Dissertations / Theses on the topic 'Mediterranean diet'

This thesis engages with the problem of valuing the Intangible Cultural Heritage (ICH) of the Mediterranean Diet (MD), into the overall context of its progressive erosion due to general decline in adherence to the Mediterranean dietary pattern by Mediterranean people, especially young generations. This work is also engaged with the problem of what it may be done to preserve, safeguard and revitalize the ICH of the MD. In this context, with the double specific objective to calculate economic value of the Mediterranean Diet - Intangible Cultural Heritage and to define the specific determinants of respondents WTP for MD heritage and, consequently, for preserving it, a contingent valuation (CV) survey was conducted between July and October 2016, using nationwide internet-based interviews on a sample of 897 Italian respondents. To this scope, ICH of MD was declined in a prototypical project, which factoring the most affective elements of the intangible cultural heritage of the Mediterranean diet into a tangible product related with cultural as well as tourism sector: the “Mediterranean Diet District”. It was designed to let people, physically and actively, “experience” the ICH of the MD, making explicit and tangible its use value. The results of this study provide quantitative information and important insights for both policymaking and research.

Ketogenic diets (KDs) are diets in which the net carbohydrate intake, calculated by subtracting fibres from total carbohydrates, is between 20 and 50 g/day (<10% of total energy intake) with a variable proportion of proteins and fats (Noakes, Windt 2017). In these conditions, glycogen stores are depleted (Paoli, Canato et al. 2011), insulin level is low and energy metabolism is mainly dependent from fat oxidation. KDs lead a significant increase in circulating levels of ketone bodies (KBs) β-hydroxybutyrate (βOHB), acetoacetate (AcAc) and acetone (Veldhorst, Westerterp et al. 2010). While AcAc and βOHB are used as energy, acetone is a volatile compound and is eliminated through expiration, giving the “sweet” breath odour typical of ketosis, or via renal excretion (Paoli, Canato et al. 2011). The concentration of KBs in the blood of healthy individuals during the carbohydrate fed state is about 0.1 mmol/L and increases to about 0.3 mmol/L after an overnight fast, but after prolonged fasting up to 20 days KBs can increase to more than 10 mmol/L. A diet is considered “ketogenic” when produces a stable increase in the level of βOHB higher than 0.6 mmol/L (Wiggam, O'Kane et al. 1997) or when the molar ratio of blood glucose to blood ketone body βOHB is less than or equal to 1 (Meidenbauer, Mukherjee et al. 2015). Since KBs AcAc and βOHB are acids, the ketosis state implies a condition of acidosis. Given the fact that the pH of the blood is 7.4 and that the pKa of AcAc is 3.8 and that of βOHB is 4.8, these acids circulate in the blood in a completely dissociated form and are eliminated together with sodium and potassium ions (Siliprandi & Tettamanti 2011). This loss of cations implies a decrease of pH, which is normally balanced from the body apart when potassium and sodium intake are impaired (Phinney 2004) or in pathological overproduction of KBs during untreated diabetes type 1 which leads to diabetic ketoacidosis, characterized by a KBs level higher than 20 mmol/L with a decrease of pH. Biochemistry Hans Krebs was the first who diversified physiologic from pathologic ketosis (Krebs 1966). For skeletal and cardiac muscle, which usually oxidize fats, the use of KBs is a relative advantage, while for the central nervous system, in which the entrance of fatty acids is prevented from the blood-brain-barrier (BBB), the availability of KBs is an important surrogate of glucose, which is the habitual substrate of nervous tissue. During starvation, under a ketogenic diet or in new-born infants, the brain can utilize KBs as primary fuel instead of glucose (Laeger, Metges et al. 2010) in proportion to the degree of ketosis (Hartman, Gasior et al.). βOHB is the most abundant circulating ketone body and its transport across the blood-brain barrier is mediated both by diffusion and by several monocarboxylic acid transporters as MCT1 and MCT2, the former being upregulated during a ketogenic diet (Newman, Verdin 2014). This complementary action between the liver, which produces KBs in periods of shortage of carbs, and the CNS which use them, it’s a very important event which was determinant for the survival of the human species over the millennia. My research focused on three important aspects of KDs and weight loss, which needed further investigation: 1. long-term successful weight loss after a KD: the maintenance of weight loss over long time is challenging and the fear of weight regain is common, so that this phenomenon is named “yo-yo” effect. In this regard, low-carbohydrate diets are known to bring better results compared to low-fat diets in terms of weight loss (Shai, Schwarzfuchs et al. 2008) but not of compliance (Greenberg, Stampfer et al. 2009). Recently, Sumithran and colleagues have demonstrated that the increase in circulating ghrelin and in subjective appetite, which accompanied a hypocaloric diet, was reduced with a ketogenic approach (Sumithran, Prendergast et al. 2013). Thus, we hypothesized that certain aspects of the KD such as muscle mass retention, RMR (resting metabolic rate) and orexigenic hormone stability combined with the acknowledged health benefits of traditional Mediterranean nutrition may favour long-term weight loss. The aim of our study was to investigate the effect on weight and body composition of two short periods of a modified KD, i.e., a very low carbohydrate ketogenic diet with phytoextracts (KEMEPHY) (Paoli, Cenci et al. 2010, Paoli 2011, Paoli 2012) interspersed between longer periods of maintenance nutrition, based on the traditional Mediterranean diet, over a total period of 12 months in obese/overweight healthy subjects and was designed as a retrospective study. We analysed 89 male and female subjects, aged between 25 and 65 years who were overall healthy apart from being obese (mean BMI 35.82 ± 4.11 kg/m2). Data from this study demonstrate that the majority of subjects showed significant weight loss (10%) as a result of a two-phase KD and were compliant both during the six month weight loss phase and the six month normocaloric maintenance phase, with no weight regain. Moreover, the proposed protocol led improvements in health risk factors (total cholesterol, LDL cholesterol, triglycerides and glucose levels) in the majority of subjects. Compliance was very high which was a key determinant of the results seen; 2. formulation of new low-carbohydrate ultraprocessed foods to overcome the lack of sweet taste during a KD: a point of interest, which has always been a detrimental aspect of KDs, is the lack of sweet taste, which could be difficult to sustain for long periods, especially for people with a high sweet food preference. During consumption of a KD, it is mandatory to maintain a low level of glycaemia (about 80–90 mg/dL) to avoid insulin spikes (Paoli, Canato et al. 2011). This condition allows subjects to improve their fat oxidation as demonstrated by Paoli et al. (Paoli, Grimaldi et al. 2012) and by Tagliabue et al. (Tagliabue, Bertoli et al. 2012). Today the new food technology, which is able to build ultra-processed products very low in sugar content and high in protein and fibres, can help to solve this problem, formulating products with a high palatability and ready-to-consume format, useful both in ketosis and in easier low carb diets. Usually, ultra-processed products lack in proteins and fibres and produce postprandial glucose and insulin spikes (PAHO WHO 2015). This effect is known to elicit food craving and overeating, with a preference for high-glycaemic index carbohydrates (high-GI CHO) (Lennerz, Alsop et al. 2013), a phenomenon defined as CHO-craving effect (Ventura, Santander et al. 2014). In order to analyse the effect of 10 different high-protein low-CHO proprietary foods on glycaemia, we recruited 14 healthy females, which were tested for their glycaemic response through the glycaemic score (GS) method. All test foods, compared with glucose, produced a significantly lower glycaemic response and their GS resulted lower than 25 (compared to the reference GS value of glucose which is 100). We concluded that the reformulation of ultraprocessed ready-to-consume foods in a low-CHO, high-protein version can produce a significantly lower glycaemic response whilst maintaining the valued ready-to-use format and high palatability demanded by consumers, facilitating the adherence to a KD of individuals who tend to have a high preference for sweet foods; 3. effect of KDs on cognitive functions: the range of variation of glucose and ketone bodies (KBs) in the blood of non-diabetic individuals is wide and both of them can be used as energy from the brain. Data on glycaemia and ketonemia effects on cognitive functions on healthy humans following different diets are scarce. The purpose of this study was then to compare the effects of glycaemia and ketonemia variation after ten days of two different ketogenic diets and a calorie-restricted Mediterranean diet (MD) on working memory and executive functions in 63 sedentary healthy overweight (BMI>25) young women (age: 20-35), which were recruited in the university area. Subjects were divided in groups according to the day of the beginning of their follicular phase in order to minimize hormonal effects on mood and came for the basal measurements five days before the start of the dietary protocol. The following controls were set on the starting day of the diet (t1), on the third (t3), on the fifth (t5), on the seventh (t7) and on the last day (t10). On the basal control day, the weight of the subjects was measured and a body impedance analysis was performed. Subjects took a standard high carb breakfast and afterwards they completed the psychological tests. At t1, t3, t5, t7 and t10 ketone bodies levels and glycaemia were measured, as well as appetite levels. On the last control day (t10) subjects repeated the body impedance analysis, the body weight measure and, after breakfast (each group had a different breakfast according to the prescribed diet), the psychological tests. Psychological tests consisted in a mood test, two cognitive tasks, one to investigate working memory (visuo-spatial n back) and the second to stress executive functions (inhibitory control task) and in a VAS scale to test the appetite level. 45 subjects completed the study. Considering all participants together, pre-diet glucose levels were positively correlated with reaction time in the go-trial of the executive function test (r(43) = 0.358, p = 0.018), but this relation was not found in the post-diet measure both when subjects were analysed all together and when subjects were divided according to the type of diet followed. In the same psychological test, in the post-diet measure ketonemia showed a negative correlation with accuracy of the no-go trials (r(29) = -0.455, p = 0.027). We can conclude that healthy young overweight subjects with fasting glycaemia below prediabetes level were negatively affected by a high-carb breakfast during an executive function test. Moreover, the effect of mild KBs levels (2 ± 1.3 mmol/L) negatively affected accuracy of the no-go trials of the executive functions test.
