Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study Adherence to the Mediterranean Diet and all-cause mortality risk in an elderly Italian population: Data from the ILSA study Adoption and maintenance of a Mediterranean diet in patients with coronary heart disease from a Northern European population: a pilot randomised trial of different methods of delivering Mediterranean diet advice. Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study. Effectiveness of A Multifactorial Intervention in Increasing Adherence to the Mediterranean Diet among Patients with Diabetes Mellitus Type 2: A Controlled and Randomized Study (EMID Study) Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC) Mediterranean diet impact on changes in abdominal fat and 10-year incidence of abdominal obesity in a Spanish population. Evaluating associations between Mediterranean diet adherence indexes and biomarkers of diet and disease. Mediterranean diet and CHD: the Greek European Prospective Investigation into Cancer and Nutrition cohort. Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study Mediterranean diet and cognitive decline over time in an elderly Mediterranean population Mediterranean Diet and Cognitive Status in Free-Living Elderly: A Cross-Sectional Study in Northern Italy Mediterranean diet and risk of frailty in community-dwelling older adults. Similar prediction of total mortality, diabetes incidence and cardiovascular events using relative- and absolute-component Mediterranean diet score: the SUN cohort. Mediterranean Diet Score and Its Association with Age-Related Macular Degeneration: The European Eye Study. Mediterranean diet and mortality in Switzerland: an alpine paradox? Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Interaction between Mediterranean diet and statins on mortality risk in patients with cardiovascular disease: Findings from the Moli-sani Study. The Mediterranean diet pattern and its main components are associated with lower plasma concentrations of tumor necrosis factor receptor 60 in patients at high risk for cardiovascular disease. Mediterranean diet and mobility decline in older persons A Mediterranean diet rich in virgin olive oil may reverse the effects of the -174G/C IL6 gene variant on 3-year body weight change. Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort. The Effects of the Mediterranean Diet on Biomarkers of Vascular Wall Inflammation and Plaque Vulnerability in Subjects with High Risk for Cardiovascular Disease. A Randomized Trial
Purpose Mediterranean-type dietary pattern has been associated with lower risk of cardiovascular ( CVD ) and other chronic diseases , primarily in Southern European population s. We examined whether Mediterranean diet score ( MDS ) is associated with total , CVD , coronary heart disease ( CHD ) and stroke mortality in a prospect i ve cohort study in three Eastern European population s. Methods A total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe ( HAPIEE ) study in the Czech Republic , Pol and and the Russian Federation were included in the analysis . Diet was assessed by food frequency question naire , and MDS was derived from consumption of nine groups of food using absolute cut-offs .  Mortality was ascertained by linkage with death registers . Results Over the median follow-up time of 7 years , 1314 participants died .  The proportion of participants with high adherence to Mediterranean diet was low ( 25 % ) . One st and ard deviation ( SD ) increase in the MDS ( equivalent to 2.2 point increase in the score ) was found to be inversely associated with death from all causes ( HR , 95 % CI 0.93 , 0.88–0.98 ) and CVD ( 0.90 , 0.81–0.99 ) even after multivariable adjustment . Inverse but statistically not significant link was found for CHD ( 0.90 , 0.78–1.03 ) and stroke ( 0.87 , 0.71–1.07 ) . The MDS effects were similar in each country cohort . Conclusion Higher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban population s. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean population Objective The aim of this study was to evaluate adherence to the Mediterranean Diet ( MD ) and its association with  all-cause mortality in an elderly Italian population . Design Data analysis of a longitudinal study of a representative , age stratified , population sample . Setting Study data is based upon the Italian Longitudinal Study on Aging ( ILSA ) a prospect i ve , community-based cohort study . The baseline evaluation was carried out in 1992 and the follow-up in 1996 and 2000.ParticipantParticipant food intake assessment was available at baseline for 4,232 subjects ; information on survival was available for 2,665 at the 2000 follow-up . Measurements  Adherence to the MD was evaluated with an a priori score based on the Mediterranean pyramid components . Cox proportional hazard models were used to assess the relationship between the MD score and all-cause mortality .  