Cardiology Research and Practice Table 2: Results from multiple linear regression analysis that evaluated the association of physical activity status (independent) on TAC levels (dependent), by dietary habits. Mediterranean diet status Away Close Very close Physical activity status HEPA versus Inactive Minimally active versus inactive Age (years) Males versus females BMI (kg/m2) HEPA versus Inactive Minimally active versus inactive Age (years) Males versus Females BMI (kg/m2) HEPA versus Inactive Minimally active versus inactive Age (years) Males versus females BMI (kg/m2) b ± SE 13.47 ± 5.7 3.34 ± 2.6 −0.14 ± 0.2 −4.36 ± 6.7 −0.32 ± 0.64 15.7 ± 9.4 2.82 ± 4.3 −0.76 ± 0.3 −4.85 ± 8.2 −1.79 ± 1.33 19.7 ± 7.4 2.4 ± 9.6 −0.16 ± 0.3 −21.8 ± 10.7 −0.35 ± 1.30 P .21 .48 .58 .52 .62 .05 .09 .03 .56 .18 .03 .06 .65 .04 .78 needs to clarify whether other plant antioxidants, or their combination, or whole dietary patterns that induce the endogenous antioxidant defense, can reduce pathogenesis of cardiovascular disease. Moreover, since there is some evidence that exhaustive exercise may have negative impact on the body’s antioxidant capacity, it seems necessary to determine the level of physical activity that in combination with adaptation of a speciﬁc dietary pattern, like the Mediterranean diet, has optimal eﬀect on TAC. In this work it was observed that almost a 20% increment in the diet score (that assessed greater adherence to the Mediterranean dietary pattern) was associated with about 6% rise in TAC irrespective of various potential confounding factors. The high content of the Mediterranean diet in vegetables, fresh fruits, cereals, and olive oil, as well as the moderate intake of wine, guarantee a high intake of β- carotene, vitamins B6, B12, C, and E, folic acid, polyphenols and various minerals, known for their antioxidant eﬀect. However, the inﬂuence of the Mediterranean dietary pattern on antioxidant capacity of human body has been rarely investigated. To the best of our knowledge, only Leighton et al. [35] based on an intervention study, reported that total antioxidant reactivity increased by 28% above basal levels in the Mediterranean diet group, compared to the high fat diet 5 group. In this study, we expanded the previous results since we were able to study a “free eating” population. Thus, these ﬁndings could be applicable to the general population, since the “doses” of this dietary pattern were not excessive even in the high consuming group. From this work, it can be concluded that the combination of certain dietary patterns with an increased level of physical activity is essential for the protection of the cardiovascular system. 5. Limitations Due to the cross-sectional design of the study, we cannot establish causal relations but only generate hypothesis for the association of a dietary pattern on TAC of human body. In addition, although diet is a lifelong habit and usually pre-exist a pathological condition, inverse causation may still exist. Another limitation is the misreporting of food items consumed and especially alcohol consumption, due to recall bias or social class of the participants. Moreover, the food frequency questionnaire has been validated in a sample of school teachers, while we have applied it into the general population. This may hide over- or underestimation of various nutrients estimated. However, in this work we have not used nutrient intake that may be inﬂuenced by the validation of the questionnaire. 6. Conclusions Until recently, traditional analyses in the ﬁelds of nutritional epidemiology usually relate health status to a single or a few nutrients or foods. However, it is evident that people do not eat isolated nutrients, but meals consisting of a variety of foods with complex combinations of nutrients. Furthermore, the level of physical activity seems to interact with diet and both aﬀect health status. Under this concept, the combined eﬀect of increased physical activity with greater adherence to Mediterranean diet, on TAC was examined. It was observed that the Mediterranean diet as well frequent exercise, enhanced antioxidant defences. Alternatively, the combination of a sedentary lifestyle and a high fat diet, rich in saturated fats, induced oxidative stress. Based on these ﬁndings, we underline the need for actions from public health care professionals, towards pre- vention of the development and progression of atheroscle- rotic diseases, through the adoption of an active lifestyle and a dietary pattern, low in fat, rich in fruits, vegetables and legumes, like the Mediterranean diet. Acknowledgments The authors would like to thank the ﬁeld investigators of “ATTICA” study: Dr. Natasa Katinioti (physical exam- ination), Dr. Akis Zeimbekis (physical examination), Dr. Spiros Vellas (physical examination), Dr. Eﬁ Tsetsekou (phys- ical/psychological evaluation), Dr. Dina Massoura (physical examination), Dr. Lambros Papadimitriou (physical exami- nation), as well as the technical team: Dr. Marina Toutouza