Le diete chetogeniche sono diete in cui l’introito netto di carboidrati, calcolato sottraendo la quantità di fibre dai carboidrati totali, è tra 20 e 50 g/gg (<10% dell’apporto energetico totale) con una proporzione variabile di proteine e grassi (Noakes, Windt 2017). In queste condizioni le riserve di glicogeno sono esaurite (Paoli, Canato et al. 2011), il livello di insulina è basso e il metabolismo energetico dipende prevalentemente dall’ossidazione dei grassi. Le diete chetogeniche portano un aumento significativo dei livelli circolanti dei corpi chetonici β-idrossibutirrato, acetoacetato e acetone (Veldhorst, Westerterp et al. 2010). Mentre sia l’acetoacetato che il β-idrossibutirrato vengono utilizzati come energia, l’acetone è volatile ed è eliminato attraverso l’espirazione, dando all’alito quella nota “fruttata” tipica della chetosi, oppure attraverso i reni (Paoli, Canato et al. 2011). La concentrazione ematica dei corpi chetonici in individui sani che seguono una dieta costituita prevalentemente da carboidrati è 0,1 mmol/L e può salire fino a 0,3 mmol/L dopo il digiuno notturno, ma dopo venti giorni di digiuno il livello di corpi chetonici può salire oltre 10 mmol/L. Una dieta è considerata “chetogenica” quando produce un aumento del livello di β-idrossibutirrato superiore a 0,6 mmol/L (Wiggam, O'Kane et al. 1997) oppure se il rapporto molare tra il glucosio e il β-idrossibutirrato ematici è uguale o minore di 1 (Meidenbauer, Mukherjee et al. 2015). Dato che i chetoni acetoacetato e β-idrossibutirrato sono acidi, lo stato di chetosi implica una condizione di acidosi. Siccome il pH del sangue è 7,4 e la pKa dell’acetoacetato è 3,8 e quella del β-idrossibutirrato è 4,8, questi acidi circolano nel sangue in forma dissociata e sono eliminati insieme agli ioni sodio e potassio (Siliprandi & Tettamanti 2011) . Questa perdita di cationi porta una diminuzione del pH che viene normalmente tamponata dal corpo tranne quando l’assunzione di sodio e potassio è impedita (Phinney 2004) oppure in caso di diabete scompensato, quando c’è una sovrapproduzione di corpi chetonici con livelli superiori a 20 mmol/L e conseguente riduzione del pH. Il biochimico Hans Krebs fu il primo a distinguere la chetosi fisiologica da quella patologica (Krebs 1966). Per i muscoli scheletrici e cardiaco, che utilizzano normalmente i grassi, l’utilizzo dei corpi chetonici a scopo energetico è un vantaggio relativo, mentre per il sistema nervoso centrale, in cui l’accesso degli acidi grassi è impedito dalla barriera ematoencefalica, la disponibilità dei corpi chetonici è un importante surrogato del glucosio, che è il substrato abituale dei neuroni. Durante il digiuno, in dieta chetogenica e nei neonati, il cervello utilizza i corpi chetonici come combustibili principali al posto del glucosio (Laeger, Metges et al. 2010), proporzionalmente al grado di chetosi (Hartman, Gasior et al.). Il β-idrossibutirrato è il principale corpo chetonico circolante e il suo trasporto attraverso la barriera ematoencefalica avviene sia mediante diffusione che attraverso i trasportatori MCT1 e MCT2, dei quali i primi aumentano durante una dieta chetogenica (Newman, Verdin 2014). Quest’azione complementare tra il fegato, che produce i corpi chetonici in assenza di carboidrati, e il sistema nervoso centrale che li può utilizzare, è un evento molto importante che fu determinante per la sopravvivenza della specie umana nei millenni. La mia ricerca si è focalizzata su tre importanti aspetti delle diete chetogeniche - connesse alla perdita di peso - che richiedevano di essere approfonditi: 1. il mantenimento del peso perso dopo una dieta chetogenica: il mantenimento del peso perso a lungo nel tempo è impegnativo e la paura di ritornare velocemente al peso iniziale è comune, tanto che questo fenomeno viene chiamato “effetto yo-yo". A questo proposito, le diete a basso contenuto di carboidrati sono note per portare risultati migliori rispetto alle diete a basso contenuto di grassi in termini di perdita di peso (Shai, Schwarzfuchs et al. 2008c), ma non di “compliance” (adesione al protocollo) (Greenberg, Stampfer et al. 2009). Recentemente, Sumithran e collaboratori hanno dimostrato che l'aumento dei livelli circolanti di grelina e del livello di appetito tipici di una dieta ipocalorica erano minori durante un protocollo chetogenico (Sumithran, Prendergast et al. 2013). Abbiamo quindi ipotizzato che alcuni aspetti della dieta chetogenica come il mantenimento della massa muscolare, del metabolismo energetico basale e la stabilità del principale ormone oressigenico (grelina) combinati con gli effetti benefici della nutrizione tradizionale mediterranea, potessero favorire la perdita di peso a lungo nel tempo. Lo scopo del nostro studio è stato quindi quello di indagare l'effetto sul peso e sulla composizione corporea di due brevi periodi di una dieta chetogenica modificata, cioè una dieta fitochetogenica mediterranea (KEMEPHY) (Paoli, Cenci et al. 2010a, Paoli 2011, Paoli 2012) intervallata da 2 periodi più lunghi di dieta di mantenimento basata sulla dieta mediterranea tradizionale per un periodo totale di 12 mesi. I soggetti reclutati erano obesi o in sovrappeso e lo studio è stato retrospettivo. Abbiamo analizzato 89 soggetti (uomini e donne) di età compresa tra i 25 e i 65 anni che erano in uno stato di buona salute generale benchè fossero obesi (IMC medio 35.82 ± 4.11 kg/m2). I risultati di questo studio hanno dimostrato che la maggioranza dei soggetti ha ottenuto una significativa perdita di peso (10%) a seguito delle due fasi di dieta chetogenica e l’aderenza al protocollo è stata alta sia durante i sei mesi di perdita di peso sia nei successivi sei mesi di mantenimento, senza riacquisto del peso. Inoltre, il protocollo proposto ha portato miglioramenti nella maggior parte dei soggetti dei livelli di parametri importanti per la salute (colesterolo totale, colesterolo LDL, trigliceridi e livelli di glucosio). L’alta “compliance” è stato un fattore determinante per i risultati ottenuti; 2. la formulazione di nuovi prodotti a basso contenuto di carboidrati per sopperire alla mancanza del sapore dolce durante una dieta chetogenica: un aspetto delle diete chetogeniche difficile da tollerare nel lungo tempo, soprattutto per chi ha una spiccata preferenza per i dolci, è la mancanza di questo sapore. In dieta chetogenica è necessario mantenere un basso livello di glicemia (circa 80-90 mg/dL) per evitare i picchi di insulina (Paoli, Canato et al. 2011) e permettere così ai soggetti di migliorare l'ossidazione dei grassi come dimostrato da Paoli et al. (Paoli, Grimaldi et al. 2012) e da Tagliabue et al. (Tagliabue, Bertoli et al. 2012). Oggi la nuova tecnologia alimentare, che è in grado di costruire prodotti ultra-processati con un contenuto di zucchero molto basso e un alto contenuto di proteine e fibre, può aiutare a risolvere questo problema, formulando prodotti di elevata appetibilità in un formato pronto per il consumo, utili sia in chetosi che in diete ipoglucidiche più moderate. Di solito i prodotti ultra-processati mancano di proteine e fibre e producono picchi post-prandiali di glucosio e insulina (OPS WHO 2015) . Questo effetto provoca un forte desiderio di cibo con una preferenza per i carboidrati ad alto indice glicemico (Lennerz, Alsop et al. 2013), fenomeno definito come "carb-craving" (Ventura, Santander et al. 2014). Al fine di analizzare l'effetto di 10 diversi alimenti ultra-processati ad alto contenuto proteico e basso contento di carboidrati sulla glicemia, abbiamo reclutato 14 donne sane e abbiamo testato la loro risposta glicemica attraverso il metodo del punteggio glicemico (“glucose-score”, GS). Tutti gli alimenti testati hanno prodotto, rispetto al glucosio, una risposta glicemica significativamente inferiore e il loro GS è risultato inferiore a 25 (rispetto al valore di riferimento del GS del glucosio che è 100). Abbiamo quindi concluso che la riformulazione di prodotti ultra-processati pronti al consumo in una versione ad alto contenuto proteico e basso contenuto di carboidrati è in grado di produrre una risposta glicemica significativamente più bassa, pur mantenendo l'alto valore del pratico formato pronto per l'uso e l'alta appetibilità richiesta dai consumatori, facilitando quindi l'adesione a una dieta chetogenica di individui che tendono ad avere una forte preferenza per i cibi dolci; 3. l’effetto delle diete chetogeniche sulle funzioni cognitive: il range di variazione della glicemia o dei corpi chetonici nel sangue di soggetti non diabetici è ampia e ciascuno di essi può essere utilizzato come energia dal cervello. I dati sugli effetti della variazione dei livelli di glicemia e chetonemia sulle funzioni cognitive di esseri umani sani dopo diversi tipi di dieta sono scarsi. Lo scopo di questo studio è stato confrontare gli effetti della variazione di glicemia e chetonemia dopo dieci giorni di due differenti diete chetogeniche e di una dieta mediterranea ipocalorica (MD) sulla memoria di lavoro e sulle funzioni esecutive in 63 giovani donne sovrappeso, sedentarie e in buona salute (IMC> 25, età: 20-35) che sono state reclutate nella zona universitaria. I soggetti sono stati divisi in gruppi in base al giorno di inizio della loro fase follicolare per minimizzare gli effetti ormonali sull'umore e le misurazioni basali sono state effettuate cinque giorni prima dell'inizio del protocollo dietetico. I seguenti controlli sono stati fissati al giorno di inizio della dieta (t1), al terzo (t3), al quinto (t5), al settimo (t7) e all'ultimo giorno (t10). Al controllo iniziale è stato misurato il peso dei soggetti ed è stata eseguita un'analisi impedenziometrica. I soggetti hanno poi assunto una colazione ad alto contenuto di carboidrati e hanno completato i test psicologici. Al t1, T3, T5, T7 e t10 sono stati misurati il livello dei corpi chetonici e la glicemia, così come i livelli di appetito. Nel giorno dell'ultimo controllo (T10) i soggetti hanno ripetuto l'analisi impedenziometrica, la misura del peso corporeo e, dopo la colazione (ogni gruppo ha assunto una colazione diversa a seconda della dieta prescritta), hanno completato i test psicologici. I test psicologici consistevano in un test sull'umore, due compiti cognitivi, uno per indagare la memoria di lavoro (“visuo-spatial n back”) e uno per analizzare le funzioni esecutive (“inhibitory control task”) e in una scala VAS per testare il livello di appetito. 45 soggetti hanno completato lo studio. Considerando tutti i partecipanti insieme, i livelli di glucosio pre-dieta correlavano positivamente con il tempo di reazione nel “go-trial” del test delle funzioni esecutive (r(43) = 0,358, p = 0,018), ma questa relazione non è stata trovata nel post-dieta, sia quando i soggetti sono stati analizzati tutti insieme che quando i soggetti sono stati divisi in base al tipo di dieta seguita. Nello stesso test psicologico, nel post-dieta la misura della chetonemia ha mostrato una correlazione negativa con l'accuratezza ai compiti “no-go” (r(29) = -0,455, p = 0,027). Possiamo quindi concludere che giovani soggetti in sovrappeso con livelli di glicemia inferiori al livello di pre-diabete sono stati influenzati negativamente da una colazione ad alto contenuto di carboidrati nel corso di un test di funzioni esecutive. Inoltre, l'effetto di moderati livelli di corpi chetonici (2 ± 1,3 mmol / L) ha nfluenzato negativamente l'accuratezza nelle prove “no-go” del test sulle funzioni esecutive.