Six hundred and sixty five subjects had died  at the second follow-up ( identified up to the first and second follow-up together ; mean follow-up : 7.1±2.6 years ) . Results At the 2000 follow-up , adjusting for other confounding factors , participants with a high adherence to MD ( highest tertile of the MD score distribution ) had an all-cause mortality risk that was of 34 % lower with respect to the subjects with low adherence ( Hazard Ratio=0.66 ; 95 % CI : 0.49 - 0.90 ; p=0.0144 ) . Conclusion According to study results , a higher adherence to the MD was associated with a low all-cause mortality risk in an elderly Italian population BACKGROUND A Mediterranean diet has been shown to protect against coronary heart disease ( CHD ) . Adherence to a Mediterranean diet can be assessed using a Mediterranean diet score . The primary aim of this pilot study was to examine whether CHD patients in a Northern European population would adopt and maintain a Mediterranean diet , with a secondary aim of comparing the effectiveness of different method ologies aim ed at improving compliance . METHODS Sixty-one patients with a diagnosis of CHD were r and omised to one of three groups : either to receive conventional dietetic advice for CHD or advice to implement a Mediterranean-style diet using either behavioural counselling or nutritional counselling . Patients received a follow-up assessment at 6 months ( adoption ) and a subset of patients was followed up at 12 months ( maintenance ) . The primary outcome measure was the between-group difference in the mean change in Mediterranean diet score ( MDS ) . RESULTS The change in MDS was not significantly different between groups . However , all three groups reported a significant within-group increase in MDS ( P < 0.01 ) at 6 and 12 months follow-up . CONCLUSIONS All three groups made dietary changes towards a Mediterranean diet , but behavioural counselling did not have significant additional benefit over nutritional counselling in initiating and maintaining dietary change , and neither method offering specific Mediterranean diet advice had any significant benefit in terms of improvement in MDS over conventional dietetic practice BACKGROUND AND AIMS Adherence to Mediterranean diet ( MD ) is reportedly declining in the last decades . We aim ed to investigate the adherence to MD over the period 2005 - 2010 and exploring the possible role of the global economic crisis in accounting for the changing in the dietary habits in Italy . METHODS AND RESULTS Cross-sectional analysis in a population -based cohort study which r and omly recruited 21,001 southern Italian citizens enrolled within the Moli-sani study .  Food intake was determined by the Italian EPIC food frequency question naire .  Adherence to MD  was appraised by the  Italian Mediterranean Index ( IMI ) . A wealth score was derived to evaluate the economic position and used together with other socioeconomic indicators . Highest prevalence of adherence to MD  was observed during the years 2005 - 2006 ( 31.3 % ) while the prevalence dramatically fell down in the years 2007 - 2010 ( 18.3 % ; P<0.0001 ) . The decrease was stronger in the elderly , less affluent groups , and among those living in urban areas . Accordingly , we observed that in 2007 - 2010 socioeconomic indicators were strongly associated with higher adherence to MD  , whereas no association was detected in the years before the economic crisis began ; both wealth score and education were major determinants of high adherence to MD  with 31 % ( 95%CI : 18 - 46 % ) higher adherence to this pattern within the wealthier group compared to the less affluent category . CONCLUSION Adherence to MD  has considerably decreased over the last few years . In 2007 - 2010 socioeconomic indicators have become major determinants of adherence to MD , a fact likely linked to the economic downturn The Mediterranean diet ( MD ) is recognized as one of the healthiest dietary patterns and has benefits such as improving glycaemic control among patients with type 2 diabetes ( T2DM ) . Our aim is to assess the effectiveness of a multifactorial intervention to improve adherence to the MD , diet quality and biomedical parameters . The EMID study is a r and omized and controlled clinical trial with two parallel groups and a 12-month follow-up period . The study included 204 subjects between 25–70 years with T2DM . The participants were r and omized into intervention group ( IG ) and control group ( CG ) . Both groups received brief advice about healthy eating and physical activity . The IG participants additionally took part in a food workshop , five walks and received a smartphone application for three months . The population studied had a mean age of 60.6 years . At the 3-month follow-up visit , there were improvements in adherence to the MD and diet quality of 2.2 and 2.5 points , compared to the baseline visit , respectively , in favour of the IG . This tendency of the improvement was maintained , in favour of the IG , at the 12-month follow-up visit . In conclusion , the multifactorial intervention performed could improve adherence to the MD and diet quality among patients with T2DM Aims /hypothesisThe role of diet in the prevention of diabetes remains uncertain . The aim of this study was to investigate two different dietary aspects , i.e. adherence to the Mediterranean diet and glycaemic load ( GL ) , in relation to diabetes occurrence . Methods We analysed data from the Greek cohort