The Mediterranean diet (MD) may provide metabolic benefits but no systematic review to date has examined its effect on a multitude of outcomes related to metabolic health. This systematic review with ...meta-analysis (International Prospective Register of Systematic Reviews, PROSPERO; number CRD42019141459) aimed to examine the MD's effect on metabolic syndrome (MetSyn) incidence, components and risk factors (primary outcomes), and incidence and/or mortality from MetSyn-related comorbidities and receipt of pharmacologic treatment for MetSyn components and comorbidities (secondary outcomes). We searched Pubmed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science for controlled trials published until June 2019, comparing the MD with no treatment, usual care, or different diets in adults. Studies not published in English and not promoting the whole MD were excluded. Two authors independently extracted data and assessed risk of bias using the Cochrane Collaboration's and Risk of Bias in non-randomised studies (ROBINS-I) tools. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effects meta-analyses, subgroup analyses and meta-regressions were performed, and heterogeneity was quantified using the I
statistic. We identified 2654 reports and included 84 articles reporting 57 trials (
= 36,983). In random effects meta-analyses, the MD resulted in greater beneficial changes in 18 of 28 MetSyn components and risk factors (body weight, body mass index, waist circumference, systolic and diastolic blood pressure, glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR) index, total-, low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol, triglycerides, alanine transaminase, hepatic fat mass, C-reactive protein, interleukin-6, tumour necrosis factor-a, and flow-mediated dilatation) and lower risk of cardiovascular disease incidence (risk ratio (RR) = 0.61, 95% confidence intervals (CI) 0.42-0.80; I
= 0%), and stroke (RR = 0.67, 95% CI 0.35-0.98; I
= 0%). Only six studies reported effects on pharmacotherapy use, and pooled analysis indicated no differences between diet groups. Lack of consistency in comparator groups and other study characteristics across studies resulted in high heterogeneity for some outcomes, which could not be considerably explained by meta-regressions. However, a consistent direction of beneficial effect of the MD was observed for the vast majority of outcomes examined. Findings support MD's beneficial effect on all components and most risk factors of the MetSyn, in addition to cardiovascular disease and stroke incidence. More studies are needed to establish effects on other clinical outcomes and use of pharmacotherapy for MetSyn components and comorbidities. Despite the high levels of heterogeneity for some outcomes, this meta-analysis enabled the comparison of findings across studies and the examination of consistency of effects. The consistent direction of effect, suggesting the MD's benefits on metabolic health, supports the need to promote this dietary pattern to adult populations.
Smartphone apps might represent an opportunity to promote adherence to the Mediterranean diet (MedDiet). This study aimed to evaluate the quality of commercially available apps for the MedDiet and ...the presence of behavioural change techniques (BCTs) used by these apps. A systematic search was conducted on the Apple App and Google Play stores in November 2021. Apps were included if they provided information on the MedDiet or if their objective was to promote a healthy lifestyle through adherence to the MedDiet. Eligible apps were independently evaluated by two reviewers with regard to their quality (engagement, functionality, aesthetics and information quality) using the 5-point Mobile App Rating Scale (MARS; with higher scores indicating higher quality), and the presence of BCTs using an established 26-item BCT taxonomy. Of the 55 analysed apps, 52 (94.5%) were free, 50 (90.9%) provided recipe ideas, 29 (52.7%) provided meal plans, and 22 (40%) provided information on the health benefits of the MedDiet. The overall quality mean MARS score was 2.84 (standard deviation (SD) = 0.42), with functionality being the highest scored MARS domain (mean = 3.58, SD = 0.44) and engagement the lowest (mean = 2.29, SD = 0.61). The average number of BCTs in the analysed apps was 2.3 (SD = 1.4; range: 0-6 per app). The number of BCTs was positively correlated with app information quality (r
= 0.269,
= 0.047), overall MARS score (r
= 0.267,
= 0.049), app subjective quality (r
= 0.326,
= 0.015) and app-specific quality (r
= 0.351,
= 0.009). These findings suggest that currently available apps might provide information on the MedDiet, but the incorporation of more BCTs is warranted to maximise the potential for behaviour change towards the MedDiet.
