Impact of the traditional Mediterranean diet on the Framingham risk score and the metabolic syndrome according to sex

Background: The traditional Mediterranean diet (MedDiet) has been recognized as a food pattern with beneficial effects on cardiovascular health. However, even if sex-related differences in the cardiovascular response to diet have been previously highlighted, the existence of such differences in the impact of the MedDiet on the global cardiovascular risk has not been yet investigated. This study examined sex differences in the global cardiovascular impact of a 4-week isoenergetic controlled MedDiet using the Framingham risk score and the National Cholesterol Education Program (NCEP) metabolic syndrome criteria. Methods: This study included 38 men and 32 premenopausal women (24–53 years) who had slightly elevated low-density lipoprotein cholesterol (LDL-C) concentrations (between 3.4 and 4.9¿mmol/L) or total cholesterol-to-high-density lipoprotein cholesterol (HDL-C) ratios =5.0. Cardiovascular risk factors were measured before and after the controlled MedDiet. Results: A time effect (P=0.04) was found for the Framingham risk score, with both men and women showing a nonsignificant decrease in response to the MedDiet. No time effect was found for the prevalence of the metabolic syndrome and the number of metabolic syndrome criteria that were met by participants (P>0.05). However, a time effect was noted for the continuous metabolic syndrome score (P=0.008), with nonsignificant decreases in both men and women. No sex-by-time interaction was noted for any of variables studied (P>0.05). Conclusions: Results from this study suggest that the global cardiovascular impact of the MedDiet, as assessed by the Framingham risk score and metabolic syndrome criteria, is not significantly different in men than in premenopausal women in isoenergetic conditions

Gender differences in the effects of repeated taste exposure to the Mediterranean diet : a 6-month follow-up study

Objectif. Déterminer si une intervention basée principalement sur l'exposition au régime méditerranéen, accompagnée de recommandations et d'outils pour encourager une alimentation saine, mène à des effets différents en ce qui concerne l'adhésion au régime alimentaire et la gestion du poids six mois après l'intervention chez des femmes et des hommes canadiens. Méthodes. Trente-huit hommes et 32 femmes préménopausées (tous âgés de 24 à 53 ans) ont été exposés au même régime méditerranéen expérimental pendant 4 semaines au cours desquelles la nourriture leur était fournie. Les participants ont aussi reçu des recommandations et des outils pour les aider à adhérer à un régime alimentaire sain, sans autre contact jusqu'à la visite de suivi 6 mois plus tard. Résultats. En comparaison au début de l'étude, le score méditerranéen a augmenté à la fin du suivi de 6 mois (effet temps P = 0,003) sans différence entre les sexes (interaction entre le sexe et le temps P = 0,97). Concernant les composantes du score méditerranéen, on a observé des différences entre les sexes, les hommes déclarant des changements dans plus de groupes alimentaires que les femmes. Bien que l'intervention n'était pas axée sur la gestion du poids, en comparaison au début, l'IMC des participants a diminué au cours de l'intervention tant chez les hommes que chez les femmes. Cependant, seules les femmes ont maintenu un IMC plus bas 6 mois après l'intervention. Conclusions. L'exposition de courte durée au régime méditerranéen favorise l'adhésion à ce modèle alimentaire chez les deux sexes et aide à la gestion du poids, particulièrement chez les femmes.Purpose: To determine whether an intervention based mainly on exposure to the Mediterranean diet (MedDiet), along with recommendations/tools for encouraging healthy eating, lead to different effects on dietary adherence and body weight management six months post-intervention in Canadian men and women. Methods: Thirty-eight men and 32 premenopausal women (24-53 years) were exposed to the same 4-week experimental MedDiet during which all foods were provided to participants. Participants also received some recommendations/tools to adhere to a healthy way of eating, with no other contact until the 6-month follow-up visit. Results: Compared to baseline, the Mediterranean score (MedScore) had increased at the end of the 6-month follow-up (time effect P=0.003), with no gender difference (gender-by-time interaction P=0.97). Although our intervention was not focused on body weight management, compared to baseline, BMI decreased during the intervention in both men and women (respectively P<0.0001 and P=0.03); however, only the female participants of this study managed to maintain the lower BMI, six months after the intervention (P=0.03 for women; gender-by-time interaction P=0.04). Conclusions: Exposure to the MedDiet for a short duration promotes the adherence to this food pattern in both genders and helps in the management of body weight, especially in women

