Understanding the ‘traditional’ Mediterranean cuisine: relationship to cognitive health and advances in measurement of adherence

The Mediterranean diet has been associated with reduced chronic disease risk. Recent research is focussing on cognitive function as dementia is a global health priority. Varied Mediterranean diet interventions and adherence tools have impeded comparisons across trials. No tool has been specifically developed for, nor validated within, cohorts at increased dementia risk. The aims of this thesis were to improve understanding of the ‘traditional’ Mediterranean cuisine; systematically review the effect of a Mediterranean diet on cognition and brain morphology/function within clinical trials; develop a new index tool to assess adherence to the ‘traditional’ dietary pattern and aspects of cuisine; and test reliability and validity of this tool for online and in-person use among older Australians, including those with mild cognitive impairment. This thesis has identified additional culinary aspects of the ‘traditional’ cuisine, which were previously poorly examined. The systematic review found no overall cognitive benefits for a Mediterranean diet across included trials but the interventions variably reflected a ‘traditional’ diet. In the best trial, cognitive decline was reduced over four years compared to a lower fat diet. The Mediterranean Diet and Culinary Index (MediCul) (scored from 0 to 100) was developed using elements and cut-off points based on the ‘traditional’ cuisine. This survey tool, taking 20 minutes to complete, was tested within two cohorts and found to have very good reliability using the intra-class correlation coefficient (ICC) (ICC=0.86, 95% CI: 0.789, 0.910 and ICC=0.93, 95% CI: 0.884, 0.954, respectively, p<0.0001). Validity was moderate with the tool overreporting the MediCul score by 6% compared to a food record. Promotion of lifestyle interventions to slow progression of cognitive decline in at-risk groups is critical. Availability of validated tools such as MediCul may advance understanding of the role of diet in healthy brain ageing

Diet, exercise and dementia: The potential impact of a Mediterranean diet pattern and physical activity on cognitive health in a UK population

Diet and physical activity play key roles in maintaining health and preventing or delaying disease. The global prevalence of dementia, an umbrella term describing a set of symptoms which affect cognitive function, is set to rise dramatically by 2050, with current drug treatments inadequate. Diet and physical activity are modifiable factors in dementia, influencing both disease risk and pathophysiology. It has been known since the 1950s that a Mediterranean diet has positive health benefits. Over the past 25 years, a causal link has been shown between consumption of a Mediterranean diet and decreased risk of cardiovascular disease, particularly in Mediterranean countries. There have also been indications that a Mediterranean diet and increased physical activity can improve cognitive health and delay the onset of dementia. However, causative demonstrations of these effects, as well as the feasibility of implementing such lifestyle changes in a non‐Mediterranean population, are lacking. The new MedEx‐UK programme will attempt to address both these points

Dietary Education Provision Within a Cardiac Rehabilitation Programme in the UK: A Pilot Study Evaluating Nutritional Intakes Alongside Physical Activity Levels

Background/aims: The primary aim of this study was to evaluate the effectiveness of two 30-minute dietary education sessions, within cardiac rehabilitation (CR), as a means to optimise nutrient and energy intakes (EI). A secondary aim was to evaluate patients’ habitual physical activity (PA) levels. Methods: Thirty patients (males: n = 24, 61.8 ± 11.2 years; females: n = 6, 66.7 ± 8.5 years) attended a six-week early outpatient CR programme in the UK and received two 30-minute dietary education sessions emphasising Mediterranean diet principles. EI and nutrient intakes were measured through completion of three-day food diaries in weeks one and six (before and after the dietary education sessions) to assess the impact of these sessions on nutrient intakes. At the same time-points, a sub-group (n = 13) of patients had their PA levels assessed via accelerometery to assess the impact of the CR programme on PA. Findings: Estimated energy requirements (EER) at week one (1988 ± 366 kcal . d -1 ) were not matched by actual EI (1785 ± 561 kcal . d -1 ) ( P = 0.047, d = -0.36). EI reduced to 1655 ± 470 kcal . d -1 at week six ( P = 0.66, d = -0.33) whereas EER increased as a function of increased activity (CR sessions). Nutrient intakes remained suboptimal, while no significant increases were observed in healthy fats and fibre, which consist core elements of a Mediterranean diet. Statistically significant increases were not observed in PA however patients decreased sedentary time by 11 ± 12% in week six compared to week one ( P = 0.009; d = -0.54). Conclusion : The present study findings suggest that two 30-minute dietary education sessions did not positively influence EI and nutrient intakes, while habitual PA levels were not significantly increased as a result of the CR programme. Future research should explore means of optimising nutrition and habitual PA within UK CR