The United Kingdom is experiencing an ageing population. Currently one sixth of the UK’s population is aged over 65 years and this is estimated to rise to one quarter by 2050. There is considerable inter-individual variation in human lifespan and much of this variation appears to be due to non-genetic factors, including lifestyle. Both observational and intervention studies indicate that adherence to a Mediterranean dietary pattern is associated with increased lifespan and reduced risk of age-related disease. The LiveWell Programme was established to develop and pilot lifestyle-based interventions (including promoting a Mediterranean diet) to enhance healthy ageing, which could be delivered to individuals in the retirement transition. The aim of this PhD was to test age-appropriate dietary assessment methods suitable for measuring change in adherence to a Mediterranean diet, as a consequence of lifestyle-based interventions. Six different approaches for estimating Mediterranean diet scores (MDS) were applied to dietary data from the Mediterranean Diet in Northern Ireland (MEDDINI) intervention study. Based on the number of assumptions and modifications that were made to calculate the scores, the percentage change in diet between intervention groups and the coefficient of variation from baseline to follow up, the relative Mediterranean diet score (rMED) was identified as the most suitable score for testing the efficacy of intervention studies in a UK context. The next stage of the work was to investigate the utility of INTAKE24, an online 24 hour recall, as a method for assessing the diet of retirement-age adults. INTAKE24 is a self-completed dietary assessment tool which was developed originally for use with young people. This was the first time that this tool was used with older people and so it was essential to undertake user-testing and estimation of relative validation. The system usability was rated as above average by the majority of users. Of the food items recorded in INTAKE24, 87% of the foods recorded during user-testing and 84% of the food items recorded during relative validation, either exactly or approximately matched foods iii recorded in a comparable interviewer-led 24 hour recall. No significant differences in nutrient intakes or adherence to the Mediterranean diet (assessed by the rMED) were found between the two dietary assessment methods for either the user-testing or the relative validation study. In conclusion, INTAKE24 was well-received and assessed the diets of older adults well when compared with a conventional approach. However, further modifications of INTAKE24 (detailed within my thesis) would improve the usability and accuracy of the system for future studies involving older adults. In addition, the rMED method of scoring adherence to the Mediterranean dietary pattern is compatible with data collected using INTAKE24 and appears suitable for use in future dietary intervention studies with adults in the retirement transition.

The Mediterranean diet (Medi) has been highlighted as the golden diet rich in protective properties associated with cognitive- and emotional health. The foundation of the Medi comprises vegetables, fruits, nuts and seeds, legumes, and extra virgin olive oil. Research has been conducted in both holistic dietary approach and single nutrient approach regarding the impact of nutrition and diet, in this case, the Medi‟s effect on brain health. This review aims to give an up to date overview of the Mediterranean diet, outline some of the diet's abundant nutrients, and discuss studies linking the nutrient's potential effect on depression, cognitive decline, dementia, and brain structure and function. In addition, this review will attempt to assess whether the Medi as a whole or if a single nutrient approach is accountable for the health-promoting findings. Furthermore, the gut-brain axis, and other potential underlying mechanisms involved in the modulation of food- and nutrient intake and their effects on the brain, will be outlined. A diet high in fruit-, vegetable-, polyunsaturated fatty acid-, and monounsaturated fatty acid content has great power for health-maintenance and decreases the risk of suffering cognitive decline, dementia, and potentially depression. More randomized controlled trials are however eagerly awaited to give more substance to previous findings.

This thesis aimed to assess the feasibility of peer support (PS) for encouraging adoption and maintenance of a Mediterranean diet (MD) in a Northern European population at high CVD risk. It consists of (i) a systematic review of the effect of PS in encouraging dietary change in adults; (ii) qualitative analysis of barriers to a MD in a Northern European population; (iii) validation of a Mediterranean diet score (MDS) to assess MD adherence in a Northern European population and (iv) development and interim-analysis of a pilot RCT to assess the effectiveness of PS for encouraging MD adoption and maintenance in a Northern European population at high CVD risk (TEAM-MED study). The systematic review found that more studies reported a positive effect of PS or mixed results, than studies that did not find an effect of PS for achieving dietary change. However, as evidence was mixed, the effect of PS in encouraging dietary change in adults is not clear and further information is needed. Individuals at high risk of CVD from a Northern European population showed preference towards a group based PS model which was developed for assessment in the TEAM-MED study. Qualitative research among this population indicated a limited knowledge of, and a number of barriers towards consuming a MD which were addressed in the development of the TEAM-MED study. Validation of the TEAM-MED study MDS deemed this to be a reliable tool for assessing MD adherence among Northern European populations. The TEAM-MED study interim-analysis demonstrated that there was no significant difference in MD adherence between the PS, minimal and proven intensive intervention groups. Full analysis of the TEAM-MED study will confirm these results. While evidence is not yet clear, PS has the potential to encourage dietary change towards a MD in Northern European populations.

A 6-month intervention study with a quasi-experimental design and a 3-month follow-up was conducted to evaluate the effectiveness of an Internet-based, step-wise, tailored-feedback intervention promoting four key components of the Mediterranean diet (vegetables, fruits, nuts and seeds, legumes and ratio of monounsaturated to saturated fat). Fifty-three (intervention group) and nineteen (control group) healthy females, aged 25-55 years, were recruited from the Universities of Glasgow and Glasgow Caledonian, Scotland, respectively. Participants in the intervention group received tailored dietary and psychosocial feedback and Internet nutrition education over a 6-month period, while participants in the control group were provided with minimally-tailored dietary feedback and general healthy-eating brochures. Internet education was provided via an innovative Mediterranean Eating website. Between group comparisons carried out on an "intention-to-treat" basis, providing the strongest evidence of the effect of the intervention, showed that participants in the intervention group had made more favourable changes to their fruit, nut and seed intake over the 6-month intervention, as well as increased their vegetable intake over the 9-month trial. Over both the 6-month intervention and 9-month trial, participants in the intervention group had more favourable levels of HDL-cholesterol and ration of total:HDL-cholesterol, a higher proportion progressed through the stages of behavioural change regarding legumes and olive intake and self-efficacy skills were generally increased, compared with the control group. Participants in the control group however, showed more favourable urinary electrolyte levels throughout the study. Within group comparisons showed that at 6 months, participants in the intervention group had significantly increased their intake of vegetables, fruits, legumes, as well as the MUFA:SFA ratio in their diet, had increased their mean total MDS and had significantly increased plasma HDL-cholesterol levels and a reduced ratio of total:HDL-cholesterol, as well as higher nutrition knowledge scores compared with baseline. In addition, a higher percentage of participants in this group were in the action and maintenance stage of behavioural change for vegetables, legumes and olive oil consumption, as well as generally showing more favourable attitudes and self-efficacy skills towards consumption of most of the food components promoted by the study at 6 months. These changes were generally maintained at 9 months, when additional decreases in blood pressure and an increase in total cholesterol, compared with baseline, were reported. Participants in the control group increased their intake of legumes, as well as their mean total MDS, and had significantly reduced urinary sodium levels at 6 months, compared with baseline. In addition, a higher efficacy skills generally decreased, compared with baseline. These changes were not maintained at 9 months, but at this time point participants in this group had a higher nutrition knowledge score, compared with baseline.