of the population -based European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . From a total of 22,295 participants , actively followed for a median of 11.34 years , 2,330 cases of incident type 2 diabetes were recorded . All participants completed a vali date d , interviewer-administered semi-quantitative food frequency question naire at enrolment . From this information , we calculated a ten point Mediterranean diet score ( MDS ) , reflecting adherence to the traditional Mediterranean diet , as well as the dietary GL . We estimated HRs and the corresponding 95 % CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders . Results A higher MDS was inversely associated with diabetes risk ( HR 0.88 [ 95 % CI 0.78 , 0.99 ] for MDS ≥6 vs MDS ≤3 ) . GL was positively associated with diabetes ( HR 1.21 [ 95 % CI 1.05 , 1.40 ] for the highest vs the lowest GL quartile ) . A significant protection of about 20 % was found for a diet with a high MDS and a low GL . Conclusions /interpretationA low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes Abdominal obesity is a strong predictor of metabolic disorders . Prospect i ve data on the association between the Mediterranean diet and surrogate markers of abdominal adiposity are scarce . The present study evaluated the relationship between adherence to the Mediterranean diet and ( 1 ) changes in waist circumference ( WC ) and ( 2 ) 10-year incidence of abdominal obesity . We conducted a prospect i ve , population -based study in 3058 male and female Spaniards aged 25 - 74 years , followed from 2000 to 2009 .  Dietary intake and leisure-time physical activity levels were recorded using vali date d question naires . Weight , height and WC were measured . Adherence to the Mediterranean diet , determined using the previously vali date d REGICOR-Mediterranean diet score ( R-MDS ) , based on the distribution of population food intake and on the dietary recommendations ( MDS-rec ) , was negatively associated with WC gain ( P = 0.007 and 0.024 , respectively ) in fully adjusted models . In the multivariate logistic analysis , the odds of abdominal obesity incidence decreased across the tertiles of the R-MDS , but the association was not significant . In conclusion , adherence to the Mediterranean diet was associated with lower abdominal fat gain , but not with 10-year incidence of abdominal obesity OBJECTIVE We examined associations between two  Mediterranean diet ( MD ) adherence indexes ( the MD index , MDI , and the MD score , MDS ) and several blood biomarkers of diet and disease . SUBJECTS We studied 328 individuals from Catalonia ( Northeastern Spain ) , ages 18 - 75 , who provided fasting blood sample s , a subset of the 2346 individuals as part of a larger representative and r and om sample from the 1992 - 1993 Catalan Nutritional Survey . DESIGN AND METHOD Diet was measured using 24-h recalls . Biomarkers studied were plasma levels of beta-carotene , alpha-tocopherol , retinol , vitamins B12 , C and folates as well as serum total cholesterol , HDL cholesterol , LDL cholesterol and triglycerides . Multivariate linear regression was used to analyse associations of the nutrient biomarkers with the dietary pattern indexes , adjusting for potential confounders . RESULTS AND CONCLUSIONS Subjects with higher MD adherence , as measured by the two dietary indexes , had significantly higher plasma concentrations of beta-carotene , folates , vitamin C , alpha-tocopherol and HDL cholesterol . The most highly significant relationship was that between folates and the adherence to the MD Pattern , as determined by both indexes . These research findings suggest the potential usefulness of biomarkers as complementary tools for assessing adherence to a dietary pattern . This type of data not only informs the development of robust dietary adherence indexes , but it also provides specific clues about the potential physiological mechanisms that explain the beneficial effects of the MD pattern on chronic disease risk Adherence to the Mediterranean diet ( MD ) has been reported to improve CHD prognosis and to be inversely associated with CHD mortality . The aim of the present study was to investigate the association of adherence to the MD with CHD incidence and mortality in the Greek European Prospect i ve Investigation into Cancer and Nutrition cohort , a population with traditional Mediterranean roots . In a general population sample of 23,929 adult men and women with no CVD or cancer at enrolment , a vali date d FFQ was interviewer-administered , sociodemographic , physical activity and other characteristics were recorded , and arterial blood pressure and anthropometric characteristics were measured . In a median period of 10 years , 636 incident CHD cases and 240 CHD deaths were recorded . Associations of adherence to the MD , operationalised through a nine-component score ( 0 , poor ; 9 , excellent ) , with CHD incidence and mortality were evaluated through Cox regression controlling for potentially confounding variables . A two-point increase in the MD score was associated with lower CHD mortality by 25 % ( 95 % CI 0.57 , 0.98 ) among women and 19 % ( 95 % CI 0.67 , 0.99 ) among men . The association