Metabolic and vascular effect of the mediterranean diet

Several studies indicated how dietary patterns that were obtained from nutritional cluster analysis can predict disease risk or mortality. Low-grade chronic inflammation represents a background pathogenetic mechanism linking metabolic risk factors to increased risk of chronic degenerative diseases. A Mediterranean diet (MeDi) style has been reported as associated with a lower degree of inflammation biomarkers and with a protective role on cardiovascular and cerebrovascular events. There is heterogeneity in defining the MedDiet, and it can, owing to its complexity, be considered as an exposome with thousands of nutrients and phytochemicals. Recently, it has been reported a novel positive association between baseline plasma ceramide concentrations and cardiovascular events and how adherence to a Mediterranean Diet-style may influence the potential negative relationship between elevated plasma ceramide concentrations and cardiovascular diseases (CVD). Several randomized controlled trials (RCTs) showed the positive effects of the MeDi diet style on several cardiovascular risk factors, such as body mass index, waist circumference, blood lipids, blood pressure, inflammatory markers and adhesion molecules, and diabetes and how these advantages of the MeDi are maintained in comparison of a low-fat diet. Some studies reported a positive effect of adherence to a Mediterranean Diet and heart failure incidence, whereas some recent studies, such as the PREDIMED study, showed that the incidence of major cardiovascular events was lower among those assigned to MeDi supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet. New studies are needed to better understand the molecular mechanisms, whereby the MedDiet may exercise its effects. Here, we present recent advances in understanding the molecular basis of MedDiet effects, mainly focusing on cardiovascular diseases, but also discussing other related diseases. We review MedDiet composition and assessment as well as the latest advances in the genomic, epigenomic (DNA methylation, histone modifications, microRNAs, and other emerging regulators), transcriptomic (selected genes and whole transcriptome), and metabolomic and metagenomic aspects of the MedDiet effects (as a whole and for its most typical food components). We also present a review of the clinical effects of this dietary style underlying the biochemical and molecular effects of the Mediterranean diet. Our purpose is to review the main features of the Mediterranean diet in particular its benefits on human health, underling the anti-inflammatory, anti-oxidant and anti-atherosclerotic effects to which new knowledge about epigenetic and gut-microbiota relationship is recently added

A systematic review and meta-analysis of the effects of flavanol-containing tea, cocoa and apple products on body composition and blood lipids: exploring the factors responsible for variability in their efficacy

Several randomized controlled trials (RCTs) and meta-analyses support the benefits of flavanols on cardiometabolic health, but the factors affecting variability in the responses to these compounds have not been properly assessed. The objectives of this meta-analysis were to systematically collect the RCTs-based-evidence of the effects of flavanol-containing tea, cocoa and apple products on selected biomarkers of cardiometabolic risk and to explore the influence of various factors on the variability in the responses to the consumption of these products. A total of 120 RCTs were selected. Despite a high heterogeneity, the intake of the flavanol-containing products was associated using a random model with changes (reported as standardized difference in means (SDM)) in body mass index (−0.15, p < 0.001), waist circumference (−0.29, p < 0.001), total-cholesterol (−0.21, p < 0.001), LDL-cholesterol (−0.23, p < 0.001), and triacylglycerides (−0.11, p = 0.027), and with an increase of HDL-cholesterol (0.15, p = 0.005). Through subgroup analyses, we showed the influence of baseline-BMI, sex, source/form of administration, medication and country of investigation on some of the outcome measures and suggest that flavanols may be more effective in specific subgroups such as those with a BMI ≥ 25.0 kg/m2, non-medicated individuals or by specifically using tea products. This meta-analysis provides the first robust evidence of the effects induced by the consumption of flavanol-containing tea, cocoa and apple products on weight and lipid biomarkers and shows the influence of various factors that can affect their bioefficacy in humans. Of note, some of these effects are quantitatively comparable to those produced by drugs, life-style changes or other natural products. Further, RCTs in well-characterized populations are required to fully comprehend the factors affecting inter-individual responses to flavanol and thereby improve flavanols efficacy in the prevention of cardiometabolic disorders

European Guidelines for Obesity Management in Adults

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management. (C) 2015 S. Karger GmbH, Freibur

Improving Adherence to Mediterranean Diet to prevent or reduce Metabolic Syndrome in Heart Transplanted Patients