Promoting traditional diets could potentially reduce the current high rates of non-communicable diseases (NCDs) globally. While the traditional Mexican diet (TMexD) could be specifically promoted in ...Mexico, a concise definition of the TMexD and evidence of its association with NCDs are needed before its promotion. To evaluate what constitutes this diet pattern, we aimed to systematically review, for the first time, how the TMexD has been described in the literature to date. A secondary aim was to examine whether the TMexD, as described by available definitions, is associated with NCD outcomes. We searched for records describing a whole TMexD up to July 2019 in 12 electronic databases, reference lists, a relevant journal, and by contacting experts on the topic. We reported the results using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included 61 records for the definition of the diet and six for the association with NCD outcomes. The food groups characterising the TMexD that were consistently mentioned in all the study subgroups were grains and tubers, legumes, and vegetables; specific foods included maize, beans,
, squash, tomato, and onion. Other groups also mentioned, although with lesser frequency, were maize products, fruits, beverages, fish and seafood, meats, sweets and sweeteners, and herbs and condiments. Only a few studies reported on the frequency of consumption or the amounts in which these foods were consumed in the TMexD. It was not possible to reach strong conclusions for the association between adherence to the TMexD and NCD outcomes. The TMexD was weakly associated with developing breast cancer, not associated with triglyceride levels, and inconsistently associated with obesity and diabetes outcomes. However, results were limited by the small number of studies (
= 6), of which most were of observational nature and evaluated diets using different TMexD definitions. These findings provide systematically identified evidence of the characteristics of the TMexD. More studies are needed to ascertain the exact quantities by which foods were consumed in the TMexD in order to establish whether this dietary pattern is associated with health and should be promoted within the Mexican population.
Female breast cancer is the most frequently diagnosed cancer. The long-term survival rates for this disease have increased; however, the unique demand for high-quality healthcare to improve ...breast-cancer survivorship are commonly unmet. The Mediterranean diet (MD) is associated with reduced breast-cancer risk and various health-related benefits in the general population, but its effect on breast-cancer survivors remains uncertain. The objective of this systematic review and meta-analysis was to assess current evidence from randomised controlled trials (RCTs) and observational studies (cohort, cross-sectional and case-control) regarding the effect of the MD on survival, quality of life (QoL) and health-related outcomes in female breast-cancer survivors. MEDLINE, EMBASE, Web of Science and the Cochrane library were searched for studies published before and including April 2022. Two reviewers independently screened the literature and completed the data extraction and risk-of-bias assessment. Eleven studies (fifteen reports) were included, including two RCTs, four cohort and five cross-sectional studies. The meta-analysis of the cohort studies showed strong evidence of an inverse association between high adherence to the MD and all-cause mortality (hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.66-0.93, I
: 0%, Grading of Recommendations Assessment, Development and Evaluation (GRADE) = low certainty of evidence) and non-breast-cancer mortality (HR 0.67, 95% CI 0.50-0.90, I
: 0%, GRADE = very low certainty of evidence). The associations between high adherence to the MD and QoL and health-related parameters were not consistent. These findings highlight the potential of adherence to the MD to reduce the risk of mortality. Future research with better study designs, as well as more consistent measurements of QoL and MD adherence, taking into account changes in MD adherence over time and population subgroups, is needed to provide more robust evidence on the survival, QoL and health-related outcomes in BC survivors.
An energy-dense, high-fat, low-fibre dietary pattern has been prospectively associated with the development of obesity in childhood but is population-specific, which limits translating the pattern ...into interventions. We explored the generalisability and correlates of this obesogenic dietary pattern in the UK National Diet and Nutrition Survey (NDNS) for the first time. Data came from participants (
= 4636 children and
= 4738 adults) with 4-day food diaries in NDNS 2008-2014. Reduced rank regression was applied to 51 food groups to explain variation in energy density, fibre and fat intake. Consistency of the pattern in population subgroups (according to sex, age, occupation and income) was compared with the whole sample pattern using coefficients of congruence (COC). Pattern correlates (sociodemographic, survey year, physical activity and eating related behaviours) were explored using multiple linear regression. Food group loadings were similar to the previously identified obesogenic dietary pattern and were generalisable across all sub-groups (COC: 0.93-0.99). An obesogenic diet was associated with eating takeaways, being omnivorous, a manual household occupation and lower household income in both adults and children (
< 0.0001). Dieting for weight loss, being older, more physically active and less sedentary was associated with a less obesogenic diet among adults (
< 0.0001). Future experimental studies should investigate if changes in this obesogenic pattern could be used to monitor the effectiveness of obesity prevention policies or develop personalised interventions.
Aims
This study aimed to explore the perceptions of Meals on Wheels (MoWs) service users (SUs), and people who refer them to MoWs (‘referrers’), with accessing and commencing the service in England, ...the barriers that might hinder service uptake, and what information would be valued when considering accessing the service.
Methods
Semistructured interviews were conducted in May–July 2022 with seven SUs and 21 referrers, recruited from four MoWs providers across England. Data were analysed using inductive thematic analysis.