of adherence to the MD with CHD incidence was again inverse , but weaker ( hazard ratios 0.85 ( 95 % CI 0.71 , 1.02 ) among women and 0.98 ( 95 % CI 0.87 , 1.10 ) among men ) . With respect to score components , only meat among men ( positively ) and fruits and nuts among women ( inversely ) were associated with both the incidence of and mortality from CHD . The MD , as an integral entity , is inversely associated with CHD incidence and , particularly , mortality Background Despite convincing evidence in the Mediterranean region , the cardiovascular benefit of the Mediterranean diet is not well established in non-Mediterranean countries and the optimal criteria for defining adherence are unclear . The population attributable fraction ( PAF ) of adherence to this diet is also unknown . Methods In the UK-based EPIC-Norfolk prospect i ve cohort , we evaluated habitual diets assessed at baseline ( 1993–1997 ) and during follow-up ( 1998–2000 ) using food-frequency question naires  ( n = 23,902 ) . We estimated a Mediterranean diet score ( MDS ) using cut-points projected from the Mediterranean dietary pyramid , and also three other pre-existing MDSs . Using multivariable-adjusted Cox regression with repeated measures of MDS and covariates , we examined prospect i ve associations between each MDS with incident cardiovascular diseases ( CVD ) by 2009 and mortality by 2013 , and estimated PAF for each outcome attributable to low MDS . Results We observed 7606 incident CVD events ( 2818/100,000 person-years ) and 1714 CVD deaths ( 448/100,000 ) . The MDS based on the Mediterranean dietary pyramid was significantly associated with lower incidence of the cardiovascular outcomes , with hazard ratios ( 95 % confidence intervals ) of 0.95 ( 0.92–0.97 ) per one st and ard deviation for incident CVD and 0.91 ( 0.87–0.96 ) for CVD mortality . Associations were similar for composite incident ischaemic heart disease and all-cause mortality . Other pre-existing MDSs showed similar , but more modest associations . PAF due to low dietary pyramid based MDS ( < 95th percentile ) was 3.9 % ( 1.3–6.5 % ) for total incident CVD and 12.5 % ( 4.5–20.6 % ) for CVD mortality . Conclusions Greater adherence to the Mediterranean diet was associated with lower CVD incidence and mortality  in the UK . This diet has an important population health impact for the prevention of CVD Abstract Purpose Evidence suggests that dietary patterns compatible with the traditional Mediterranean diet ( MD ) may protect against cognitive decline . We prospect ively assessed whether adherence to MD in the Mediterranean country of Greece is inversely associated with  cognitive decline in the elderly and whether any particular MD component may play a key role . Methods Elderly men and women ( N = 401 ) residing in the greater Athens area had dietary variables ascertained in 1994–1999 . Adherence to MD was represented by the MD score [ MDS , 0–3 ( low ) , 4–5 ( intermediate ) , 6–9 ( high ) ] . The mini-mental state examination ( MMSE ) was administered by trained professionals to individuals aged 65 years or older in 2004–2006 ( first assessment ) and re-administered in 2011–2012 ( second assessment ) . MMSE change ( cMMSE ) was categorized as : improved/unchanged ( cMMSE ≥ 0 ) , mildly lower ( cMMSE −1 to −4 ) or substantially lower ( cMMSE ≤ −5 ) . Associations were evaluated through multinomial logistic regression . Results Decline in MMSE performance was inversely associated with adherence to MD . For mild versus no decline , odds ratio ( OR ) comparing high to low MD adherence was 0.46 [ 95 % confidence interval ( CI ) 0.25–0.87 , p = 0.012 ] . For substantial versus no decline , OR comparing high to low MD adherence was 0.34 ( 95 % CI 0.13–0.89 , p = 0.025 ) . Among the nine MDS components , only vegetable consumption exhibited a significant inverse association with cognitive decline . Conclusions Closer adherence to the traditional MD is highly likely to protect against cognitive decline in this elderly Mediterranean population . Higher vegetable consumption appears to play a key role , possibly in synergy with additional components of the diet ABSTRACT Objective : Few data are available on the Italian elderly population with regard to adherence to the Mediterranean diet ( MD ) and cognitive impairment . Our aim was to investigate adherence to the MD and its association with cognitive function  in an Italian urban sample . Methods : A cross-sectional study of 279 participants aged ≥ 65 years ( 80 men , 199 women ) was carried out at a nutritional center .  Adherence to the MD was evaluated using a 14-item question naire  . Cognitive function was assessed with the Mini-Mental State Examination ( MMSE ) . Results : The clinical and nutritional assessment s performed revealed 30.1 % to have a dietary pattern in accordance with the MD ; 13.6 % had suspected or mild cognitive impairment ( MMSE score ≤ 23 ) . The MD pattern was associated with a lower risk of cognitive impairment ( odds ratio [ OR ] = 0.39 ; 95 % confidence interval [ CI ] , 0.15–0.99 ; p = 0.045 ) , as was the consumption of wine ( OR = 0.37 ; 95 % CI , 0.16–0.84 ; p = 0.018 ) and nuts ( OR = 0.30 ; 95 % CI , 0.13–0.69 , p = 0.005 ) . No association was found with other food groups . Conclusion : A closer adherence to the MD  was associated with a better cognitive status . Further cohort studies and r and omized controlled trials are warranted BACKGROUND AND OBJECTIVE Low intake of certain micronutrients and protein has been associated with higher risk of frailty . However , very few studies have assessed the effect of global dietary patterns on frailty . This study examined the association between adherence to the Mediterranean diet ( MD ) and the risk of  frailty in older adults . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study with 1815 community-dwelling individuals aged ≥60 years recruited in 2008 - 2010 in Spain . MEASUREMENTS At baseline , the degree of MD adherence was measured with the Mediterranean Diet Adherence Screener ( MEDAS ) score and the Mediterranean Diet Score  , also known as the Trichopoulou index . In 2012 , individuals were reassessed to detect incident frailty , defined as having at least 3 of the following criteria : exhaustion , muscle weakness , low physical activity , slow walking speed , and weight loss . The study associations were summarized with odds ratios ( OR ) and their 95 % confidence interval ( CI ) obtained from logistic regression , with adjustment for the main confounders . RESULTS Over a mean follow-up of 3.5 years , 137 persons with incident frailty were identified . Compared with individuals in the lowest tertile of the MEDAS score ( lowest MD adherence ) , the OR ( 95 % CI ) of frailty was 0.85 ( 0.54 - 1.36 ) in those in the second tertile , and 0.65 ( 0.40 - 1.04 ; P for trend = .07 ) in the third tertile . Corresponding figures for the Mediterranean Diet Score were 0.59 ( 0.37 - 0.95 ) and 0.48 ( 0.30 - 0.77 ; P for trend = .002 ) . Being in the highest tertile of MEDAS was associated with reduced risk of slow walking ( OR 0.53 ; 95 % CI 0.35 - 0.79 ) and of weight loss ( OR 0.53 ; 95 % CI 0.36 - 0.80 ) . Lastly , the risk of frailty was inversely associated with consumption of fish ( OR 0.66 ; 95 % CI 0.45 - 0.97 ) and fruit ( OR 0.59 ; 95 % CI 0.39 - 0.91 ) . CONCLUSIONS Among community-dwelling older adults , an increasing adherence to the MD was associated with decreasing risk of frailty BACKGROUND AND AIM Accumulated evidence supports the effectiveness of Mediterranean-type diets ( MeDiet ) in reducing mortality and preventing several chronic diseases . Widely used scores to assess adherence to MeDiet are based on specific sample characteristics ; alternatively , they might be built according to absolute/normative cut-off points for the consumption of specific food groups ( pre-defined servings/day or/week ) . The aim of this study was to compare sample -specific MeDiet adherence scores ( MDS ) versus absolute-normative scores ( Mediterranean Diet Adherence Screener - MEDAS ) on their association with macronutrient intake , total mortality and incidence of chronic diseases . DESIGN SUN ( Seguimiento Universidad de Navarra ) dynamic prospect i ve cohort study ( 60.5 % women ; mean age 38.4 years ) . METHODS AND RESULTS In cross-sectional analyses ( n=20,155 ) we evaluated macronutrient distribution according to MDS ( based on 136-item FFQ ) , MEDAS ( based on 13 questions ) , and variants of both . In prospect i ve analyses ( n=9109 ; mean follow-up : 6.2 years ) , we evaluated disease incidence or mortality . Adherence to MeDiet increased with age and , as expected , was associated with higher fiber intake , lower total fat intake but higher monounsaturated/saturated fat ratio , using all scores . Among subjects initially free of cancer , diabetes , and cardiovascular disease ( CVD ) , adherence to MeDiet appraised with an absolute-normative score ( MEDAS ) similarly predicted macronutrient distribution and disease incidence or mortality ( diabetes incidence , CVD or all-cause mortality ) , when compared to a sample -specific score based on 136-item FFQ ( MDS ) . CONCLUSIONS Adherence to MeDiet was associated with a decreased incidence of a composite outcome including diabetes incidence , cardiovascular events incidence or all-cause mortality PURPOSE To examine associations between adherence to a Mediterranean diet and  prevalence of age-related macular degeneration ( AMD ) in countries ranging from Southern to Northern Europe . DESIGN Cross-sectional , population -based epidemiologic study . PARTICIPANTS Of 5060 r and omly sample d people aged 65 years or older from 7 study centers across Europe ( Norway , Estonia , United Kingdom , France , Italy , Greece , and Spain ) , full dietary data were available in 4753 . The mean age of participants was 73.2 years ( st and ard deviation , 5.6 ) , and 55 % were women . METHODS Participants underwent an eye examination and digital retinal color photography . The images were grade d at a single center . Dietary intake during the previous 12 months was assessed by using a semiquantitative food-frequency question naire ( FFQ ) . A previously published Mediterranean Diet Score ( MDS ) was used to classify participants according to their responses on the FFQ . Multivariable logistic regression was used to investigate the association