Validation of a newly automated web-based 24-hour dietary recall using fully controlled feeding studies

BACKGROUND: Assessment of food intake is a cornerstone of nutritional research. However, the use of minimally validated dietary assessment methods is common and can generate misleading results. Thus, there is a need for valid, precise and cost-effective dietary assessment tools to be used in large cohort studies. The objective is to validate a newly developed automated self-administered web-based 24-h dietary recall (R24W), within a population of adults taking part in fully controlled feeding studies. METHODS: Sixty two adults completed the R24W twice while being fed by our research team. Actual intakes were precisely known, thereby allowing the analysis of the proportion of adequately self-reported items. Association between offered and reported portion sizes was assessed with correlation coefficients and agreement with the kappa score while systematics biases were illustrated with Bland-Altman Plot. RESULTS: Participants received an average of 16 food items per testing day. They reported 89.3% of the items they received. The more frequently omitted food categories were vegetables included in recipes (40.0%) as well as side vegetables (20.0%) and represented less than 5% of the actual daily energy intake. Offered and self-reported portion sizes were significantly correlated (r = 0.80 P &lt; 0.001) and demonstrated a strong agreement as assessed by the kappa score of 0.62. Reported portion sizes for individual food items were on average 3.2 g over the offered portion sizes. Portions of 100 g and above were on average underestimated by 2.4% (r = 0.68 P &lt; 0.01; kappa score = 0.50) while small portions (less than 100 g) were overestimated by 17.1% (r = 0.46 P &lt; 0.01; kappa score = 0.43). A nonsignificant underestimation (−13.9 kcal ± 646.3 kcal; P = 0.83) of energy intake was noted. CONCLUSION: R24W performed well as participants were able to report the great majority of items they ate and selected portion size strongly related to the one they received. This suggests that food items are easily to find within the R24W and images of portion sizes used in this dietary assessment tool are adequate and can provide valid food intake evaluation

Promoting fruit and vegetable intake in childbearing age women at risk for gestational diabetes mellitus : a randomised controlled trial

This randomised controlled trial verified the efficacy of an implementation intentions intervention (n=24) to promote fruit and vegetable consumption among childbearing age women at risk for gestational diabetes mellitus against a control condition based on the question-behaviour effect (n=26). There was only a significant time effect (F(2,85)=5.69, p=0.0048). Both groups increased their vegetable consumption compared to baseline at 3 months (p=0.0022) and 6 months (p=0.0042). There were no significant effects on weight, waist circumference and blood glucose levels. Implementation intentions and the question-behaviour effect appear to be effective behaviour change techniques to promote vegetable intake among this high-risk population

Effects of a dietary intervention promoting the adoption of a Mediterranean food pattern on fast-food consumption among healthy French-Canadian women

It is expected that a dietary intervention based on the traditional Mediterranean food pattern should be associated with a reduction in fast-food consumption but this has never been tested before. We assessed the impact of a 12-week dietary intervention, promoting the adoption of a Mediterranean food pattern, on fast-food consumption among seventy-one healthy women aged between 30 and 65 years. The dietary intervention consisted of two group sessions and seven individual sessions with a dietitian. To determine the Mediterranean dietary score (MedScore) and fast-food consumption, an FFQ was administered. During the 12-week intervention, the MedScore significantly increased (from 21·1 (SD 3·6) units at baseline to 28·6 (SD 4·4) units at week 12, P,0·0001), while the fast-food consumption significantly decreased (from 51·7 (SD 46·4) g/d at baseline to 20·5 (SD 18·2) g/d at week 12, P,0·0001). Moreover, women who had a higher consumption of fast food at baseline decreased their fast-food consumption to the most (r 20·50, P,0·0001). When four subgroups were formed on the basis of median values of Medscore and fast-food consumption changes, it was found that only the subgroup of women which increased the most their MedScore and decreased the most their fast-food consumption experienced a significant decrease in BMI (P,0·01). In conclusion, a dietary intervention promoting the Mediterranean food pattern led to a decrease in fast-food consumption among healthy women even if it was not a specific target of the intervention. Dietary strategies for increasing intake of healthy foods may be a useful approach for decreasing intake of less healthy foods