[eng] Introduction: The Mediterranean diet was proved to be beneficial in the prevention and prognosis of chronic diseases. Older adults are the age group with the highest incidence of chronic disease. The study was conducted in Spain and Lebanon. Research content: In Mallorca, the nutritional content of the food consumed by 211 older adults was researched using two non-consecutive recall diets. The mean daily intake of polyphenols was 332.7 mg/d. Polyphenol intake was highest among alcohol drinkers, high educational level, high income, and physically active people Flavonoids were the highest ingested polyphenols. Alcoholic beverages were the major contributors to the total polyphenol intake, mainly red wine. Mean daily intake of lipids was 68.6 g/day. Sex, age and educational level influenced fat intake. MUFA was the highest ingested fatty acid, and “oils & seeds” was the food group with highest contribution to lipid intake; both were in accordance with the Mediterranean diet pattern. However, the fatty acid intake did not abide by the recommendations in Mediterranean older adults. Calcium, copper, magnesium and iron were consumed in quantities lower than DRI. Female sex and an income ≥900euros were associated respectively with an increased and decreased probability of compliance with the DRI on a 5points scale. The intake of minerals should be adjusted to abide by the recommendations. Along with the nutritional content of food, the correlation between age, body composition and biomarker variables on one hand and the physical fitness variables on the other hand were researched. Many physical fitness measurement variables correlated negatively with predictors of cardiovascular disease. Physical fitness might be essential in healthy aging. Overall, 36.8%, 24.5% and 0.3% of participants had low maximum 8-f TUG score, low maximum HGS and sarcopenia, respectively. Prevalence of these low values varies according to sociodemographic and body composition variables. In Lebanon, adherence to Mediterranean diet was assessed in 525 university students and 125 older adults using MEDAS. Among university students, the mean Mediterranean score estimated was 7.96. Men had a slightly higher adherence to the Mediterranean diet than women. Nonsmokers had higher score than those who smoke. 59.05% of the sample had a score lower than adequate adherence but this did not affect their will to participate in research to ameliorate their health. 0.7% of the willingness to change diet depended on the score of adherence to Mediterranean diet and 28.58% of the participants were primarily worried about their health. Stratification of the questionnaire revealed a relatively high spread of olive oil usage in cooking (86.3%) although only 50.3% consume more than 4 teaspoons per day. The percentage of participants consuming food according to the Mediterranean diet standards was higher than 50% except for wine and fish. Positive correlations were found between the different components of MEDAS, in addition the percentage of participants who had an adequate score was higher in non-smokers. Among older adults, mean Mediterranean score estimated was 8.48. Men had a slightly higher adherence to the Mediterranean diet than women. Those who work had a higher adherence to Mediterranean diet than those who don’t. 52% of the sample had a higher score than adequate adherence and the highest percentage of participants who had adequate score were primarily worried about their health and were willing to engage in physical activity, diet and research for a better health. The percentage of participants consuming food according to the Mediterranean diet standards was higher than 50% except for wine and fish. Conclusion: More studies must be conducted to compare between Lebanon and Spain and develop strategies to increase adherence to Mediterranean diet in Lebanon for a better health.
[spa] Introducción: Se ha demostrado que la dieta mediterránea es beneficiosa para la prevención y el pronóstico de las enfermedades crónicas. Los adultos mayores son el grupo de edad con mayor incidencia de enfermedades crónicas. Este estudio se realizó en España y Líbano. Contenido de la investigación: En Mallorca, la composición nutricional de los alimentos consumidos por 211 adultos mayores se investigó utilizando dos recordatorios de 24h en días no consecutivos. La ingesta diaria media de polifenoles fué de 332.7 mg/d. La ingesta de polifenoles fué más alta entre los bebedores de alcohol, alto nivel educativo, altos ingresos y personas físicamente activas. Los flavonoides fueron los polifenoles que se ingirieron en más cantidad. Las bebidas alcohólicas fueron las principales contribuyentes a la ingesta total de polifenoles, principalmente el vino tinto. La ingesta diaria media de lípidos fué de 68.6 g/día. El sexo, la edad y el nivel educativo influyeron en la ingesta de grasas. MUFA fueron el tipo de ácido graso más altamente ingerido, y "aceites y semillas" fué el grupo de alimentos con mayor contribución a la ingesta de lípidos. La ingesta de ácidos grasos no cumplió con las recomendaciones en adultos mayores. El calcio, el cobre, el magnesio y el hierro se consumieron en cantidades inferiores a las IDR. La ingesta de minerales debe ajustarse para cumplir con las recomendaciones. Muchas variables de medición de la aptitud física se correlacionaron negativamente con los predictores de enfermedad cardiovascular. La aptitud física podría ser esencial para un envejecimiento saludable. Se evaluó la condición física y su asociación con los hábitos sociodemográficos, la composición corporal y el estilo de vida. 36.8%, el 24.5% y el 0.3% de los participantes tenían una puntuación TUG máxima inferior a 8-f, un HGS máximo bajo y sarcopenia, respectivamente. En Líbano, se evaluó la adherencia a la dieta mediterránea en 525 estudiantes universitarios y en 125 adultos mayores usando el MEDAS. Entre los estudiantes universitarios, la puntuación media estimada de adherencia a la dieta mediterránea fué 7.96. Los hombres tuvieron una adherencia ligeramente mayor a la dieta mediterránea que las mujeres. Los no fumadores tenían una puntuación más alta que aquellos que fuman. El 59,05% de la muestra tenía una puntuación inferior a la adecuada. El 0.7% de la voluntad de cambiar la dieta dependía del grado de adherencia a la dieta mediterránea y el 28.58% de los participantes estaban preocupados principalmente por su salud. La estratificación del cuestionario reveló una difusión relativamente alta del uso de aceite de oliva en la cocina, aunque solo el 50.3% consumía más de 4 cucharaditas por día. El porcentaje de participantes que consumían alimentos de acuerdo con los estándares de la dieta mediterránea era superior al 50% a excepción del vino y el pescado. Se encontraron correlaciones positivas entre los diferentes componentes de MEDAS. Entre los adultos mayores, la puntuación promedio estimada de adherencia a una dieta mediterránea fué de 8.48. Los hombres tenían una adherencia ligeramente mayor a la dieta mediterránea que las mujeres. El 52% de la muestra tenía una puntuación en adherencia superior a la adecuada y la mayor parte de participantes que tenían una puntuación adecuada estaban preocupados principalmente por su salud y estaban dispuestos a participar en intervención para mejorar la salud. El porcentaje de participantes que consumían alimentos de acuerdo con los estándares de la dieta mediterránea fué superior al 50% a excepción del vino y el pescado. Conclusión: Se deben realizar más estudios en el futuro para comparar Líbano y España, así como desarrollar estrategias para aumentar la adherencia a un patrón de dieta mediterránea en Líbano, con el fin de mejorar la salud de la población.
[cat] Introducció: S'ha demostrat que la dieta mediterrània és beneficiosa en la prevenció i prognòstic de malalties cròniques. Els adults majors són el grup d'edat amb major incidència de malalties cròniques. L'estudi s’ha portat a terme a Espanya i el Líban, dos països mediterranis. Continguts de recerca: A Mallorca, s’ha investigat la composició nutricional dels aliments consumits per 211 adults majors utilitzant dos recordatoris de 24h de dies no consecutius. La ingesta mitjana diària de polifenols va ser de 332.7 mg/d. La ingesta de polifenols va ser més elevada entre els bevedors d'alcohol, nivell educatiu elevat, ingressos elevats i persones físicament actives. Els flavonoides van ser els polifenols més ingerits. Les begudes alcohòliques van ser els principals contribuents a la ingesta total de polifenols, principalment el vi negre. La mitjana de consum diari de lípids va ser de 68.6 g/dia. El sexe, l'edat i el nivell educatiu van influir en la ingesta de lípids. MUFA van ser el tipus d’àcid gras més consumit, i "olis i llavors" va ser el grup alimentari amb major contribució a la ingesta de lípids. No obstant això, la ingesta d'àcids grassos no va complir amb les recomanacions per adults majors mediterranis. El calci, el coure, el magnesi i el ferro es van consumir en quantitats inferiors a les IDR. La ingesta de minerals s'hauria d'ajustar per complir amb les recomanacions. Moltes variables de mesura d'aptitud física es van correlacionar negativament amb els predictors de malaltia cardiovascular. L'aptitud física pot ser essencial en l'envelliment saludable. En total, el 36.8%, el 24.5% i el 0.3% dels participants tenien una puntuació màxima de TUG inferior a 8-f, HGS màxim baix i sarcopenia, respectivament. La prevalença d'aquests valors baixos varia segons les variables sociodemogràfiques i de composició corporal. Al Líban, l'adhesió a la dieta mediterrània es va avaluar en 525 estudiants universitaris i 125 adults majors utilitzant MEDAS. Entre els estudiants universitaris, la mitjana de la puntuació d’adherència a un patró de dieta mediterrània va ser de 7.96. Els homes tenien un grau d’adherència a la dieta mediterrània lleugerament superior a les dones. Els no fumadors tenien una puntuació més alta que els fumadors. El 59.05% de la mostra tenia una puntuació inferior a l'adherència adequada. El 0.7% de la voluntat de canviar de dieta depenia de la puntuació d'adhesió a la dieta mediterrània i el 28.58% dels participants es preocupaven principalment per la seva salut. L'estratificació del qüestionari va revelar una distribució relativament alta de l'ús de l'oli d'oliva en la cuina tot i que només el 50.3% consumia més de 4 culleradetes diàries. El percentatge de participants que consumien aliments d’acord amb un patró de dieta mediterrània era superior al 50%, excepte pel vi i el peix. Es van trobar correlacions positives entre els diferents components de MEDAS. A més, el percentatge de participants que tenien una puntuació adequada era major en els no fumadors. Entre els adults majors, la puntuació d’adhesió mitjana a un patró de dieta mediterrània va ser de 8.48. Els homes tenien una adherència lleugerament superior a la dieta mediterrània que les dones. Els que treballaven tenien una major adhesió a la dieta mediterrània que els que no treballaven. El 52% de la mostra tenia una puntuació per sobre de l'adherència adequada. El percentatge de participants que consumien aliments d’acord amb un patró de dieta mediterrània era superior al 50%, excepte pel vi i el peix. Conclusió: Cal fer més estudis en el futur per comparar el Líban amb Espanya i desenvolupar estratègies per augmentar l'adhesió a la dieta mediterrània al Líban per a una millor salut.

Thesis (MSc)--University of Stellenbosch, 2001.
ENGLISH ABSTRACT: Experiments using the Mediterranean fruit fly, Ceratitis capitata (Wiedemann), were conducted to determine the mortality of males and females and the ovipositing ability of females fed on two diets. The sugar diet consisted of 5: 1 sugar:protein and the protein diet consisted of 5:1 protein: sugar. Dilutions of 80%, 60%, 40%, 20% and 10% with water of both diets were also provided to the flies. Female longevity was shorter than male longevity. There was no difference in female longevity between fruit flies fed on the two diets. However, males fed on the sugar diet lived longer than those fed on the protein diet. More eggs per female per day were laid by those fed the sugar diet than by those fed the protein diet. There were no differences m oviposition between flies fed on the different concentrations of the two diets.
AFRIKAANSE OPSOMMING: Proewe met die Mediterreense vrugtevlieg, Ceratitis capitata (Wiedemann), is uitgevoer om die mortaliteit van die mannetjies en wyfies, asook eierlegging van wyfies wat met twee verskillende diëte voorsien is, te bepaal. Die onderskeie diëte het uit 'n mengsel van proteïen en suiker (5 dele suiker en 1 deel proteïen) en (5 dele proteïen en 1 deel suiker) bestaan. Verdunnings van 80%, 60%, 40%, 20% en 10% is van die onderskeie diëte gemaak en aan die vlieë voorsien. Daar was geen verskil in die lewensduur van wyfies wat op die twee diëte gevoed is nie. Mannetjies wat op die oorwegende suiker dieët gevoed is, het langer as dié wat op die proteïen dieët gevoed is, geleef. Vlieë wat op die suiker dieët gevoed het, het regdeur 'n hoër gemiddelde daaglikse eierlegging per wyfie as dié wat op die proteïen dieët gevoed het, getoon. Geen noemenswaardige verskil in eierlegging vir vlieë wat op verskillende konsentrasies van die twee diëte gevoed het, is gevind nie.