of the MDS score and AMD , taking account of potential confounders and the multicenter study design . MAIN OUTCOME MEASURES Images were grade d according to the International Classification System for age-related maculopathy and stratified using the Rotterdam staging system into 5 exclusive stages ( AMD 0 - 4 ) and a separate category of large drusen ( ≥125 μm ) . Age-related macular degeneration 4 included neovascular AMD ( nvAMD ) and geographic atrophy ( GA ) . RESULTS Increasing MDS was associated with reduced odds of nvAMD in unadjusted and confounder-adjusted analysis . Compared with the lowest MDS adherence ( ≤4 score ) , those in the highest category MDS adherence ( > 6 score ) showed lower odds of nvAMD ( odds ratio , 0.53 ; 0.27 - 1.04 ; P trend = 0.01 ) . The association with MDS did not differ by Y204H risk allele ( P = 0.89 ) . For all early AMD ( grade 1 - 3 ) , there was no relationship with MDS ( P trend = 0.9 ) . There was a weak trend ( P = 0.1 ) between MDS and large drusen ; those in the highest category of MDS had 20 % reduced odds compared with those in the lowest ( P = 0.05 ) . CONCLUSIONS This study adds to the limited evidence of the protective effect of adherence to a Mediterranean dietary pattern in those with late AMD , although it does not support previous reports of a relationship with genetic susceptibility . Interventions to encourage the adoption of the Mediterranean diet should be developed , and methods by which such behavior change can be achieved and maintained investigated Purpose Reports on the protective effect of a Mediterranean diet  on mortality usually refer to population s from Mediterranean countries , leaving uncertain whether really diet is the fundamental cause . Our aim was to examine the effect of a Mediterranean diet on mortality in Switzerl and , a country combining cultural influences from Mediterranean and Central European countries within a common national health and statistical registry . Methods In this prospect i ve investigation , we included 17,861 men and women aged ≥16 years who participated 1977–1993 in health studies and were followed up for survival until 2008 by anonymous record linkage with the Swiss National Cohort . A 9-point score Mediterranean Diet Score ( MDS ) was used to assess adherence to a Mediterranean diet .  Mortality hazard ratios ( HR ) and 95 % confidence intervals ( CIs ) were calculated by using Cox regression models adjusted for age , sex , survey wave , marital status , smoking , body mass index , language region and nationality . Results In all language regions , MDS was inversely associated with mortality . Consumption of dairy products was also consistently associated with lower mortality . When categorizing dairy food consumption as beneficial instead of harmful , this association between MDS and mortality increased in strength and was partly statistically significant . For all causes of death combined ( HR for a one-point increase in MDS 0.96 , 95 % CI 0.94–0.98 ) , in men ( 0.94 , 0.92–0.97 ) , in women ( 0.98 , 0.95–1.02 ) for cardiovascular diseases ( CVD , 0.96 , 0.92–0.99 ; 0.95 , 0.90–1.00 ; 0.98 , 0.92–1.04 ) and for cancer ( 0.95 , 0.92–0.99 ; 0.92 , 0.88–0.97 ; 0.98 , 0.93–1.04 ) . Conclusions Stronger adherence to a Mediterranean diet was associated with lower all-cause , CVD and cancer mortality , largely independently of cultural background . These associations were primary due to the effect in men . Our finding of a beneficial rather than a deleterious impact of dairy products consumption prompts at considering culturally adapted Mediterranean diet recommendations . However , results should be interpreted with caution since only a crude 1-day dietary estimate was available to assess individuals ’ habitual dietary intake Epidemiological studies show that adherence to a Mediterranean diet ( MD ) increases longevity ; however , few studies are restricted to Mediterranean population s or explore the effect of a MD pattern that directly incorporates olive oil . Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Spain ) . The EPIC-Spain analysis included 40 622 participants ( 37·7 % males ) aged 29 - 69 years who were recruited from five Spanish regions in 1992 - 1996 . During a mean follow-up of 13·4 years , 1855 deaths were documented : 913 from cancer , 399 from CVD , 425 from other causes and 118 from unknown causes of death . Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD ( rMED ) score , measured using an 18-unit scale incorporating nine selected dietary components . A high compared with a low rMED score was associated with a significant reduction in mortality from all causes ( hazard ratio ( HR ) 0·79 ; 95 % CI 0·69 , 0·91 ) , from CVD ( HR 0·66 ; 95 % CI 0·49 , 0·89 ) , but not from overall cancer ( HR 0·92 ; 95 % CI 0·75 , 1·12 ) . A 2-unit increase in rMED score was associated with a 6 % ( P < 0·001 ) decreased risk of all-cause mortality . A high olive oil intake and moderate alcohol consumption contributed most to this association . In this Spanish cohort , following an olive oil-rich MD was related to a significant reduction in all-cause mortality , and reduced the risk of mortality from CVD . These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries BACKGROUND Statins are prescribed for patients with cardiovascular disease ( CVD ) , along with the recommendation of adopting healthy diets . We evaluated the independent and the combined effect of statins and Mediterranean diet ( MD ) towards mortality risk in patients with previous CVD by using real-life data from a population -based prospect i ve cohort . METHODS Longitudinal analysis on 1180 subjects ( mean age 67.7 ± 10 ) with prior CVD at enrollment in the Moli-sani Study and followed up for 7.9 y ( median ) .  