The Metabolic Syndrome (MetS) is a multi-factorial condition, which enhances the risk to develop chronic related diseases. Despite many advances in patients’ management and pharmacological treatment, MetS represents a real burden in heart transplanted (HTx) patients, mainly due to the side effects of immunosuppressive therapy which severely affects their long-term outcomes. The improvement of dietary habits seems to represent an effective strategy to reduce the MetS in general population, decreasing the cardiovascular risk factors. Among all, number of studies associate the Mediterranean diet (MedDiet) to a reduction of cardiovascular incidence and of all-cause mortality. Unfortunately, dietary programs for the long-term period after HTx are not yet adequately provided in the routine follow-up of these patients. The first Aim of this PhD research was to assess the prevalence of MetS in HTx patients at the University Hospital of Udine, since 2007, and evaluate the impact on the long-term outcome in terms of morbidity and mortality. Through a retrospective collection of clinical data, we observed that more than half (52%) of the patients were affected by MetS at 5 years of follow-up and that the early development of this condition, both before and within 1 year of HTx, were associated to a worst survival and to a higher risk to develop cardiac allograft vasculopathy. Since the beneficial effects of MedDiet on cardiovascular risk factors, the second Aim of the project was to assess the adherence to the MedDiet of 143 HTx patients. Through the administration of a validated Food Frequency Questionnaire (FFQ) we observed an overall weak adherence to the MedDiet, together with an inadequate consumption of many healthy foods characteristic of this dietary pattern. Finally, the Aim 3 was to evaluate any beneficial effect of a structured and personalized dietary intervention in a sample of HTx patients. Changes were compared at baseline and at each timepoint, within the intervention group and between the intervention and the control group, which followed general nutritional advices. The variables of interest were the adherence to the MedDiet, clinical, anthropometric, body composition and blood parameters data, and general dietary habits. Fifteen patients were recruited for the intervention group versus 13 in the control group. The comparison between intervention and control group occurred at baseline and at the intermediate meeting, after 6 months, reached by 11 patients of the intervention group versus and 10 patients of the control group. The analysis within the intervention group included also the final meeting, after 12 months, reached by 7 patients. The main findings were: 1) MedDiet adherence significantly increased in the intervention group during the study period, both comparing the intervention and the control group, and within the intervention group over the three timepoints; 2) moreover, parameters of body composition in the intervention group significantly changed over the study period, with a significant decrease of fat mass % and a subsequent increase of fat free mass %, and body cell mass %; also waist circumference decreased on average of -1.3±2.6cm. Furthermore, both blood pressure and renal function resulted significantly improved in the intervention group versus the control group, at the intermediate timepoint. 3) finally, dietary habits of the intervention group showed an improvement of macronutrients balance, a significant decrease of energy from saturated fatty acids and soluble sugars, and a positive trend to micronutrients intake. Concluding, we confirmed that the implementation of a structured and personalized dietary programme may be feasible in HTx population and exerts many beneficial effects. The future goal will be to offer a nutritional education, in line with the MedDiet principles, to all HTx patients at the University Hospital of Udine

Trimethylamine-N-oxide (TMAO) as novel potential biomarker of early predictors of metabolic syndrome

There is a mechanistic link between the gut-derived metabolite trimethylamine-N-oxide (TMAO) and obesity-related diseases, suggesting that the TMAO pathway may also be linked to the pathogenesis of obesity. The Visceral Adiposity Index (VAI), a gender-specific indicator of adipose dysfunction, and the Fatty Liver Index (FLI), a predictor of non-alcoholic fatty liver disease (NAFLD), are early predictors of metabolic syndrome (MetS). In this cross-sectional observational study, we investigated TMAO levels in adults stratified according to Body Mass Index (BMI) and the association of TMAO with VAI and FLI. One hundred and thirty-seven adult subjects (59 males; 21⁻56 years) were enrolled. TMAO levels were detected using HPLC/MS analysis. Homeostatic Model Assessment of Insulin Resistance (HoMA-IR), VAI and FLI were included as cardio-metabolic indices. TMAO levels increased along with BMI and were positively associated with VAI and FLI, independently, on common potential covariates. The most sensitive and specific cut-offs for circulating levels of TMAO to predict the presence of NAFLD-FLI and MetS were ≥8.02 µM and ≥8.74 µM, respectively. These findings allow us to hypothesize a role of TMAO as an early biomarker of adipose dysfunction and NAFLD-FLI in all borderline conditions in which overt MetS is not present, and suggest that a specific cut-off of TMAO might help in identifying subjects at high risk of NAFLD