Introduzione: La prevalenza della sindrome metabolica (SM) sta aumentando in tutto il mondo in qualsiasi fascia d’età, esponendo la popolazione ad un maggior rischio di gravi problemi di salute: diabete mellito, obesità, ipertensione, malattie cardiovascolari e tumori. Diversi studi hanno dimostrato che l'obesità è un fattore di rischio per diverse patologie, incluso il cancro alla mammella. Il tumore della mammella è uno dei tumori maligni più frequentemente diagnosticati, con oltre un milione di casi per anno, ed è la principale causa di morte per neoplasia, al mondo, nelle donne. L'attività fisica e la dieta mediterranea rappresentano dei fattori protettivi che possono ridurre la recidiva di tumore al seno. Il nostro scopo è di valutare le abitudini di vita in due gruppi di pazienti: BCS (Breast Cancer Survivors), sopravvissute al tumore al seno con follow-up <6 mesi; CG (Control Group), donne senza tumore al seno. Materiali e metodi: tra settembre 2015 e giugno 2016 sono state arruolate 100 pazienti BCS e 100 soggetti CG (età 55 ± 3.3 vs 53 ± 1.2 anni, P = NS). Il protocollo prevede una raccolta anamnestica: storia clinica, circonferenza della vita con valori limite per l'adiposità viscerale di IDF (International Diabetes Federation) e ATPIII (Adult Treatment Panel III), BMI (Indice di Massa Corporea), la somministrazione di un questionario specifico personalizzato (MEDSTYLE) e l’uso del software Winfood® (Medimatica, Teramo, Italia) per la valutazione del metabolismo basale, dell'attività fisica, della dieta quotidiana, del consumo di "cibo spazzatura", del fumo e delle abitudini di consumo. Risultati: La circonferenza della vita era maggiore nelle BCS rispetto al CG (89.7 ± 4.7 cm per IDF rispetto a 80.1 ± 2.2, P <0.0001; ATPIII 104.6 ± 3.5 vs 90.3 ± 4.1 cm, rispettivamente, P <0.0001). Il BMI era maggiore nelle BCS rispetto al CG (25.8 ± 1.8 vs 21.3 ± 0.8 cm, rispettivamente, P <0.0001). Complessivamente, l'apporto calorico giornaliero è stato di 1412 ± 25 Kcal nel CG vs 1833 ± 40 Kcal nelle BCS (P <0.000001) acquisiti in pasti di 4.3 ± 0.1. La prevalenza del fumo di sigaretta (14.4% vs 19.1%) e il consumo di alcol (76.5% vs 62.2%, P = 0.056) tendevano ad essere più bassi nel CG che nelle BCS. Il numero di bevande alcoliche settimanali era 2.0 ± 0.3 in CG e 2.2 ± 0.3 in BCS. La vita sedentaria era simile tra CG e BCS (60.0% vs 51.5%). In coloro che svolgono attività fisica, il numero di attività settimanali è stato di 2.7 ± 0.2 per 88 ± 8 Kcal/d nel CG e 2.5 ± 0.2 per 113 ± 14 Kcal/d nelle BCS (P = NS). Il consumo giornaliero di olio di oliva extravergine era maggiore nelle BCS che nel CG (38.7 ± 3.4 vs 23.3 ± 1.0 g / giorno, P <0.0001). L'assunzione di cibo spazzatura solido-liquido (veloce) basato su un punteggio composito a 7 dimensioni in frequenza era maggiore nelle BCS rispetto al CG (19.3 ± 0.8 vs 16.8 ± 0.6, P = 0.015) e tendeva a correlarsi positivamente con la circonferenza addominale nell'intero gruppo (r = + 0.28; P = 0.052). Sebbene la frequenza del consumo di legumi fosse comparabile, il punteggio per la dimensione del consumo di legumi era significativamente inferiore nel CG rispetto alle BCS (1.6 ± 0.07 vs 1.9 ± 0.09, P = 0.0028). L'assunzione di proteine (carne rossa> pollame> pesce) non ha rispettato le linee guida internazionali raccomandate (50 g / giorno) ed era più alta nelle BCS che nel CG (67.3 ± 10.9 vs 88.8 ± 14.6, P <0.001). Il consumo di fibre era basso, più basso nel CG rispetto alle BCS (14.4 ± 0.25 vs 15.7 ± 0.4 g / giorno, P = 0.0038). Conclusioni: questo studio fornisce un ricco database dei parametri antropometrici e degli stili di vita in due gruppi di donne che vivono in Puglia, una tipica regione mediterranea. Le sopravvissute al tumore al seno mostrano un profilo "dismetabolico", con un aumento del grasso viscerale, sovrappeso, obesità, un elevato apporto di proteine, assunzione maggiore di cibo spazzatura e un stile di vita sedentario. Sebbene l'area oggetto di studio fosse una regione mediterranea, entrambi i gruppi hanno mostrato una scarsa aderenza alla dieta mediterranea con un basso apporto di fibre e un elevato apporto di carne rossa. I cattivi stili di vita e il profilo dismetabolico aumentano la possibilità di recidiva in soggetti a "alto" rischio (precedente storia di neoplasia maligna). Sono auspicabili maggiori e più incisivi programmi educazionali sulla salute sia nella popolazione generale che in quella "selezionata".
Introduction: The prevalence of the metabolic syndrome (MS) is increasing worldwide at any age, exposing the populations at risk of major health problems: diabetes mellitus, obesity, hypertension, cardiovascular diseases, and cancer. Several trials have shown that obesity is a risk factor for several malignancy, including breast cancer. Breast cancer is one of the most frequently diagnosed malignancy, counting over a million cases each year, and the leading cause of cancer death in women worldwide. Physical activity and mediterranean diet represent protective factors that may reduce breast cancer recurrence. We aimed to assess lifestyle habits in two groups of subjects (i.e., BCS, breast cancer survivors in follow-up (<6 mo.); CG, females without breast cancer). Materials and Methods: between September 2015-June 2016, 100 BCS subjects and 100 CG subjects were enrolled (age 55±3.3 vs. 53±1.2 yrs, P=NS). The protocol included a brief physical examination: history, waist circumference with cut-off values for visceral adiposity by IDF (International Diabetes Federation) and ATPIII (Adult Treatment Panel III), the BMI (Body Mass Index), the administration of a specific custom-designed questionnaire (MEDSTYLE) and use of Winfood® software (Medimatica, Teramo, Italy) for assessing basal metabolic rate, physical activity, daily average diet, “junk food” consumption, smoking and drinking habits. Results: Waist circumference was greater in BCS than CG (IDF 89.7±4.7 cm vs. 80.1± 2.2, P<0.0001; ATPIII 104.6±3.5 vs. 90.3±4.1 cm, respectively, P<0.0001). Body mass index (BMI) was greater in BCS than CG (25.8±1.8 vs. 21.3±0.8 cm, respectively, P<0.0001). Overall, daily caloric intake was 1412±25 Kcal in CG vs 1833±40 Kcal in BCS (P<0.000001) gained across 4.3±0.1 meals. Prevalence of cigarette smoking (14.4% vs. 19.1%) and alcohol consumption (76.5% vs. 62.2%, P=0.056) tended to be lower in CG than in BCS. Number of weekly alcoholic drinks were 2.0±0.3 in CG and 2.2±0.3 in BCS. Sedentary life was similar between CG and BCS (60.0% vs 51.5%). In those performing physical activity, the number of weekly activities were 2.7±0.2 for 88±8 Kcal/d in CG and 2.5±0.2 for 113±14 Kcal/d in BCS (P=NS). Daily consumption of extravirgin olive oil was greater in BCS than in CG (38.7 ±3.4 vs. 23.3±1.0 g/day, P<0.0001). Intake of solid-liquid junk (fast) food based on a frequency-size 7-items composite score, was greater in BCS than CG (19.3±0.8 vs. 16.8±0.6, P=0.015) and tended to correlate positively with abdominal girth in the whole group (r=+0.28; P=0.052). Although the frequency of legumes consumption was comparable, the score for size of legume intake was significantly smaller in CG than BCS (1.6±0.07 vs 1.9±0.09, P=0.0028). Protein intake (red meat >poultry>fish) did not respect the international recommended guidelines (50 g/d) and was higher in BCS than in CG (67.3±10.9 vs. 88.8±14.6, P<0.001). Fiber consumption was low, lower in CG than BCS (14.4±0.25 vs.15.8±0.4 g/day, P=0.0038) Conclusions: this survey provides a consistent anthropometric and lifestyles database in two groups of women living in Apulia, Italy, a typical Mediterranean region. Breast cancer survivors display a “dysmetabolic” profile, with increased visceral fat-overweight-obesity, high intake of proteins, junk food, and sedentary life. Although the area of enrollment was a mediterranean region, both groups showed low adherence to mediterranean diet with low intake of fiber and high intake of red meat. Hazardous habits and metabolic profile can be dangerous in subjects at “high” risk (previous history of cancer). Educational healthy programs are mandatory in the general and in “selected” populations.

L'obesitat i la síndrome metabòlica són problemes importants de salut pública que estan en augment a tot el món. S'ha establert que la microbiota intestinal juga un paper important en l'obesitat, el metabolisme energètic de l'hoste i és essencial comprendre el seu paper en el context de la salut. Com a objectiu principal d'aquesta tesi, avaluem l'efecte que va tenir 1 any d'intervenció intensiva de pèrdua de pes, en el context de l'estudi PREDIMED-Plus, en la composició de la microbiota intestinal. Vàrem observar que la pèrdua de pes mediada per la intervenció indueix canvis en la microbiota intestinal i alguns d’aquests gèneres microbians es van associar amb canvis en els paràmetres d'adipositat. En segon lloc, vàrem explorar les diferències en la composició microbiana pel que fa a diverses fonts d'ingesta de proteïnes, i vàrem observar que el consum de proteïnes d'origen animal pot tenir una influència superior a la de les proteïnes d'origen vegetal. Finalment, a partir de la revisió narrativa realitzada sobre els greixos d'origen vegetal i la microbiota intestinal, es conclou que el reemplaçament de greixos saturats per fonts vegetals de greixos insaturats podria ajudar en la modulació positiva de la microbiota intestinal. Remarquem que es necessiten més estudis en humans per comprendre els efectes de diferents fonts de greixos i proteïnes sobre la microbiota intestinal i, en conseqüència, sobre la salut. En conclusió, la dieta mediterrània hipocalòrica, juntament amb l'activitat física i canvis de comportament, poden tenir efectes beneficiosos en l'hoste, potencialment modulats a través de la microbiota intestinal. Les fonts de proteïnes o greixos vegetals poden tenir efectes positius sobre la composició i funcionalitat microbiana intestinal. Ens esperen en el futur una gran quantitat de desafiaments i oportunitats per a comprendre millor les interaccions dieta-hoste-microbioma.
La obesidad y el síndrome metabólico son importantes problemas de salud pública que están en aumento en todo el mundo. Se ha establecido que la microbiota intestinal juega un papel importante en la obesidad, el metabolismo energético del huésped y es esencial comprender su papel en el contexto de la salud. Como objetivo principal de esta tesis, evaluamos el efecto que tuvo 1 año de intervención intensiva de pérdida de peso, en el contexto del estudio PREDIMED-Plus, en la composición de la microbiota intestinal. Observamos que la pérdida de peso mediada por la intervención induce cambios en la microbiota intestinal y que estos géneros microbianos se asociaron con cambios en los parámetros de adiposidad. En segundo lugar, exploramos las diferencias en la composición microbiana con respecto a varias fuentes de ingesta de proteínas y observamos que el consumo de proteínas de origen animal puede tener una influencia superior que la de las proteínas de origen vegetal. Por último, a partir de la revisión descriptiva realizada sobre las grasas de origen vegetal y la microbiota intestinal, se concluye que el reemplazo de grasas saturadas por fuentes vegetales de grasas insaturadas podría ayudar en la modulación positiva de la microbiota intestinal. Remarcamos que existe una gran necesidad de estudios en humanos para comprender los efectos de diferentes fuentes de grasa y proteínas sobre la microbiota intestinal y, en consecuencia, sobre la salud. En conclusión, una dieta mediterránea hipocalórica, junto con la actividad física y cambios comportamentales, puede tener efectos beneficiosos en el huésped, potencialmente modulados a través del microbiota intestinal. Las fuentes de proteínas o grasas vegetales pueden tener efectos positivos sobre la composición y funcionalidad microbiana intestinal. Nos esperan en el futuro una gran cantidad de desafíos y oportunidades para comprender mejor las interacciones dieta-huésped-microbioma.
Obesity and metabolic syndrome are major public health issues increasing worldwide. Gut microbiota has established to play an important role in obesity, host energy metabolism and understanding its role in the context of health is essential. As the primary objective of this thesis, we evaluated the effect of 1-year intensive weight-loss intervention in the context of PREDIMED-Plus study on gut microbiota composition. We observed that weight loss mediated by the intervention induces changes in gut microbiota and some of these microbial genera were associated with changes in adiposity parameters. Secondly, we explored the differences in microbial composition with respect to various sources of protein intake, we observed that consuming animal-based proteins may have a stronger influence than plant-based proteins on gut microbiota. Finally, from the narrative review conducted on plant-based fats and gut microbiota, it can be concluded that replacement of saturated fats with plant sources of unsaturated fats could help in positive modulation of gut microbiota. We remark that there is a great need for human studies in the context of understanding the effects of different fat and protein sources on gut microbiota and consequently on health. Overall, we conclude from this Doctoral thesis that hypocaloric Mediterranean diet, along with physical activity and behavioral changes can have beneficial effects on the host, potentially modulated via gut microbiota. Plant based protein or fat sources may have positive effects on gut microbial composition and functionality. Huge amount of challenges and opportunities awaits in front of us to better understand diet-host-microbiome interactions.

