The aim of the present review is to examine current scientific knowledge on the association between the Mediterranean diet and diabetes mellitus (mostly type 2 diabetes). A definition of the ...Mediterranean diet and the tools widely used to evaluate adherence to this traditional diet (Mediterranean diet indices) are briefly presented. The review focuses on epidemiological data linking adherence to the Mediterranean diet with the risk of diabetes development, as well as evidence from interventional studies assessing the effect of the Mediterranean diet on diabetes control and the management of diabetes-related complications. The above mentioned data are explored on the basis of evaluating the Mediterranean diet as a whole dietary pattern, rather than focusing on the effect of its individual components. Possible protective mechanisms of the Mediterranean diet against diabetes are also briefly discussed.
The link between blood lipids and cardiovascular disease (CVD) is complex. Our aim was to assess the differential effect of blood lipids on CVD risk according to age, sex, body weight, diet quality, ...use of lipid-lowering drugs and presence of hypercholesterolemia.
In this secondary analysis of the ATTICA prospective cohort study, serum blood lipids, i.e., total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and liproprotein(a) Lp(a), and sociodemographic, anthropometric, lifestyle and clinical parameters were evaluated at baseline (2001/2002) in 2020 CVD-free men and women. CVD incidence was recorded at the 10-year follow-up (2011/2012).
All blood lipids assessed were univariately related to CVD risk; however, associations remained significant only for HDL-C and TG in multivariate models adjusted for age, sex, body mass index, smoking, Mediterranean Diet Score, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, use of lipid-lowering drugs, and family history of CVD RR per 1 mg/dL (95% CI): 0.983 (0.967, 1.000) and 1.002 (1.001, 1.003), respectively. In stratified analyses, TC and LDL-C predicted CVD risk in younger subjects, normal-weight subjects, and those not on lipid-lowering drugs, while HDL-C and TG were significant predictors in older subjects, those with low adherence to the Mediterranean diet, and hypercholesterolemic subjects; a significant effect on CVD risk was also observed for TG in males, overweight participants and lipid-lowering medication users and for Lp(a) in older subjects and females (all p ≤ 0.050).
The impact of blood lipids on CVD risk differs according to several biological, lifestyle and clinical parameters.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA), its cardiometabolic benefits are questionable. Our aim was to explore whether the ...combination of a weight-loss Mediterranean diet/lifestyle intervention with OSA standard care leads to greater cardiometabolic improvements compared with standard care alone. We randomly assigned 187 adult, overweight, polysomnography-diagnosed moderate-to-severe OSA patients to a standard care group (SCG,
= 65), a Mediterranean diet group (MDG,
= 62) or a Mediterranean lifestyle group (MLG,
= 60). All three groups were prescribed with CPAP. Additionally, the SCG only received brief written healthy lifestyle advice, while intervention arms were subjected to a six-month weight-loss behavioral intervention based on the Mediterranean diet. The MLG also received guidance for improving physical activity and sleep habits. Glucose metabolism indices, blood lipids, liver enzymes and blood pressure improved only in intervention arms, and were significantly lower compared to the SCG post-intervention (all
< 0.05). The age-, sex-, baseline- and CPAP use-adjusted relative risk (95% confidence interval) of metabolic syndrome was 0.58 (0.34-0.99) for the MDG and 0.30 (0.17-0.52) for the MLG compared to the SCG. The MLG additionally presented a lower relative risk of metabolic syndrome compared to the MDG (0.52 (0.30-0.89)). After further adjustment for body-weight change, a lower relative risk of metabolic syndrome was still evident for the MLG compared to the SCG. In conclusion, although standard care alone does not improve OSA patients' cardiometabolic profile, its combination with a weight-loss Mediterranean diet/lifestyle intervention leads to significant cardiometabolic benefits.