Adherence to MD was appraised by a Mediterranean diet score .  Hazard ratios ( HR ) with 95 % confidence intervals ( 95 % CI ) were calculated by multivariable Cox regression and competing risk models . RESULTS Multivariable risk estimates associated with a 2-point increase in MD score were 0.84 ( 95 % CI 0.70 - 1.00 ) , 0.77 ( 0.61 - 0.97 ) and 0.70 ( 0.52 - 0.93 ) for overall , cardiovascular and coronary artery disease (CAD)/cerebrovascular deaths , respectively  . Statins were not associated with death risk . Subjects combining statins and average-high adherence to MD had much lower than expected risk of cardiovascular and CAD/cerebrovascular mortality ( p for interaction = 0.045 and 0.0015 , respectively ) as compared to those neither using statins nor having average-high MD . The combination of average-high MD and statins was associated in a likely synergistic way with reduced low- grade inflammation , but not with blood cholesterol . CONCLUSIONS MD lowered the risk of all-cause , cardiovascular and CAD/cerebrovascular mortality CVD patients , net of statins . In the same population , statins  reduced CVD death risk only in combination with MD . Low- grade inflammation , rather than lipids , is likely to be on the pathway of the interaction between MD and statins towards mortality risk Adherence to a Mediterranean diet ( MD ) is associated with a reduced risk of coronary heart disease . However , the molecular mechanisms involved are not fully understood . The aim of this study was to compare the effects of 2 MD with those of a low-fat-diet ( LFD ) on circulating inflammatory biomarkers related to atherogenesis . A total of 516 participants included in the Prevention with Mediterranean Diet Study were r and omized into 3 intervention groups [ MD supplemented with virgin olive oil ( MD-VOO ) ; MD supplemented with mixed nuts ( MD-Nuts ) ; and LFD ] . At baseline and after 1 y , participants completed  FFQ  and adherence to MD  question naires , and plasma concentrations of inflammatory markers including intercellular adhesion molecule-1(ICAM-1 ) , IL-6 , and 2 TNF receptors ( TNFR60 and TNFR80 ) were measured by ELISA . At 1 y , the MD groups had lower plasma concentrations of IL-6 , TNFR60 , and TNFR80 ( P < 0.05 ) , whereas ICAM-1 , TNFR60 , and TNFR80 concentrations increased in the LFD group ( P < 0.002 ) . Due to between-group differences , participants in the 2 MD groups had lower plasma concentrations of ICAM-1 , IL-6 , TNFR60 , and TNFR80 compared to those in the LFD group ( P ≤ 0.028 ) . When participants were categorized in tertiles of 1-y changes in the consumption of selected foods , those in the highest tertile of virgin olive oil ( VOO ) and vegetable consumption had a lower plasma TNFR60 concentration compared with those in tertile 1 ( P < 0.02 ) . Moreover , the only changes in consumption that were associated with 1-y changes in the geometric mean TNFR60 concentrations were those of VOO and vegetables ( P = 0.01 ) . This study suggests that a MD reduces TNFR concentrations in patients at high cardiovascular risk We examined whether adherence to a Mediterranean-style diet has positive effects on mobility assessed over a 9-year follow-up in a representative sample of older adults . This research is part of the InCHIANTI Study , a prospect i ve population -based study of older persons in Tuscany , Italy . The sample for this analysis included 935 women and men aged 65 years and older .  Adherence to the Mediterranean diet was assessed at baseline by the st and ard 10-unit Mediterranean diet score ( MDS ) . Lower extremity function was measured at baseline , and at the 3- , 6- and 9-year follow-up visits using the short physical performance battery ( SPPB ) . At baseline , higher adherence to Mediterranean diet was associated with better lower body performance . Participants with higher adherence experienced less decline in SPPB score , which was of 0.9 points higher ( p<.0001 ) at the 3-year-follow , 1.1 points higher ( p=0.0004 ) at the 6-year follow-up and 0.9 points higher ( p=0.04 ) at the 9-year follow-up compared to those with lower adherence . Among participants free of mobility disability at baseline , those with higher adherence had a lower risk ( HR=0.71 , 95 % CI=0.51 - 0.98 , p=0.04 ) of developing new mobility disability . High adherence to a Mediterranean-style diet is associated with a slower decline of mobility over time in community-dwelling older persons . If replicated , this observation is highly relevant in terms of public health Only a few studies have analyzed the effects of the potential interaction between the -174G/C polymorphism of IL6 gene and the adherence to the Mediterranean diet ( MD ) on adiposity indexes . Our aim was to investigate the interplay between the -174G/C polymorphism of the IL6 gene and a Mediterranean-style diet on body weight changes after 3 years of nutritional intervention in a high cardiovascular risk population . A total of 737 participants , aged 55 - 80 years were assigned to a low-fat diet or to a Mediterranean-style diet group with high intake of virgin olive oil ( VOO ) or nuts .  