The worldwide prevalence of overweight and obesity among children and adolescents has risen dramatically. Obesity is a complex and multifactorial condition associated with an increased risk of multiple comorbidities, like diabetes, arterial hypertension, dyslipidemia, cardiovascular diseases and cancer. Most of them have been already described since pediatric age. However, precocious biomarkers for identifying "high risk" subjects to an unhealthy metabolic profile are lacking, especially in pediatrics. Thus, one of the aims of this Ph.D. project was to investigate the development of obesity-related diseases in obese children and adolescents, identifying precocious biomarkers that could allow early detection and promote prevention strategies. Besides, we reported that insulin resistance, metabolic syndrome, and hyperuricemia correlated with cardiovascular dysfunction in pediatric obesity, Furthermore, we identified novel metabolic risk factors, in particular high-normal estimated glomerular filtration rate and haptoglobin phenotypes. The fundamental cause of overweight and obesity is an energy imbalance between calories consumed and calories expended. Certainly, the diet plays a key role and is a crucial variable for a healthy life. A rapidly growing number of studies, in recent years, support the hypothesis that the Mediterranean style-diet has beneficial effect. However, the urbanization of people living in the Mediterranean area modified lifestyle choices deviating to a "Western diet" richer in saturated fat, refined grains, simple carbohydrates and processed foods. Thus, we also almed to describe the adherence to the Mediterranean style-diet in children and adolescents, assessing the potential effect of healthier behaviours. In nothern Italy, we described poor food quality which replaced the Mediterranean dietary pattern in children and adolescents, in particular among younger children. Moreover, in a systematic review, we supported skipping breakfast as an easy marker of the risk of overweight and obesity and metabolic-related diseases. Besides, increasing evidence especially reported the involvement of the gut microbiota in the dysmetabolism associated with obesity. For this reason, exploring the role of the gut microbiota in the development of childhood obesity was another outcome of this Ph.D. project, for potentially revealing new strategies for obesity prevention and treatment. Our first baseline findings correlated gut microbiota to dietary pattern and adherence to the Mediterranean style-diet. This suggested that dietary intervention would have enormous potential in modulating the microbial composition and promoting a more health-associated metabolic profile. However, few data are nowadays available concerning pediatrics, so this relationship awaits further studies. Most of the above-mentioned results were published on international peer-reviewed scientific journals, hoping to contribute to the current knowledge on the crosstalk between obesity, obesity-related diseases, Mediterranean style-diet and gut microbiota. Futhermore, during the Ph.D. project the GOOD-DAY Trial was designed and realized (ID NCT03154255). Although COVID-19 pandemic temporary stopped it, further results are awaited in the next months.

La perdita di peso nei pazienti con sindrome metabolica ha effetti positivi sulle malattie cardiovascolari e sul rischio di diabete di tipo 2, ma i suoi effetti sul profilo lipidico e sul secretoma periferico sono tutt’ora poco chiari. Al fine di determinare gli effetti della perdita di peso indotta dalla dieta sui parametri metabolici sono stati analizzati il profilo lipidico e il secretoma periferico in pazienti affetti da sindrome metabolica. In questo studio sono stati arruolati 18 soggetti adulti di sesso maschile con sindrome metabolica e BMI compreso tra 25 e 35 Kg/m2, che sono stati sottoposti a dieta Mediterranea ipocalorica bilanciata per 6 mesi. Lo scopo dell'approccio dietetico era quello di indurre nei pazienti una perdita di peso di almeno il 5% del peso corporeo iniziale. Dopo la perdita di peso abbiamo osservato un miglioramento significativo del BMI, dei livelli di insulina, della glicemia a digiuno, dell’indice HOMA-I, dei livelli di trigliceridi, di LDL e HDL. L'analisi delle lipoproteine circolanti ha mostrato un cambiamento significativo nella loro composizione. In particolare, abbiamo osservato un trasferimento importante di triacilgliceroli dalle HDL alle LDL. A tale cambiamento si è associata una significativa riduzione delle citochine proinfiammatorie periferiche, come IL-6, TNF-α, IL-8 e MIP-1β. Abbiamo inoltre osservato un'interessante correlazione positiva tra i livelli di citochine e livelli periferici di CETP (cholesteryl ester transfer protein), un enzima con un ruolo chiave nel trasferimento di esteri del colesterolo tra le lipoproteine. La perdita di peso ottenuta attraverso la dieta Mediterranea ipocalorica ha determinato un miglioramento del profilo lipidico periferico, un cambiamento nella composizione delle lipoproteine e del secretoma. Questi risultati sono fondamentali per comprendere i benefici della perdita di peso e i meccanismi che possono avere un ruolo nel miglioramento del rischio cardiovascolare.
Weight loss in patients with metabolic syndrome has positive effects on cardiovascular diseases and type 2 diabetes risk, but its effects on peripheral secretome and lipidome profiles are still poorly understood. In order to determine the effects of diet-induced weight loss on metabolic parameters, lipidome and secretome profiles were evaluated. In this study, 18 adult males with metabolic syndrome and BMI between 25 and 35 Kg/m2 were enrolled, and then subjected to a balanced hypocaloric Mediterranean diet for 6 months. The aim of the dietetic approach was to induce in patients a weight loss of at least 5% of the initial body weight. After weight loss, we observed a significant improvement in BMI, insulin, fasting blood glucose, HOMA-I, triglyceridemia, LDL, and HDL levels. The analysis of circulating lipoproteins showed a significant change in their composition. In particular, a massive transfer of triacylglycerols from HDL to LDL was observed. This result was associated with a significant reduction in peripheral pro-inflammatory cytokines, such as IL-6, TNF-α, IL-8, and MIP-1β. We also observed an interesting positive correlation among cytokines levels and peripheral levels of CETP (cholesteryl ester transfer protein), an enzyme with a key role in lipid metabolism. The results achieved suggest that weight loss obtained through the hypocaloric Mediterranean diet is associated with an improvement in peripheral lipidome and secretome profiles. Furthermore, this dietetic approach stimulated changes in lipoproteins composition. These results are fundamental to understand weight loss benefits and the mechanisms that may play a role in improving cardiovascular risk.

Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Ciências da Nutrição
O estudo dos padrões alimentares capta o efeito cumulativo e de interação dos vários alimentos e nutrientes e podem ser mais facilmente interpretados pela população, assumindo assim particular importância em Saúde Pública. A Dieta Mediterrânica (DM) e a Dieta Atlântica (DA) são padrões alimentares definidos por uma abordagem orientada por hipóteses prévias (a priori) e são representativos de uma determinada região e dos seus costumes culturais e sociais, reforçados ao longo de vários anos. Cada um apresenta na sua composição propriedades que lhes conferem o estatuto de alimentação saudável. Em termos de efeitos benéficos na saúde, a DM e os seus componentes têm sido exaustivamente associados a um menor risco cardiovascular, conferindo também um papel protetor sobre a incidência e mortalidade por cancro, em especial cancro da mama, da próstata, gástrico e colo-retal. A DM também apresenta evidência de ter um papel favorável na prevenção e tratamento da obesidade, diabetes, doenças inflamatórias reumáticas, osteoporose e a nível cognitivo. Em relação ao papel da DA na saúde, este tem muito menor evidência fruto da sua definição muito mais recente, tendo sido já associada a melhor perfil cardiovascular. Quer a DM quer a DA parecem sofrer atualmente uma espécie de descaracterização, havendo uma aproximação do seu padrão tradicional a outros padrões de regiões carateristicamente diferentes. Esta ocidentalização dos padrões preocupa a comunidade científica em geral.
The study of dietary patterns captures the cumulative and interaction effect of various foods and nutrients and can be more easily interpreted by the population, thus assuming particular importance in Public Health. The Mediterranean Diet (MD) and Atlantic Diet (AD) are dietary patterns defined by a hypothesis oriented approach (a priori) and are representative of a particular region and its cultural and social customs, reinforced over several years. Each one has properties that give them the status of healthy diets. In terms of benefits to health, the MD and its components have been extensively associated with a lower cardiovascular risk, and also a protective effect on cancer incidence and mortality, especially breast cancer, prostate, gastric and colorectal cancer has been described. The MD also presents evidence of having a favorable role in the prevention and treatment of obesity, diabetes, inflammatory rheumatic diseases, osteoporosis and at the cognitive level. The role of the AD in health, has much less evidence due to its much more recent definition, but it has already been associated with a better cardiovascular profile. Both the MD and AD seem to suffer a kind of decharacterization, with an approximation of the traditional pattern to other patterns of regions that are characteristically different. This westernization of dietary patterns concerns the scientific community in general.
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Obesity-related diseases account for the majority of morbidity and mortality in U.S. adults. An estimated 4 million women in the United States deliver an infant annually, of which approximately 34% are overweight/obese prior to pregnancy. More than 30% of these women gain weight that exceeds the IOM’s recommendations; increasing their risk of postpartum weight retention and possibly increasing their risk of greater weight gain and retention over time. This research sought to test the efficacy of a traditional MED diet for 4-months on weight loss/control and biomarkers of inflammation in breastfeeding women compared to women randomized to the USDA’s MyPyramid diet for Pregnancy and Breastfeeding (control diet). At baseline, the women (N=129) were 29.7±4.6 years, overweight (BMI: 27.2±4.9 kg/m2), and primarily non-Hispanic white (75.2%). The majority of women were exclusively breastfeeding (73.6%) and a mean 17.5 weeks postpartum. Adherence to the MED diet was evaluated via calculation of the MED diet score from validated FFQs administered pre- and post- the diet intervention. Anthropometric measurements (body weight, body fat, and waist and hip circumference) and biosamples (blood, urine, and breast milk) were collected at baseline and 4-months (diet completion). Biomarkers of inflammation (IL-6 and TNF-α) were assessed via standard ELISA kits. The MED diet score was increased by 0.68±2.74 and 0.27±1.57 for the MED and control group, respectively. Increases in fish and dairy intake and a decrease in meat/poultry intake were significantly different between diet groups (P<0.05). Participants in both diet groups demonstrated significant (P=0.002) reductions in all anthropometric measurements; no significant between group differences were shown. A significant decrease in TNF-α, but not IL-6, was demonstrated in both diet groups. There were no significant between group differences. Both the MED diet and the USDA’s MyPyramid diet were effective in reducing anthropometric measurements and inflammation in postpartum breastfeeding women.

Dans un contexte de crise des pêcheries liée à la diminution de la taille et de l’amaigrissement des poissons planctonophages, l’objectif de cette thèse a été de mettre en lien l’alimentation des poissons et le plancton dans la Baie de Marseille, pour comprendre leur variabilité sous l’influence des conditions environnementales. Les variations saisonnières et interannuelles des proies en termes de composition en espèces et en tailles, d’abondance et de biomasse, ainsi que de qualité impactent la sélection de prédation des espèces de poissons planctonophages. La baie de Marseille bénéficie des apports permanents terrigènes et anthropiques, qui semblent favoriser la taille et la condition corporelle relative de la sardine et de l’anchois. Nos résultats permettent d’améliorer la compréhension du fonctionnement du réseau trophique pélagique et devraient être pris en compte dans la gestion de la pêche et des écosystèmes côtiers dans un contexte de changement climatique
In a context of fishery crisis linked to the decrease in size and body condition of planktivorous fish, the aim of this thesis was to relate the feeding habit of fish and plankton in the Bay of Marseille, in order to understand their variability under the influences of environmental conditions. Seasonal and interannual variations in species and size composition, abundance and biomass, as well as quality of prey influence the prey selection by planktivorous fish species. The Bay of Marseille benefits from the permanent terrestrial and anthropogenic inputs of the city and this seem to be in favor of the body size and the relative body condition of sardines and anchovies. Our results can improve our understanding of the functioning of the pelagic food web and should be integrated in the management of fisheries and coastal ecosystems in a context of climate change

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.