Evidence of the association between dietary habits and long-term body weight status is scarce. This study aimed to evaluate changes in Mediterranean-type diet (MTD) adherence in relation to body ...weight during 20 years of follow-up. Data from n = 1582 participants from the ATTICA cohort study (2002-2022) were used. MTD adherence was assessed via MedDietScore, and body weight status via body mass index (BMI) by 3 different measurements. We found that MTD adherence and changes in this adherence were inversely related to BMI at 20 years and the mean BMI during the 20-year follow-up. In multi-adjusted linear regression models, a 1/55 increase in baseline, 10-year, and 20-year MedDietScore was associated with a decrease of 0.05-0.13 kg/m
in BMI at 20 years and of 0.08-0.09 kg/m
in the mean BMI. Being consistently close to the MTD for 20 years was associated with a >90% decreased risk of maintaining overweight/obesity during the 20-year period. Strong, protective, long-lasting effects of the MTD were observed, even in those who deviated from the MTD in the follow-up (41% of the sample). Our results highlight the need to focus on the overall diet quality to minimize the risk of maintaining an excessive body weight during the life-course.
Vitamin D deficiency (VDD) may be associated with obstructive sleep apnea (OSA) presence and is more pronounced with increasing OSA severity; however, the relationship between these two entities ...remains unclear. This was a cross-sectional study among 262 adults with in-hospital-attended polysomnography-diagnosed OSA and no additional major comorbidities, aiming to explore possible associations between serum 25-hydroxyvitamin D 25(OH)D levels and polysomnographic parameters. Data on demographics, medical history, anthropometric indices, and lifestyle habits were collected at enrolment. Serum 25(OH)D was evaluated using chemiluminescence, with VDD defined as 25(OH)D < 20 ng/mL. VDD was observed in 63% of the participants. Serum 25(OH)D correlated negatively with apnea-hypopnea index and other polysomnographic indices (all
< 0.05). In logistic regression analysis, adjusting for age, sex, smoking, body mass index, physical activity, dietary vitamin D intake, and season of blood sampling, serum 25(OH)D was associated with lower odds of severe OSA odds ratio (95% confidence interval): 0.94 (0.90-0.98). In the same multivariate model, VDD was associated with ~threefold higher odds of severe OSA 2.75 (1.38-5.48). In stratified analyses, VDD predicted OSA severity in the group of participants ≥50 y 3.54 (1.29-9.68) and among those with body mass index ≥ 30 kg/m
3.38 (1.52-7.52), but not in the younger and non-obese adults. This study provides further evidence of an inverse association between vitamin D levels and OSA severity and underscores the importance of considering vitamin D status as a potential modifiable factor in the comprehensive management of OSA.
Obstructive sleep apnea (OSA) and systemic inflammation typically coexist within a vicious cycle. This study aimed at exploring the effectiveness of a weight-loss lifestyle intervention in reducing ...plasma tumor necrosis factor-alpha (TNF-a), a well-established modulator of systematic inflammation in OSA. Eighty-four adult, overweight patients with a diagnosis of moderate-to-severe OSA were randomized to a standard care (SCG, n = 42) or a Mediterranean lifestyle group (MLG, n = 42). Both groups were prescribed continuous positive airway pressure (CPAP), while the MLG additionally participated in a 6-month behavioral intervention aiming at healthier weight and lifestyle habits according to the Mediterranean pattern. Plasma TNF-a was measured by an immunoenzymatic method both pre- and post-intervention. Drop-out rates were 33% (n = 14) for the SCG and 24% (n = 10) for the MLG. Intention-to-treat analysis (n = 84) revealed a significant decrease in median TNF-a only in the MLG (from 2.92 to 2.00 pg/mL, p = 0.001). Compared to the SCG, the MLG exhibited lower follow-up TNF-a levels (mean difference adjusted for age, sex, baseline TNF-a and CPAP use: −0.97 pg/mL, p = 0.014), and further controlling for weight loss did not attenuate this difference (p = 0.020). Per protocol analyses (n = 60) revealed similar results. In conclusion, a healthy lifestyle intervention can lower plasma TNF-a levels in patients with OSA.