Results
Participants indicated various pathways into the service, but referrers (family members) were more likely to be the ones enquiring about, and commencing, MoWs for SUs. Once an enquiry about MoWs had been made, the service was perceived as straightforward to set up. However, existing preconceptions and stereotypes were perceived to act as barriers to accessing MoWs. Information that participants deemed important to have available when deciding on whether to access MoWs related to the meals, the specific services provided, the reliability and flexibility of delivery and the cost of services.
Conclusion
These findings could inform MoWs service providers' public awareness strategies about MoWs, to facilitate referrals to the service for adults with care and support needs.
Patient or Public Contribution
An advisory group of people with lived experience of MoWs (users of the service and their family referrers) extensively discussed the findings of the research and advised on the implications and future dissemination steps.
The Mediterranean diet is considered as the foremost dietary regimen and its adoption is associated with the prevention of degenerative diseases and an extended longevity. The preeminent features of ...the Mediterranean diet have been agreed upon and the consumption of olive oil stands out as the most peculiar one. Indeed, the use of olive oil as the nearly exclusive dietary fat is what mostly characterizes the Mediterranean area. Plenty of epidemiological studies have correlated that the consumption of olive oil was associated with better overall health. Indeed, extra virgin olive oil contains (poly)phenolic compounds that are being actively investigated for their purported biological and pharma-nutritional properties. On 18 and 19 May 2018, several experts convened in Jaen (Spain) to discuss the most recent research on the benefits of olive oil and its components. We reported a summary of that meeting (reviewing several topics related to olive oil, not limited to health) and concluded that substantial evidence is accruing to support the widespread opinion that extra virgin olive oil should, indeed, be the fat of choice when it comes to human health and sustainable agronomy.
Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of ...the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration's tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (
= 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (
< 0.001) of a beneficial effect of promoting the MD and PA on body weight (-3.68 kg, 95% CI (confidence intervals) -5.48, -1.89), body mass index (-0.64 kg/m², 95% CI -1.10, -0.18), waist circumference (-1.62 cm, 95% CI -2.58, -0.66), systolic (-0.83 mmHg, 95% CI -1.57, -0.09) and diastolic blood pressure (-1.96 mmHg, 95% CI -2.57, -1.35), HOMA-IR index (-0.90, 95% CI -1.22, -0.58), blood glucose (-7.32 mg/dL, 95% CI -9.82, -4.82), triglycerides (-18.47 mg/dL, 95% CI -20.13, -16.80), total cholesterol (-6.30 mg/dL, 95% CI -9.59, -3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk.
The aim of this study was to assess the effect of living away from, or in, the family home on the dietary habits of a group of Greek undergraduate University students. Eighty-four undergraduates at ...Athens Agricultural University, aged 20–24, completed a single, self-administered food habits questionnaire that asked about their current food practices and their food practices before they started University. Students living at home did not show major changes in their eating habits since starting University. Although students living away from the family home had made some positive changes, they decreased their weekly consumption of fresh fruit, cooked and raw vegetables, oily fish, seafood, pulses and olive oil, and increased their sugar, wine, alcohol and fast food intake. Between group comparisons of dietary changes showed that since starting University, students living away from home had developed more unfavourable eating habits than students living at the family home. These findings suggest that moving away from the family home and assuming responsibility for food preparation and purchasing for the first time affect dietary habits in this sample of Greek University students. Nutrition interventions in this young population should be encouraged to promote healthier diets and lifestyles, as well as adherence to the traditional Mediterranean diet.
Abstract Objective Explore employees' perceptions of ability to follow the Mediterranean diet (MedDiet), preferences for setting goals if asked to follow the MedDiet, and expectations of an ...Internet-based, workplace MedDiet intervention. Design Seven focus groups to guide intervention development. Setting Four workplaces (business/professional services, government branches) in Southwest England. Participants Employees (n = 29, 51.7% women), ages 24–58 years. Phenomenon of Interest Ability to follow the MedDiet; preferences for goal-setting if asked to follow the MedDiet; intervention content. Analysis Data were analyzed with the use of thematic analysis. Results Participants perceived that adhering to some MedDiet recommendations would be challenging and highlighted cost, taste, and cooking skills as adherence barriers. Behavior change preferences included a tailored approach to goal-setting, reviewing goal progress via a website/smartphone app, and receiving expert feedback via an app/website/text/face-to-face session. Desirable features of an Internet-based MedDiet application included recipes, interactivity, nutritional information, shopping tips, cost-saving information, and a companion smartphone app. Engaging in social support was deemed important to facilitate adherence. Conclusions and Implications An Internet-based, workplace MedDiet intervention should address adherence barriers, utilize a tailored approach to setting and reviewing goals, and activate social support to facilitate adherence. These findings provide insights to planning to promote the MedDiet in non-Mediterranean regions.
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