Background: Studies evaluating the possible health-promoting effects of sound nutrition in heart and lung transplant recipients are currently lacking. Despite advances in drug treatment and patient monitoring, lifestyle-associated complications such as obesity, diabetes and cardiovascular disease occur frequently. Following transplantation, a low-fat eating pattern is currently viewed as best standard care. However, a Mediterranean diet based on a varied range of fresh unprocessed foods and supplemented with extra virgin olive oil has demonstrated clinical benefit in various non-transplant populations. The aim of this study was to evaluate the feasibility and acceptability of a Mediterranean vs a low-fat diet intervention in heart and lung transplant recipients, and to assess clinical and biochemical outcomes. Methods: This was a randomised controlled feasibility trial to evaluate a Mediterranean diet supplemented with extra-virgin olive oil, vs a modified low-fat diet in heart and lung transplant recipients at a single centre. In total, 41 clinically stable male and female (median age 55 years) transplant recipients were randomly assigned (1:1) in two separate 12-month waves (n=24 and n=17) to one of these diet interventions. A range of validated food frequency and adherence questionnaires captured changes in participants' reported eating habits to 6 weeks post-study. Clinical and biochemical analysis was conducted at baseline, 25 and 52 weeks. Telephone and outpatient contact provided a support mechanism to reinforce dietary behavioural change. Caloric intake and physical exercise awareness were discussed, but not promoted. Results: Thirty nine participants completed the trial (95%). Adherence to both interventions improved significantly at week 25, and was maintained at 52 and 58 weeks. Compared with baseline, waist circumference decreased in both groups at week 25 (p=0.024). A decrease in blood pressure and heart rate occurred at 52 weeks in the low-fat group only. At 52 weeks, higher adherence resulted in significant improvements in fasting glucose in the Mediterranean (< 4.8%) and low-fat (< 5%) groups. This respective pattern was also observed with total cholesterol (≤ 9% and ≤ 7%), triglycerides (≤ 9% and ≤ 20%) and IGF-1 (≤ 9% and ≤ 15%). A significant decrease in the LDL/HDL ratio (≤ 12%) occurred in the Mediterranean group only. Moreover, clinically relevant lipid and glucose regulation changes were observed in each intervention. Conclusions: The implementation of a prospective 12-month Mediterranean or low-fat diet is feasible and acceptable in a heart and lung transplant outpatient setting. Both interventions were positively associated with improvements in lipid and blood glucose regulation and circulating IGF-1. As part of a multidisciplinary framework, these findings offer an additional therapeutic strategy to optimise outpatient care.

Hydroxytyrosol is a health-promoting dietary phenol mainly present in extra virgin olive oil. Wine and beer are sources of tyrosol, a related phenolic compound. We have demonstrated that in humans tyrosol is endogenously converted into hydroxytyrosol following wine and beer consumption. Therefore, tyrosol rich foods could trigger equivalent health effects than those of hydroxytyrosol ones. The conversion of tyrosol into hydroxytyrosol is mediated by the polymorphic cytochrome P450 isoenzymes CYP2A6 and CYP2D6. In a randomized controlled clinical trial, we have shown that tyrosol and its conversion into hydroxytyrosol improved endothelial function in individuals at high cardiovascular risk following a 4-weeks of a dietary intervention enriched in tyrosol. A polygenic activity score to predict the metabolic fate of tyrosol to hydroxytyrosol based on CYP2A6 and CYP2D6 genotypes has also been developed. This score was capable of predicting the metabolism of tyrosol and the magnitude of the derived biological effects in a personalized manner.
L’hidroxitirosol és un compost fenòlic amb propietats beneficioses per la salut present principalment en l’oli d’oliva verge extra. El vi i la cervesa són fonts de tirosol, un compost fenòlic relacionat. Hem demostrat que en humans el tirosol és convertit endògenament a hidroxitirosol després del consum d’aliments rics en tirosol com el vi o la cervesa. Conseqüentment, els aliments rics en tirosol, generarien efectes saludables equivalents als aliments rics en hidroxitirosol. La conversió és mediada per CYP2A6 i CYP2D6, dos isoenzims del citocrom P450 altament polimòrfics. Mitjançant un assaig clínic aleatori controlat s’ha evidenciat que el tirosol i la seva conversió a hidroxitirosol produeixen una millora en la funció endotelial en voluntaris amb risc cardiovascular després de 4 setmanes amb una dieta enriquida en tirosol. S’ha desenvolupat també un paràmetre de valoració numèric en base als genotips de CYP2A6 i CYP2D6 per predir el metabolisme del tirosol i la magnitud dels efectes biològics esperables de forma personalitzada.

Objectives: The purpose of this study was to assess the relationship between two Mediterranean diet indices and to evaluate the proportion of participants who were ranked into identical tertiles of accordance with the Alternate Mediterranean Diet (aMed) and MedDietScore (MDS) tools when applied to an American samples.

Methods: In this secondary analysis, participants from four samples were pooled into two groups – one in which respondents completed the web-based VioScreen™ (n=200) food frequency questionnaire (FFQ) and the second, those who completed a paper-based Brief Block 2000 FFQ (n=827). Mediterranean diet scores were calculated based on the sex-specific median intakes of nine aMed components as well as meeting target frequency per week of the MDS components. Participants were categorized into a priori tertiles for each score.

Results: Scores for aMed and MDS were moderately correlated in the VioScreen™ (rho= 0.546, p<0.001) and Brief Block (rho=0.627, p<0.001) samples. The greatest proportion of participants was classified into Tertile 2 for VioScreen™ each scoring paradigm (40% for aMed and 71% for MDS). In the Brief Block sample, 47% of participants were assigned to Tertile 1 for aMed and for MDS 52% into Tertile 2. Only 47% of VioScreen™ and 60.3% of Brief Block participants were ranked into identical tertiles for aMed and MDS. Classification agreement between aMed and MDS was fair for VioScreen™ (weighted &kgr; = 0.223, p<0.001) and Brief Block samples (weighted &kgr; = 0.384, p<0.001).

Conclusions: Agreement between aMed and MDS was no more than fair for either FFQ, indicating that the scoring paradigms are not interchangeable in measuring accordance to the Mediterranean diet. Further investigation into the effects of FFQ selection on aMed and MDS scoring in addition to factor analysis of the variability between aMed and MDS is warranted in American samples.

Background: The Mediterranean diet (MD) has significant benefits for cardiovascular health, yet clinicians and researchers lack reliable tools to measure patient knowledge. This thesis aims to develop a reliable MD nutrition knowledge tool. Methods: A 20-item tool (Med-NKQ) was developed to test knowledge of MD relevant to cardiovascular disease (CVD). Themes included CVD risk factors, cardioprotective nutrients, quantifying serve sizes, label reading and common MD foods and patterns. The tool underwent content validity via an expert Delphi survey and was tested for repeatability among people with self-reported CVD, using a test-retest protocol. Participants were recruited through social media and completed an online survey which was repeated two weeks later. A paired sample t test, Pearson’s correlation and Bland Altman plot were used to compare the two test periods. Results: Delphi Survey: Ten out of 25 invited experts responded to round one and six responded to round two. All items achieved expert consensus at the end of round two. Repeatability testing: 32 participants were recruited and 20 completed the survey twice. Participants were mostly male and 50 years or older. A paired sample t test showed no significant difference in the mean total scores of test one (28, SD 5.4) compared to test two (29.5, SD 5.5) (t= 1.41, p=0.174). Pearson’s correlation was significant between the two test scores (r= 0.59, p= 0.006). A Bland Altman plot indicated no bias between the two survey responses. Discussion: The Med-NKQ is a reliable tool for assessing MD nutrition knowledge relevant to CVD. It is short and easy to administer, making it practical in clinical and research settings. It can be administered online leading to potential use in remote education and e-health. The Med-NKQ will contribute to future clinical practice and research studies.

Nello sviluppo della comunicazione alimentare e quella sulla salute, la promozione della Dieta Mediterranea come modello alimentare sano e sostenibile può essere un tema cruciale e di tendenza. La coltivazione della conoscenza che potrebbe migliorare l'aderenza alla Dieta mediterranea è una sfida da affrontare con cautela, soprattutto quando si sviluppano campagne di comunicatione importanti che si rivolgono ad un pubblico vasto. Attingendo dalla letteratura scientifica sul tema della Dieta mediterranea e i suoi benefici sulla salute fisica e mentale, e sul tema dell'atteggiamento, dell'intenzione e della motivazione all’aderenza alla Dieta mediterranea, nonché sulla comunicazione, questa tesi propone un approccio per testare l’efficacia di un modello teorico integrato volto a spiegare il ruolo di alcuni fattori psicosociali nell'aumentare l'intenzione di aderire alla Dieta mediterranea. Inoltre, è stata studiata l'efficacia di interventi di messaggistica per promuovere l’aderenza alla Dieta mediterranea. Nello specifico, è stata studiata l’efficacia dei messaggi prefattuali sulle conseguenze positive sulla salute che derivano dall’aderenza alla Dieta mediterranea (messaggi di guadagno) o sull'evitamento delle conseguenze negative sulla salute (messaggi di non perdita). Infine, l’efficacia dei messaggi persuasivi è stata testata anche in base all'autoefficacia dei destinatari.
In the flourishing fields of food communication and health, promoting the Mediterranean Diet (MeDiet) as a healthy and sustainable dietary pattern may be a trending and crucial theme. The cultivation of knowledge that could enhance MeDiet adherence is a challenge to approach with caution, especially when developing important campaigns that target vast audiences. Drawing from the research literature on the themes of MeDiet health benefits, attitude, intention, and motivation, as well as communication, this dissertation proposes an approach to test the plausibility of an integrated theoretical model aiming to explain the role of some psychosocial factors in increasing the intention to adhere to the MeDiet. Moreover, we investigated the effectiveness of a message intervention to promote adherence to the MeDiet. Specifically, we tested the persuasiveness of prefactual messages focusing on the positive health consequences deriving from the adoption of the MeDiet (gain messages) or on the avoidance of the negative health consequences deriving from not adhering to the MeDiet (non-loss messages). We also evaluated if the persuasiveness of these messages varied according to the receivers’ eating self-efficacy.

The scope of the present work was to investigate whether the protective role of the traditional Mediterranean diet (TMD), and virgin olive oil (VOO) rich in phenolic compounds (PC), towards cardiovascular disease can be mediated through gene expression changes. Two trials were performed to assess the in vivo nutrigenomic effects of TMD and VOO in healthy volunteers. The results point out: a) significant gene expression changes of those genes related with cardiovascular-risk processes after VOO ingestion; b) a down-regulation in the expression of atherosclerosis-related genes after a 3-month intervention with a TMD; and c) an olive oil PC health-protective nutrigenomic effect within the frame of the TMD. Changes in gene expression were concomitant with decreases in oxidative damage and systemic inflammation markers. Data from our studies provide further evidence to recommend both the TMD and the VOO as a useful tool for the prevention of atherosclerosis.
El objetivo de este estudio es investigar si el papel protector de la dieta Mediterránea tradicional (TMD) y del aceite de oliva virgen (VOO), rico en compuestos fenólicos (PC), puede ser mediado a través de cambios en la expresión génica. Se realizaron dos ensayos clínicos para evaluar los efectos nutrigenómicos de la TMD y del VOO, in vivo, en voluntarios sanos. Los resultados mostraron a) cambios en la expresión génica de genes relacionados con el riesgo cardiovascular tras la ingestión del aceite virgen de oliva, b) una infra-expresión en la expresión de genes relacionados con el proceso aterosclerótico tras una intervención con TMD de 3 meses y c) que los compuestos fenólicos del aceite de oliva ejercen un efecto nutrigenómico protector en el marco de la TMD. Los cambios en la expresión génica fueron coherentes.

