glucose intolerance
	Maternal Mediterranean diet and fetal/neonatal insulin sensitivity
	Pregnancy, lipoproteins and other coronary heart disease risk
	Maternal Mediterranean diet and neonatal lipoprotein profile and homocysteine
	Mediterranean diet and fertility
	Genetics and epigenetics
	Future remarks
	Summary points
	Acknowledgments
	Conflict of interest
	References
38
Laryngopharyngeal reflux and the Mediterranean diet
	Introduction
	Laryngopharyngeal reflux
	Gastroesophageal reflux disease
	Epidemiology
	The cost of reflux
	Pathophysiology
	Symptoms
	Laryngopharyngeal findings of LPR
	Objective testing
	Esophageal and dual pH probe testing
	Oropharyngeal pH testing
	Impedance/pH testing
	Barium swallow
	Manometry and gastric emptying
	Scintigraphy
	Transnasal esophagoscopy
	Esophagogastroduodenoscopy
	Pepsin testing
	Treatment as a diagnostic tool
	Historical treatment
	Treatment
	Standard reflux precautions
	Pharmacological interventions
	Mucosal protection
	Other agents
	H2-receptor antagonists
	PPI therapy
	Procedural interventions for reflux
		Transoral incisionless fundoplication
		Laparoscopic fundoplication
	Traditional treatment revisited
	Low acid diet approach
	Combining low acid with decreasing pepsin approach: Plant based diet theory of LPR suppression
	A Mediterranean style, plant-based diet with alkaline water clinical approach to LPR treatment
	A diet-based approach to treating reflux disease
	How to taper PPI successfully
	Beneficial side effects to the plant based approach to treating reflux
	The reflux institute concept
	References
39
The Mediterranean style diet and cognition
	Introduction
	The aging brain, cognitive aging, and risk factors
	Cognitive findings and sensitivity of cognitive testing
	Nutrition and the effect on cognition
	The Mediterranean diet and cognition
		The effect of Mediterranean diet adherence on cognitive function and the effect of medications
		The effect of Mediterranean diet and aerobic exercise on cognition
	Implications
	References
40
Mediterranean diet and mental well-being in the young
	Introduction
	Relationship between Mediterranean diet and depression and anxiety
		Cross-sectional studies
		Observational cohort studies
		Case - control studies
		Intervention studies
		Metaanalyses
	Other mental psychosocial indicators related with Mediterranean diet adherence
		HRQoL and MD
		Cross-sectional studies
		Intervention studies
		Self-esteem and MD
	Measures
	Limitations
	Discussion and implications
	Conclusion
	References
41
Mediterranean diet and female fertility: Cross-talk of an evidence-based approach
	Introduction
	Female infertility
	Mediterranean diet and female fecundity
	Is it the Mediterranean diet, or is it a “healthy” diet in general?
	Mediterranean diet and female infertility: Weighing the evidence
	Mediterranean diet and primary modifiable causes of female infertility
	Hype or hope?
	References
42
Mediterranean diet and the postprandial state: A focus on inflammation, endothelial dysfunction, and hemostasis
	Introduction
	Olive oil
		Acute effects of olive oil consumption on inflammation, endothelial function, and hemostasis
		Effect of long-term olive oil consumption on postprandial inflammation, endothelial function, and hemostasis
	Fish
	Wine
	Nuts
	Conclusions
	References
	Further reading
43
Socioeconomic determinants of the adherence to the Mediterranean diet
	Introduction
	The Mediterranean diet is no longer the diet of the poor country people
	The global economic crisis: A global dietary threat
	SES gradient in food selection and diet quality
	Health benefits of a Mediterranean diet may not be equal to all
	Nutrition knowledge beyond traditional SES factors
	Conclusions
	References
44
Fungal species and toxins in wines and grapes in the Mediterranean area
	Introduction
	Mycotoxigenic fungal species in grapes in the Mediterranean area
	Mycotoxins in grapes and grape-derived products in the Mediterranean area
	Control measures to reduce the occurrence of GBA and of OTA contamination in grapes, wines, and grape-derived products
	Conclusions
	Summary points
	References
45
Metabolomics and the Mediterranean diet
	What is metabolomics?
	What are metabolites? Types
	Pathways
	Techniques
		Acquisition and preprocessing of 1H NMR spectra
		Sample preparation
		1H NMR spectra acquisition
		Data preprocessing for fingerprinting analysis
		Data analysis
		Metabolite identification and quantification
		Quantitative analysis of metabolic profiles by targeted approach
		Statistical analysis and biological interpretation
	Metabolomics and the Mediterranean diet
	References
46
Antiinflammatory activity exerted by minor compounds found in virgin olive oils
	Mediterranean diet
	Virgin olive oil
	Minor compounds in virgin olive oil
		Squalene
		Pinoresinol
		Oleanolic acid
		Maslinic acid
		Uvaol
		Erythrodiol
	Biological activities of minor compounds in inflammation
		Squalene
		Pinoresinol
		Oleanolic acid
		Maslinic acid
		Uvaol
		Erythrodiol
	Summary points
	References
47
Red wine and atherosclerosis: Implications for the Mediterranean diet
	Introduction
	Phenolic compounds in the red wine
	Potential antiatherogenic effects of phenolic compounds present in red wine
	Red wine and Mediterranean diet: Potential synergy
	Summary points
	References
Section D: Novel nutraceuticals and edible plants used in the Mediterranean region
48
Effects of nutraceuticals of Mediterranean diet on aging and longevity
	Introduction
	Nutraceuticals of Mediterranean diet
	Nutraceuticals effects on molecular pathways
	Antiaging effects of nutraceuticals
	Focus on Mediterranean nutraceutical foods
	References
49
Essential oils from Mediterranean aromatic plants
	The Mediterranean area
	Essential oils
	Mediterranean plants and essential oils
	Aromatic plants in Mediterranean diet
	Chemical composition
	Antimicrobial activity
	Summary points
	References
50
Apoptotic activities of Mediterranean plants
	Introduction
		Apoptosis and its implications in inflammation and cancer
		Antioxidant properties and apoptosis
		Apoptosis, inflammation, and cancer
	Antiinflammatory and chemopreventive properties of Mediterranean plants and their role in apoptosis
		Saffron
		Garlic
		Onion
		Capsicum
		Mistletoe
		Rue
		Myrtle
		Lavender
		Wolfberry
		Lemon balm
		Sage
		Broadleaved pepperweed
		Bay tree
		Olive tree
		Oregano
		Grapevine
		Mastic
		Mock privet and wild madder
	Concluding remarks
	Summary points
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	Y
	Z
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