The role of Mediterranean diet in the prevention of hypertension in relation to the assessment of individual nutrients

The purpose of this case-control study was to investigate the effect that mediterranean diet model has in preventing hypertension and to hierarchy estimate mediterranean diet in relation to individual nutrients regardless of other risk factors. During the period 2004-2006, 300 adult patients with a history of primary hypertension were evaluated during their visit to Hypertension Clinic of the General Hospital of Halkidiki. As a control group 100 healthy individuals were enrolled. Recording of data and other parameters were done during interview by using a questionnaire. The questionnaire included questions on general demographics, physical activity at work and recreation, nutrition, consumption of alcoholic beverages, smoking habits, family history of hypertension and medication. The calculation of the total energy intake, the Keys Score, simple carbohydrates, fiber, sodium, potassium, calcium and magnesium in nutrition as well as the calculation of the Mediterranean diet score followed. Univariable and multivariable analysis were applied and found that the model of the Mediterranean diet was the main factor in the prevention of arterial hypertension followed by the dietary intake of sodium, magnesium and total energy intake. Finally, the adoption of nutritional models seems to outweigh the modification of individual nutrients

Metabolic Syndrome: Impact of Dietary Therapy

Metabolic syndrome refers to the coexistence of insulin resistance (IR) with several risk factors, including abdominal obesity, atherogenic dyslipidemia, and hypertension, which is usually complicated by cardiovascular and/or cerebrovascular diseases. This clustering of risk factors suggests that they are interrelated and not independent of one another and that they share underlying mechanisms, mediators, and pathways. Its prevalence exceeds 40% of those over 40, and it has recently been diagnosed in adolescents and even children. Metabolic syndrome is a pro-inflammatory prothrombotic state with determination of elevated level of cytokines, acute phase reactants, fibrinogen, and plasminogen activator inhibitor-1. A comprehensive definition of metabolic syndrome and its pathogenesis would facilitate research into its causes and disease pathophysiology linking the components of metabolic syndrome with the increased risk of cardiovascular diseases. The management to mitigate these underlying risk factors constitutes a first-line intervention; dietary therapy of metabolic syndrome includes lifestyle modification, hypocaloric diet, and consumption of functional food. Healthy food quantity and time of consumption help restore the normal metabolic profiles. Hopefully, this will lead to new insights into facilitating epidemiological and clinical studies of pharmacological, lifestyle, and preventive treatment approaches

Effects of the Mediterranean Diet on the Components of Metabolic Syndrome Concerning the Cardiometabolic Risk

Metabolic syndrome is a cluster of risk factors, including abdominal obesity, insulin resistance, hypertension, dyslipidemia (intended as an increase in triglyceride levels and a reduction in HDL cholesterol levels), and elevated fasting glucose, that increase the risk of cardiovascular disease and type 2 diabetes. With the rising prevalence of metabolic syndrome, effective dietary interventions are essential in reducing these health risks. The Mediterranean diet, rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil and moderate in fish and poultry, has shown promise in addressing metabolic syndrome and its associated components. This diet’s anti-inflammatory and antioxidant properties, primarily due to its unsaturated fats, polyphenols, and fiber, have improved blood pressure, lipid levels, and insulin sensitivity. Adherence to the Mediterranean diet has been linked to reductions in central obesity and insulin resistance, both key elements in managing metabolic syndrome. Regarding lipid management, the Mediterranean diet lowers triglyceride levels and low-density lipoprotein (LDL) cholesterol while raising high-density lipoprotein (HDL) cholesterol, enhancing lipid profiles. It also helps regulate blood glucose levels, reducing the likelihood of developing type 2 diabetes. Additionally, the diet promotes weight loss and improves body composition, particularly by decreasing visceral fat, a primary driver of metabolic syndrome according to IDF classification. The Mediterranean diet offers a holistic approach to managing metabolic syndrome and reducing the risk of related chronic diseases. Its positive impact on metabolic health, combined with lifestyle changes like increased physical activity, provides a sustainable method for addressing the global burden of this syndrome. This review aimed to summarize the positive effects of the Mediterranean diet on the component of the metabolic syndrome with subsequent positive effects on cardiometabolic risk profile