Development and validation of the perceived food environment questionnaire in a french-canadian population

Objective: The present study aimed to develop and validate a questionnaire assessing perceived food environment in a French-Canadian population. Design: A questionnaire, the Perceived Food Environment Questionnaire, was developed assessing perceived accessibility to healthy (nine items) and unhealthy foods (three items). A pre-test sample was recruited for a pilot testing of the questionnaire. For the validation study, another sample was recruited and completed the questionnaire twice. Exploratory factor analysis was performed on the items to assess the number of factors (subscales). Cronbach’s a was used to measure internal consistency reliability. Test–retest reliability was assessed with Pearson correlations. Setting: Online survey. Results: Men and women from the Québec City area (n 31 in the pre-test sample; n 150 in the validation study sample). The pilot testing did not lead to any change in the questionnaire. The exploratory factor analysis revealed a two-subscale structure. The first subscale is composed of six items assessing accessibility to healthy foods and the second includes three items related to accessibility to unhealthy foods. Three items were removed from the questionnaire due to low loading on the two subscales. The subscales demonstrated adequate internal consistency (Cronbach’s a=0·77 for healthy foods and 0·62 for unhealthy foods) and test–retest reliability (r=0·59 and 0·60, respectively; both P<0·0001). Conclusions: The Perceived Food Environment Questionnaire was developed for a French-Canadian population and demonstrated good psychometric properties. Further validation is recommended if the questionnaire is to be used in other populations

Carotenoids as biomarkers of fruit and vegetable intake in men and women

High fruit and vegetable (FAV) intake is associated with a lower prevalence of chronic diseases. Identifying the ideal number of FAV servings needed to reduce chronic disease risk is, however, difficult because of biases inherent to common self-report dietary assessment tools. The aim of our study was to examine the associations between daily FAV intake and plasma carotenoid concentrations in men and women enrolled in a series of fully controlled dietary interventions. We compiled and analysed data from a group of 155 men and 109 women who participated in six fully controlled dietary interventions and compared post-intervention fasting plasma carotenoid (a-carotene, ß-carotene, ß-cryptoxanthin, lutein, lycopene, zeaxanthin) concentrations with regard to the daily FAV servings consumed by the participants. We found that plasma ß-cryptoxanthin, lutein and zeaxanthin concentrations were positively associated with daily FAV servings (P=0·005). However, daily FAV intake was negatively associated with plasma a-carotene (P<0·0005) and lycopene (P<0·0001) concentrations, whereas no association was noted with plasma ß-carotene. When men and women were analysed separately, we found that for any given number of FAV servings consumed women had higher circulating lutein concentrations compared with men (P<0·01). Significant sex×FAV (P<0·0001) and sex×dietary ß-cryptoxanthin (P<0·0005) interactions were also noted favouring higher plasma ß-cryptoxanthin concentrations in women than in men for a given FAV consumption. Results from these fully controlled dietary feeding studies indicate that plasma ß-cryptoxanthin and lutein concentrations can be used as robust biomarkers of FAV consumption. They also suggest the existence of sex differences influencing circulating ß-cryptoxanthin and lutein concentrations following FAV consumption

Sex differences in the impact of the Mediterranean diet on cardiovascular risk profile