The aim of the study was to evaluate physical fitness (PF) and identify its anthropometric and lifestyle determinants in a sample of Greek schoolchildren.
The study sample consisted of 335,810 ...schoolchildren (♂: 51.3%, 6-18 years old). Students' anthropometric parameters and PF levels-assessed
the Eurofit test battery-were measured by trained physical education teachers and evaluated according to the available norms, while their lifestyle habits were assessed through a questionnaire.
In all applied PF tests, students' performance was negatively associated with the presence of obesity and central obesity, defined through international criteria for body mass index and waist to height ratio, respectively. According to multiple logistic regression analysis, the presence of overweight/obesity odds ratio (OR): 4.43, 95% confidence interval (CI): 3.98-4.93, low adherence to the MD (KIDMED ≤ 3) (OR: 1.27, 95% CI: 1.09-1.48), and increased time spent in sedentary activities (>2 h per day) (OR: 1.16, 95% CI: 1.03-1.29) were positively associated with poor PF, after adjusting for age and sex. In contrast, for every 1 day increase in the weekly frequency of engagement in athletic activity, the probability of poor PF decreased by 26% (OR: 0.74, 95% CI: 0.72-0.77). In a similar model, the presence of central obesity emerged as an even stronger possible predictor of poor PF (OR: 5.20, 95% CI: 4.66-5.78), compared to the presence of general obesity.
Higher general or abdominal adiposity, as well as the adoption of a low-quality diet and a sedentary lifestyle, is strongly associated with low PF levels during childhood.
Abstract Background/Objectives Although lifestyle modifications remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD), the optimal lifestyle intervention is still ...controversial. The aim of this meta-analysis was to evaluate the effect of exercise and/or dietary interventions, type or intensity of exercise and type of diet, on liver function outcomes (liver enzymes, intrahepatic fat and liver histology), as well as on anthropometric and glucose metabolism parameters in NAFLD patients. Subjects/Methods Literature search was performed in Scopus and US National Library of Medicine databases to identify all randomized controlled clinical trials (RCTs) in adult patients with NAFLD, diagnosed through imaging techniques or liver biopsy, published in English between January 2005 and August 2016. Studies' quality was evaluated using the Cochrane Risk of Bias Tool. Heterogeneity was tested using the Cochran's Q test and measured inconsistency by I2 . Effect size was calculated as the standardized mean difference (SMD). The meta-analysis was performed in accordance with PRISMA guidelines. Results Twenty RCTs with 1073 NAFLD patients were included. Compared to standard care, exercise improved serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (all P < 0.05). Ιntrahepatic fat also improved, irrespectively of weight change (SMD = − 0.98, 95% CI: − 1.30 to − 0.66). Regarding the type of exercise, aerobic compared to resistance exercise did not yield any superior improvements on liver parameters, whereas moderate-to-high volume moderate-intensity continuous training was more beneficial compared to continuous low-to-moderate-volume moderate-intensity training or high intensity interval training. Interventions combining exercise and diet showed decreases in ALT (P < 0.01) and improvement in NAFLD activity score (SMD = − 0.61, 95% CI: − 1.09 to − 0.13). Moderate-carbohydrate diets yielded similar changes in liver enzymes compared to low/moderate-fat diets. Conclusions Exercise alone or combined with dietary intervention improves serum levels of liver enzymes and liver fat or histology. Exercise exerts beneficial effects on intrahepatic triglycerides even in the absence of weight loss.