Defining the Traditional Mediterranean Lifestyle: Joint International Consensus Statement

Introduction: The term “Mediterranean lifestyle” has gained increasing prominence in recent years, yet a specific definition remains elusive. In response, the Mediterranean Lifestyle Medicine Institute Board of Directors convened a multidisciplinary panel comprising international experts and leaders in lifestyle medicine. Their goal was to review existing literature and formulate a consensus definition of the “traditional Mediterranean lifestyle (tMedL),” referring to the historical way of living of the people in the Mediterranean region. This paper presents the agreed consensus statement and a comprehensive holistic definition of the term “traditional Mediterranean lifestyle.”. Methods: Major medical and social sciences electronic databases from inception to February 2023 were searched, employing keywords relevant to the Mediterranean lifestyle and its constituent elements (diet, physical activity, sleep, stress, socialization). Subsequently, definitions for each pillar were created and synthesized to derive a comprehensive definition of the “traditional Mediterranean lifestyle.”. Results: This proposed definition received ratification from the Mediterranean Lifestyle Medicine Institute's expert working group during the First International Mediterranean Lifestyle Medicine Conference held in June 2023 on the island of Leros, Greece. “The traditional Mediterranean lifestyle is characterized by its diverse and adaptable nature. Key facets encompass conviviality, lifelong social connectedness, purposeful living, strong community and familial bonds, harmony with nature and the environment, profound spirituality, adherence to religious practices, preservation of local customs, resilience cultivated through adversity, and a commitment to moderation across all spheres of life.”. Conclusions: This definition comprehensively outlines the primary lifestyle factors ingrained in Mediterranean inhabitants across generations. Its holistic nature furnishes a crucial conceptual framework for directing lifestyle medicine practitioners in assisting patients to mitigate diseases, promote overall well-being, devise research initiatives to investigate the health ramifications of this lifestyle, and inform curriculum development

Electronic food records among middle‐aged and older people: A comparison of self‐reported and dietitian‐assisted information

AIM: Nutrition-based applications ("apps") offer enormous research potential, however evidence of their use and acceptability among older adults is limited. We compared self-reported and dietitian-adjusted dietary intake records among adults aged 55 to 75 years using the Research Food Diary (RFD) app. METHODS: Participants were recruited from the 45 and Up Study and completed a 3-day food record using the RFD. A follow-up dietetic telephone interview was performed to confirm the electronic dietary data. Independent of these interviews, a set of adjustments based on dietetic skills, nutritional database knowledge, food composition and dietary assessment was established to resolve probable reporting errors. The "adjusted" and "dietitian-assisted" records were compared to self-reported records for nutrient intakes and serves of The Five Food Groups using one-way repeated measures analysis of variance. RESULTS: Sixty-two participants were recruited, with 48 using the RFD app which included eight records without any identified errors. Reporting errors contained in the raw self-reported records included: food items with missing/implausible quantities or insufficient descriptions to allow automatic coding. After removal of unusable records, 44 records were analysed. Differences were found between the self-reported and adjusted records for protein, calcium, vitamin B12 , zinc and dairy food serves (all P < .001; differences up to 8%). No significant differences were found between the adjusted and dietitian-assisted measures. CONCLUSIONS: Similarities between adjusted and dietitian-assisted records suggest carefully applied dietetic assumptions are likely to improve accuracy of self-reported intake data where dietitian interviews are not possible. We provide four key recommendations to guide this process