Adherence to Mediterranean Diet and Nutritional Status in Women with Breast Cancer: What Is Their Impact on Disease Progression and Recurrence-Free Patients’ Survival?

Introduction: Nutritional status impacts the survival of patients with cancer. There are few studies that investigate the role of nutritional status on breast cancer survival in women with breast cancer, and even fewer regarding the impact of adhering to the Mediterranean diet (MD). The present study aims to assess the nutritional status, MD adherence, physical activity levels and health-related quality of life (HRQOL) in women diagnosed with breast cancer and evaluate these parameters regarding recurrence-free survival. Methods: A total of 114 women, aged 35–87 years old, diagnosed with breast cancer in Larissa, Greece, participated in the study. Tumor histopathology was reported, and anthropometric indices were measured by a trained nurse, while questionnaires regarding nutritional status (via mini nutritional assessment), HRQOL via EORTC QLQ-C30, physical activity levels via IPAQ and Mediterranean diet adherence via MedDietScore were administered. The participants were followed-up for a maximum time interval of 42 months or until recurrence occurred. Results: A total of 74% of patients were overweight or obese, while 4% of women were undernourished, and 28% were at risk of malnutrition. After 42 months of follow-up, 22 patients (19.3%) had relapsed. The median time to recurrence was 38 months (IQR: 33–40 months) and ranged between 23 to 42 months. Higher levels of MD adherence were significantly associated with lower body mass index (BMI) values, earlier disease stage, smaller tumor size, absence of lymph node metastases and better physical activity levels (p \u3c 0.05). Normal nutritional status was significantly associated with higher BMI values and better health-related quality of life (p ≤ 0.05). In univariate analysis, patients with higher levels of MD adherence and well-nourished patients had significantly longer recurrence-free survival (p \u3c 0.05). In multivariate analysis, MD adherence and nutritional status were independently associated with recurrence-free patients’ survival after adjustment for several confounding factors (p \u3c 0.05). Conclusions: The impact of MD on time to recurrence is still under investigation, and future interventional studies need to focus on the role of adhering to the MD before and after therapy in survival and breast cancer progression. Furthermore, the present study also highlights the importance of an adequate nutritional status on disease progression, and the need for nutritional assessment, education and intervention in women with breast cancer

Temporal and inter habitat variations of substratum, vegetation and substratum macroinvertebrates attributes across coastal wetland systems, North East Aegean, Greece

Using five coastal wetland systems across Kalloni bay, Lesvos Island, NE Aegean, we investigated: (I) the interaction between spatial units (land, wetland, sea) and seasons (spring, autumn) of substratum physicochemical attributes, vegetation composition and aerial cover, and substratum macroinvertebrates distribution and abundance and (II) the relative importance of substratum attributes in explaining temporal and inter habitat variations in vegetation and substratum macroinvertebrates distributions to elucidate the functional role of these coastal wetlands in the landscape. Electrical conductivity, percent organic matter and bulk density of substratum showed the most pronounced differences among spatial units, between seasons, and among spatial units x seasons interaction, respectively. Comparison of C:N and N:P ratios among spatial units and between seasons indicated that, in general, nitrogen and phosphorus appear to be limiting factors at the sea and the land unit, respectively. It is likely that these coastal wetlands function as transformers of chemical elements while P limits primary production. Significant substratum physicochemical attributes explained 23.4 and 14.7% of plants distribution in spring (percent organic matter, total phosphorus concentration, electrical conductivity) and autumn (electrical conductivity, pH), respectively, while significant substratum variables explained 46.1 and 73.3% of macroinvertebrates distribution in spring (percent organic matter) and autumn (total phosphorus concentration, electrical conductivity, percent organic matter), respectively

Assessing the risks to Mediterranean islands ecosystems from non-native plant introductions.

Peer Reviewe

Conservation of Mediterranean oak woodlands: understorey dynamics under different shrub management

The effect of experimental disturbances on the dynamics of a shrub community was studied on a ‘Montado’ ecosystem, in southern Portugal. The evolution of the community physiognomy, composition and diversity were monitored after shrub clearing followed by biomass removal, deposition on soil surface and incorporation with the soil, over a 9-year period. Maximum shrub density was recorded in the first year after the disturbances, excepting in mulched plots which showed the greatest number of individuals 1 year later. The increment of shrub leaf biomass was very fast in the first 3 years, whereas wood production was slower but occurred along the whole study period. At the end of the study, leaf and wood biomass was still significantly lower than in the predisturbance situation. The variation pattern of leaf area index was similar to that of leaf biomass. The evolution of total plant cover and diversity was similar across treatments. The highest species richness and diversity were recorded 2 years after cutting, decreasing afterwards with the increasing dominance of shrubs. Thus it seems likely that, although a 9 year period is too short for these communities to reach steady equilibrium, they are very resistant and resilient to disturbances, as regeneration was fast and vegetation dynamics was not influenced by differences among treatments. We can conclude that shrub clearing promotes biodiversity and the time of permanence of shrub patches depends on the particular goal we want to achieve

Conservation of Mediterranean oak woodlands: understorey dynamics under different shrub management

The effect of experimental disturbances on the dynamics of a shrub community was studied on a ‘Montado’ ecosystem, in southern Portugal. The evolution of the community physiognomy, composition and diversity were monitored after shrub clearing followed by biomass removal, deposition on soil surface and incorporation with the soil, over a 9-year period. Maximum shrub density was recorded in the first year after the disturbances, excepting in mulched plots which showed the greatest number of individuals 1 year later. The increment of shrub leaf biomass was very fast in the first 3 years, whereas wood production was slower but occurred along the whole study period. At the end of the study, leaf and wood biomass was still significantly lower than in the predisturbance situation. The variation pattern of leaf area index was similar to that of leaf biomass. The evolution of total plant cover and diversity was similar across treatments. The highest species richness and diversity were recorded 2 years after cutting, decreasing afterwards with the increasing dominance of shrubs. Thus it seems likely that, although a 9 year period is too short for these communities to reach steady equilibrium, they are very resistant and resilient to disturbances, as regeneration was fast and vegetation dynamics was not influenced by differences among treatments. We can conclude that shrub clearing promotes biodiversity and the time of permanence of shrub patches depends on the particular goal we want to achieve