Summary Background & aims Nutrition has been proposed as a potential environmental factor affecting the risk of non-alcoholic fatty liver disease (NAFLD). In the present study, the impact of ...adherence to the Mediterranean diet (MD) on the presence and severity of NAFLD was explored. Methods Seventy-three consecutive adult patients with recent NAFLD diagnosis were included. Adherence to the MD was estimated with MedDietScore. Demographic and anthropometric data, body composition analysis and several biochemical and inflammatory markers were estimated. Liver stiffness measurements by transient elastography were available in 58 patients and liver biopsies in 34 patients. Fifty-eight patients were matched with 58 healthy controls in terms of age, sex and body mass index. Results MedDietScore was negatively correlated to patients' serum alanine aminotransferase ( p = 0.03) and insulin levels ( p = 0.001), insulin resistance index ( p = 0.005) and severity of steatosis ( p = 0.006) and positively to serum adiponectin levels ( p = 0.04). Patients with non-alcoholic steatohepatitis (NASH) exhibited lower adherence to MD (29.3 ± 3.2 vs. 34.1 ± 4.4, p = 0.004) compared to those with simple fatty liver. Logistic regression analysis revealed that one unit increase in the MedDietScore was associated with 36% lower likelihood of having NASH (odds ratio: 0.64, 95% confidence interval: 0.45–0.92), after adjusting for sex and abdominal fat level. No difference in the MedDietScore was observed between patients and controls. Conclusions Higher adherence to the Mediterranean diet is not associated with lower likelihood of having NAFLD, but it is associated with less degree of insulin resistance and less severe liver disease among patients with NAFLD.
Although continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA), lifestyle interventions have also emerged as complementary therapeutic choices. We ...aimed to explore whether the addition of a weight-loss Mediterranean diet/lifestyle intervention to OSA standard care, i.e. CPAP prescription and brief written healthy lifestyle advice, has an incremental effect on improving OSA severity, over the effect of standard care alone.
We designed a parallel, randomized, controlled, superiority clinical trial. Eligible participants were adult, overweight men and women, diagnosed with moderate-to-severe OSA apnea-hypopnea index (AHI)≥ 15 events/h through an attended overnight polysomnography. Participants were blindly randomized to a standard care group (SCG, n = 65), a Mediterranean diet group (MDG, n = 62) or a Mediterranean lifestyle group (MLG, n = 60). All three study groups were prescribed with CPAP. The SCG additionally received written healthy lifestyle advice, while intervention arms were subjected to a 6-month behavioral intervention aiming at weight loss and increasing adherence to the Mediterranean diet. The MLG also received counselling on physical activity and sleep habits. Polysomnographic data and OSA symptoms were evaluated pre- and post-intervention.
A total of 187 OSA patients were recruited. Seven patients were excluded post-randomization and 53/180 (29%) were lost to follow-up. No harms from the interventions applied were reported. According to intention-to-treat analysis (n = 180), mean (95% confidence interval) AHI change was −4.2 (−7.4, −1.0) for the SCG, −24.7 (−30.4, −19.1) for the MDG and −27.3 (−33.9, −20.6) for the MLG. Post-intervention age-, sex-, baseline- and CPAP use-adjusted AHI was significantly lower in the MDG and the MLG compared to the SCG (mean difference: −18.0, and −21.2, respectively, both P < 0.001), and the differences remained significant after further adjustment for body-weight change (P = 0.004 and 0.008, respectively). Other respiratory event indices, daytime sleepiness and insomnia were also significantly lower in both intervention arms compared to the SCG (all P < 0.05). The MLG only presented higher percent rapid-eye-movement sleep and lower daytime sleepiness compared to the MDG (both P < 0.05). Results were similar in the per-protocol analysis (n = 127).
A dietary/lifestyle intervention on top of standard care leads to greater improvements in OSA severity and symptomatology compared to standard care alone. Benefits are evident regardless of CPAP use and weight loss.
Clinicaltrials.gov NCT02515357, https://clinicaltrials.gov/ct2/show/NCT02515357.
•A weight-loss dietary/lifestyle intervention improves OSA severity and symptoms.•CPAP therapy alone does not affect weight status.•The Mediterranean diet/lifestyle improves OSA regardless of CPAP use and weight loss.•Lifestyle interventions should be encouraged for OSA management in clinical practice.
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