Anthropometric measurements were taken at baseline and after 3-year follow-up . The -174G/C polymorphism of the IL6 gene was genotyped . Minor allele frequency ( C ) was 0.39 . At baseline , the CC genotype was associated with higher measures of adiposity . After 3 years , a significant interaction ( p=0.028 ) was found between the polymorphism ( GG+GC versus CC ) and the nutritional intervention : CC subjects following the MD+VOO had the lowest body weight gain . In conclusion , at baseline , CC subjects for the -174G/C polymorphism of IL6 had the highest body weight and BMI . However , after 3 years of nutritional intervention with MD+VOO , these subjects were predicted to have the greatest reduction in body weight BACKGROUND AND AIM The Mediterranean diet is considered a model for healthy eating . However , prospect i ve evidence in Mediterranean countries evaluating the relationship between this dietary pattern and non-fatal cardiovascular events is scarce . The aim of the present study was to evaluate the association between the adherence to the Mediterranean diet and the incidence of fatal and non-fatal cardiovascular events among initially healthy middle-aged adults from the Mediterranean area . METHODS AND RESULTS We followed-up 13,609 participants ( 60 percent women , mean age : 38 years ) initially free of cardiovascular disease ( CVD ) during 4.9 years . Participants were part of a prospect i ve cohort study of university graduates from all regions of Spain .  Baseline diet  was assessed using a vali date d 136-item food-frequency question naire . A 9-point score was used to appraise adherence to the Mediterranean diet . Incident clinical events were confirmed by a review of medical records . We observed 100 incident cases of CVD . In multivariate analyses , participants with the highest adherence to the Mediterranean diet ( score>6 ) exhibited a lower cardiovascular risk ( hazard ratio=0.41 , 95 % confidence interval [ CI ] : 0.18 - 0.95 ) compared to those with the lowest score ( <3 ) . For each 2-point increment in the score , the adjusted hazard ratios were 0.80 ( 95 % CI : 0.62 - 1.02 ) for total CVD and 0.74 ( 0.55 - 0.99 ) for coronary heart disease . CONCLUSIONS There is an inverse association between adherence to the Mediterranean diet and the incidence of fatal and non-fatal CVD in initially healthy middle-aged adults Background Adherence to the Mediterranean diet ( MD ) is associated with reduced morbidity and mortality due to cardiovascular disease . However , how the MD exerts its effects is not fully known . Aim To assess the 12-month effects of two enhanced MDs compared to a low-fat diet on inflammatory biomarkers related to atherosclerosis and plaque vulnerability in a subcohort of the PREDIMED ( Prevención con Dieta Mediterránea ) study . Methods A total of 164 participants at high risk for cardiovascular disease were r and omized into three diet groups : MD supplemented with 50mL/d of extra virgin olive oil ( MD+EVOO ) or 30 g/d of nuts ( MD+Nuts ) and a low-fat diet . Changes in classical cardiovascular risk factors , inflammatory biomarkers of atherosclerosis and plaque vulnerability were measured after 12 months of intervention . Results Compared to participants in the low-fat diet group , those receiving MD+EVOO and MD+Nuts showed a higher decrease in systolic ( 6mmHg ) and diastolic ( 3mmHg ) blood pressure ( P = 0.02 ; both ) , as well as a reduction of 10 % and 8 % in LDL-cholesterol ( P = 0.04 ) , respectively . Patients in the MD+Nuts group showed a significant reduction of 34 % in CD40 expression on monocyte surface compared to low-fat diet patients ( P = 0.03 ) . In addition , inflammatory biomarkers related to plaque instability such as C-reactive protein and interleukin-6 were reduced by 45 % and 35 % and 95 % and 90 % in the MD+EVOO and MD+Nuts groups , respectively ( P<0.05 ; all ) compared to the low-fat diet group . Likewise , sICAM and P-selectin were also reduced by 50 % and 27 % , respectively in the MD+EVOO group ( P = 0.04 ) and P-selectin by 19 % in MD+Nuts group ( P = 0.04 ) compared to the low-fat diet group . Conclusions Adherence to the MD is associated with an increase in serum markers of atheroma plaque stability which may explain , at least in part , the protective role of MD against ischemic heart disease . Trial Registration www.controlled-trials.com IS RCT
The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality .
Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population .
OBJECTIVE The aim of this review was to evaluate the conceptual suitability , applicability and psychometric properties of scores used internationally to measure adherence to the Mediterranean diet ( MD ) .