2 mortality from cancer (6%), and incidence of Parkinson’s disease and Alzheimer’s disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases [19]. These beneﬁts have been associated with higher ability to cope with daily oxidative stress [20]. The determination of antioxidant capacity is a well- established tool in medical diagnosis and treatment of several diseases, such as cardiovascular disease, diabetes mellitus, cancer, and aging [21]. One of the most widely accepted index of whole body antioxidant ability is the total antioxidant capacity (TAC). Evaluation of TAC is one of the most common procedures employed to evaluate the hydrosoluble antioxidant status of biological ﬂuids. Total antioxidant capacity (TAC) considers the cumulative action of all antioxidants that are present in plasma and body ﬂuids and provides an integrated measurement rather than the simple sum of measurable antioxidants. A wide range of evidence indicates the importance of TAC in plasma and tissues, and of its practicability as a tool for investigating the association between diet and oxidative stress [22]. In a recent study, investigating the relation between TAC and obesity in children and adolescences, TAC was inversely associated with body mass index, standard deviation score of body mass index, and total body fat, only in obese subjects. These data suggest that TAC can also be used as a potential indicator of the risk to develop obesity- related features [23]. Furthermore, data from the same group suggest that dietary TAC may be also a potential early estimate of the risk to develop metabolic syndrome features [24]. Finally, in a crossover trial where 24 subjects received a two-week diet high in antioxidant capacity, the results indicated that this type of diet improves signiﬁcantly endothelial function in the volunteers at low cardiovas- cular risk, and may further reduce their risk of CVD [25]. Summarizing, the eﬀect of exercise on oxidative stress seems not to be clear and the exercise eﬀects might be modulated by other important factors like diet. Therefore, the purpose of the present study was to examine the separate and combined eﬀect of physical activity and adherence to the Mediterranean diet on TAC. 2. Materials and Methods The “ATTICA” epidemiological study has been carried out in the province of Attica (including 78% urban and 22% rural areas). The sampling was random, multistage by city, and stratiﬁed by age and gender group according to the gender-age distribution of the province of Attica (2001 census). From May 2001 to December 2002, 4056 inhabitants from the above area were randomly selected to enrol into the study (via mail or telephone). However, 3042 of them agreed to participate (75% participation rate). Each participant gave informed written consent and the protocol was approved by the Medical Research Ethics Committee of Athens Medical School. All participants were Cardiology Research and Practice interviewed by trained personnel (cardiologists, general practitioners, dieticians, and nurses) who used standard questionnaires that evaluated lifestyle habits and various sociodemographic, clinical and biological characteristics. Five percent of men and 3% of women were excluded from the study because they had history of cardiovascular or other atherosclerotic disease, as well as chronic viral infections, as it was ascertained by their medical records. Moreover, participants did not have cold or ﬂu, acute respiratory infection, dental problems, or any type of surgery during the past weeks. Power analysis showed that the number of enrolled participants is adequate to evaluate two-sided standardised diﬀerences greater than 0.5 between diet subgroups and the investigated biochemical parameters, achieving statistical power greater than 0.90 at 5% probability level (P-value). The study was approved by the Medical Research Ethics Committee of Athens Medical School and was carried out in accordance with the Declaration of Helsinki (1983) of the World Medical Association. 2.1. Physical Activity Ascertainment. A translated version of the validated “International Physical Activity Questionnaire” (iPAQ), suitable for assessing population levels of self- reported physical activity was used [26]. The short version of iPAQ provided information on weekly time spent walking, in vigorous, moderate-intensity, and in sedentary activity. Participants were instructed to refer to all domains of physical activity during a usual week of the past year. Both continuous and categorical indicators of physical activity status were assessed. In particular, the continuous indicator was calculated as a sum of weekly MET-minutes per week of walking, moderate- and vigorous-intensity exercise. Further- more, the categorical analysis grouped the subjects in three levels that were developed based on a key concept in current public health guidelines for physical activity [27], that is, (a) inactive, (b) minimally active, and (c) HEPA active (health enhancing physical activity, a high active category). The criteria of grouping in each category have been previously described [28]. 2.2. Dietary Assessment. Consumption of unreﬁned cere- alsand products, legumes, fruits, poultry, vegetables, olive oil, nonfat or low-fat dairy products, ﬁsh, nuts, potatoes, eggs, sweets, red meat, and meat product, was measured as average amounts consumed per week during the past year, with the use of a validated food frequency questionnaire (FFQ) from the department of nutritional epidemiology of Athens Medical School [29]. The frequency of consumption was then quantiﬁed approximately in terms of the number of times per month that a food was consumed. Alcohol consumption was measured by daily ethanol intake, in wine glasses (100 mL and 12 g ethanol concentration). Based on the Mediterranean diet pyramid [30], we calculated a special diet score ranging from 0 to 55 [31]. Higher values of this score (MedDietScore) indicate adherence to the Mediterranean diet, whereas lower values indicate adherence to the “Westernized” diet.