The traditional Mediterranean diet (MedDiet) is now widely recommended in the prevention of CVD. However, it is not known whether the MedDiet has the same beneficial cardiovascular effects in women and in men. The objective of the present study was to investigate sex-related differences with regard to changes in cardiometabolic variables in response to a 4-week isoenergetic MedDiet. Participants were thirty-eight men and thirty-two premenopausal women aged between 25 and 50 years who had slightly elevated LDL-cholesterol (LDL-C) concentrations (3·4–4·9 mmol/l) or total cholesterol:HDL-cholesterol ratio = 5·0. A 4-week run-in period preceded the MedDiet in order to control the inter- and intra-individual variability. Cardiometabolic variables were measured before and after the MedDiet. Total cholesterol, LDL-C, apoB and apoA-1 plasma concentrations as well as diastolic blood pressure decreased (P < 0·05) in both men and women (respectively, 10, 10, 10, 6 and 5 % for men and 6, 7, 9, 4 and 4 % for women). ApoA-2 concentrations and insulin concentrations 2 h after the oral administration of 75 g of glucose demonstrated sex × time interactions (respectively, P = 0·05 and P = 0·03) and only men experienced a decrease for these variables (respectively, 8 and 25 %). In conclusion, consuming a MedDiet led to significant changes in plasma lipid profile in both men and women, while only men had significant improvements in insulin homeostasis. These results support the importance of investigating sex-related differences in response to diet in order to perhaps further individualise dietary guidelines in the prevention of CVD and type 2 diabetes

Sex differences in the impact of the Mediterranean diet on LDL particle size distribution and oxidation

Sex differences have been previously highlighted in the cardioprotective effects of the Mediterranean diet (MedDiet). The objective of this study was to investigate whether sex differences also exist with regard to LDL particle size distribution and oxidation. Participants were 37 men and 32 premenopausal women (24–53 years) with slightly elevated LDL-C concentrations (3.4–4.9 mmol/L) or total cholesterol/HDL-C =5.0. Variables were measured before and after a four-week isoenergetic MedDiet. Sex differences were found in response to the MedDiet for the proportion of medium LDL (255–260 Å) (p for sex-by-time interaction = 0.01) and small, dense LDL (sdLDL; <255 Å) (trend; p for sex-by-time interaction = 0.06), men experiencing an increase in the proportion of medium LDL with a concomitant reduction in the proportion of sdLDL, while an opposite trend was observed in women. A sex difference was also noted for estimated cholesterol concentrations among sdLDL (p for sex-by-time interaction = 0.03), with only men experiencing a reduction in response to the MedDiet. The MedDiet marginally reduced oxidized LDL (oxLDL) concentrations (p = 0.07), with no sex difference. Results suggest that short-termconsumption of the MedDiet leads to a favorable redistribution of LDL subclasses from smaller to larger LDL only in men. These results highlight the importance of considering sex issues in cardiovascular benefits of the MedDie

Sex differences in the impact of the Mediterranean diet on systemic inflammation

Background: Some intervention trials have reported a reduction in systemic inflammation with the Mediterranean diet (MedDiet) while others have observed no effect. Despite the fact that sex differences have been highlighted in the inflammatory regulation, it is still not known whether MedDiet exerts similar effects on systemic inflammation in men and women. The aim of this study was therefore to investigate sex differences in the effects of the MedDiet on high-sensitivity C-reactive protein (hs-CRP). Findings: Participants were 35 men and 27 premenopausal women (24–53 years) presenting a slightly deteriorated lipid profile. All foods were provided to participants during a 4-week isocaloric MedDiet. At baseline, women had higher hs-CRP concentrations than men (P¿=¿0.03). No sex difference was observed in hs-CRP response to the MedDiet (P for sex-by-time interaction¿=¿0.36), with both men and women experiencing no change (respectively P¿=¿0.62 and P¿>¿0.99). When subgroups were formed according to hs-CRP concentration before the MedDiet phase, men with elevated baseline values (=2 mg/l) experienced a reduction in hs-CRP over time with the MedDiet (-26.5 %) while an increase was observed in men with lower baseline values (+96.6 %; P for group-by-time interaction¿=¿0.02). This pattern of change was not observed in women. Conclusions: Results from this controlled feeding study suggest that men and women have similar effects from the MedDiet on systemic inflammation. The individual’s overall inflammatory status seems to influence these effects, but only in men