Les malalties cardiovasculars (CV) són una de les primeres causes de morbimortalitat a tot el món. Aquestes malalties, en gran mesura, es podrien prevenir. La Dieta Mediterrània ha estat reconeguda com un dels patrons alimentaris més saludables. Fins el moment, existeix una forta evidència científica que demostra els beneficis de la dieta Mediterrània en la prevenció i el tractament de la malaltia cardiovascular. Aquesta tesi ha estat realitzada en el context de l’estudi PREDIMED, un estudi clínic paral•lel, multi cèntric i aleatoritzat que avaluava l’efecte de la dieta Mediterrània, en comparació a una dieta baixa en greix, en la prevenció primària de la malaltia cardiovascular. L’objectiu va ser determinar l’efecte dels fruits secs, l'oli d’oliva i les seves varietats, i el magnesi en el risc cardiovascular, mortalitat per causa específica i mortalitat per totes les causes en una població Mediterrània amb alt risc cardiovascular. Tots els aliments avaluats són components claus del patró de dieta Mediterrània i són consumits en altes quantitats en la nostra població. Els resultats del nostre treball demostren que consumir fruits secs amb més freqüència estava inversament relacionat amb la mortalitat cardiovascular, mortalitat per càncer i mortalitat total després de seguir als participants durant una mitja de 4.8 anys. L’oli d’oliva, concretament la varietat extra verge, s’associava a un risc reduït de malaltia cardiovascular i mortalitat cardiovascular després de 4.8 anys de mitja de seguiment. També vam observar que el magnesi dietètic s’associava inversament a la mort cardiovascular, per càncer i mortalitat total. En conclusió, els resultats d’aquesta tesi corroboren els efectes beneficiosos dels components de la dieta Mediterrània en la prevenció de malaltia cardiovascular i mort.
Las enfermedades cardiovasculares (CV) son una de las primeras causas de morbi-mortalidad en todo el mundo. Estas enfermedades, en gran medida, se podrían prevenir. La Dieta Mediterránea ha sido reconocida como uno de los patrones alimentarios más saludables. Hasta el momento, existe una fuerte evidencia científica que demuestra los beneficios de la dieta Mediterránea en la prevención y el tratamiento de la enfermedad cardiovascular. Esta tesis ha sido realizada en el contexto del estudio PREDIMED, un estudio clínico paralelo, multicéntrico y aleatorizado que evalúa el efecto de la dieta mediterránea, en comparación a una dieta baja en grasa, en la prevención primaria de la enfermedad cardiovascular. El objetivo fue determinar el efecto de los frutos secos, aceite de oliva y magnesio en el riesgo cardiovascular, mortalidad por causa específica y mortalidad por todas las causas en una población Mediterráneo con alto riesgo cardiovascular. Todos los alimentos evaluados son componentes claves del patrón de dieta Mediterránea y son consumidos en altas cantidades en nuestra población. Los resultados del presente trabajo demostraron que consumir frutos secos con más frecuencia estaba inversamente relacionado con la mortalidad cardiovascular, mortalidad por cáncer y mortalidad total tras seguir a los participantes durante una media de 4.8 años. Observamos también que el aceite de oliva, concretamente la variedad extra virgen, se asociaba a un riesgo reducido de enfermedad cardiovascular y mortalidad cardiovascular después de 4.8 años de media de seguimiento. También observamos que el magnesio dietético se asociaba inversamente a la muerte cardiovascular, por cáncer y mortalidad total. En conclusión, los resultados corroboran los efectos beneficiosos de los componentes de la dieta Mediterránea en la prevención de enfermedad cardiovascular y muerte.
Cardiovascular disease (CVD) is one of the main causes of disability and death worldwide. Importantly, in a large extent, CVD are preventable. The Mediterranean Diet (MedDiet) is recognized as one of the healthier dietary patterns. To date, strong evidence exists supporting the benefits of the MedDiet for the prevention and management of CVD. This thesis has been conducted in the framework of the PREDIMED Study, a parallel-group, multicenter randomized nutrition trial evaluating the efficacy of a MedDiet compared to a low-fat control diet on the primary prevention of CVD. We aimed to asses the associations between nuts, olive oil and its varieties, and magnesium on the risk of CVD, cause-specific and all-cause mortality on an elderly Mediterranean population at high cardiovascular risk. All of these foods are key components of the MedDiet pattern and are highly consumed in our population. The results of the present work demonstrate that the frequency of nut consumption was inversely related to cardiovascular, cancer and total mortality after 4.8 years of follow-up. We found that olive oil consumption, specifically the extra-virgin variety, was associated with reduced risk of cardiovascular disease and cardiovascular mortality after 4.8 years of follow-up. We have also observed that dietary magnesium intake was inversely associated with cardiovascular, cancer and total mortality risk after 4.8 years of follow-up. In conclusion, the findings of this thesis support the healthy benefits of the components of a MedDiet on the primary prevention of cardiovascular disease and mortality.

Introduction: Scientific evidences demonstrate that Mediterranean Diet is a protective factor for several kinds of chronic non-communicable diseases, such as cardiovascular diseases. This dietary pattern is essential as preventive and treatment measure for these diseases. The accession to changes in habit is a dynamic process, challenging for both patients and healthcare professionals. Nevertheless, in Brazil there are few works that show adherence to diet in patients with Acute Coronary Syndrome. Objective: To assess the accession to a nutritional intervention based on Mediterranean Diet in patients after Acute Coronary Syndrome. Method: A nutritional intervention based on the Mediterranean Diet was performed in 282 patients after Acute Coronary Syndrome, attended at the cardiology ranked hospitals in the state of Sergipe. The intervention was carried out in two appointments, with interval of 90 days between the first and the second, through individualized nutritional care. During the consultations, the food intake frequency questionnaire was applied, anthropometric measures were checked and a dietary prescription was made based on this food pattern. Results: After nutritional intervention, patients significantly increased adherence to Mediterranean dietary patterns (p <0.001). There was no significant difference in adherence to the intervention between patients assisted by the Brazilian Unified Health System and the Supplementary Health Network. The mean of BMI, neck and waist circumferences had a significant reduction (p <0.001) in the interval between the first and the second query.
Introdução: Evidências científicas demonstram que a adesão à Dieta Mediterrânea é fator protetor para diversos tipos de doenças crônicas não transmissíveis, como as doenças cardiovasculares. Este padrão dietético é essencial como medida preventiva e de tratamento para essas doenças. A adesão às mudanças de hábito é um processo dinâmico, desafiador tanto para pacientes quanto para profissionais de saúde. Entretanto, no Brasil são escassos trabalhos que mostrem a adesão à dieta em portadores de Síndrome Coronariana Aguda. Objetivo: Avaliar a adesão à intervenção nutricional baseada na Dieta do Mediterrâneo em pacientes após Síndrome Coronariana Aguda. Casuística e Métodos: Foi realizada intervenção nutricional baseada na Dieta do Mediterrâneo em 282 pacientes após Síndrome Coronariana Aguda, atendidos nos hospitais de referência cardiológica no estado de Sergipe. A intervenção foi realizada em duas consultas, com intervalo de 90 dias entre a primeira e a segunda, por meio de atendimento nutricional individualizado. Durante as consultas aplicou-se o questionário de frequência alimentar, aferiram-se medidas antropométricas e realizou-se prescrição dietética baseada neste padrão alimentar. Resultados: Após a intervenção nutricional, os pacientes aumentaram significativamente a adesão aos padrões da Dieta do Mediterrâneo (p < 0,001). Não houve diferença significativa na adesão à intervenção entre os pacientes assistidos pelo Sistema Único de Saúde brasileiro e pela Rede Suplementar de Saúde. A média do IMC, circunferências do pescoço e da cintura tiveram redução significativa (p < 0,001) no intervalo entre a primeira e a segunda consulta. Conclusão: A intervenção nutricional baseada na dieta do Mediterrâneo obteve satisfatória adesão dos participantes, tanto da rede pública quanto privada, e resultou em significativa redução dos parâmetros antropométricos.
Aracaju, SE

La fragilità è una condizione di aumentata vulnerabilità a fattori di stress a causa del declino età- correlato delle riserve fisiologiche nei sistemi neuromuscolare, metabolico e immunitario. La fragilità è una sindrome geriatrica con molteplici cause ed è caratterizzata da ridotta forza, potenza e resistenza. Nella definizione del fenotipo fragile un ruolo chiave potrebbe essere svolto dallo stato nutrizionale e dall'infiammazione. Scopo di questa tesi di dottorato è stato quello di individuare soggetti anziani fragili nella coorte dello Studio Moli-sani e stabilire una possibile relazione tra fragilità, dieta mediterranea (DM) e infiammazione. Lo Studio Moli-sani è una coorte prospettica di 24,325 uomini e donne (età ≥35 anni) che sono stati reclutati in maniera random dalla popolazione della Regione Molise, tra Marzo 2005 e Aprile 2010 per indagare i fattori di rischio genetici ed ambientali delle malattie cardiovascolari, cerebrovascolari e tumorali. La fase di richiamo dello Studio Moli-sani è iniziata a Marzo 2017 e, per il presente lavoro, è stato selezionato un sottocampione di partecipanti di età ≥65 anni. Da Maggio 2018 a Maggio 2019, 226 partecipanti (età media 72,7 ± 5,5 anni) hanno partecipato alla visita di follow-up. Per valutare la fragilità, è stato utilizzato lo strumento “Survey of Health, Ageing and Retirement in Europe-Frailty Instrument” (SHARE-FI). La popolazione è stata classificata in tre categorie-non fragili, pre-fragili e fragili-utilizzando specifici calcolatori SHARE-FI. Le informazioni sull’alimentazione sono state raccolte attraverso il questionario “European Prospective Investigation in Cancer and Nutrition Food Frequency Questionnaire” (EPIC-FFQ). L’adesione alla DM è stata calcolata utilizzando lo score Trichopoulou. Il deterioramento cognitivo e la qualità della vita correlata alla salute sono stati studiati usando due questionari: il “Montreal Cognitive Assessment” (MoCA) e lo “Short Form Health Survey” (SF-36). I marcatori biochimici per le malattie cardiovascolari (colesterolo totale, colesterolo HDL, trigliceridi, glucosio) sono stati dosati su campioni di siero. Inoltre, sono stati misurati biomarcatori dell'infiammazione e della coagulazione: la proteina C-reattiva ad alta sensibilità (hs-CRP), la conta delle cellule del sangue e i D-dimeri. In base ai marcatori dell'infiammazione, è stato calcolato uno score di low-grade inflammation (INFLA-score). La prevalenza di individui non fragili, pre-fragili e fragili è stata rispettivamente del 78,8%, 15,9% e 5,3%. Le categorie dei pre-fragili e fragili sono state unite in un’unica categoria: “pre-fragili/fragili” vs “non fragili”. Le donne erano più pre-fragili/fragili rispetto agli uomini (28,2% vs 14,7%, P=0,015). Non sono state osservate differenze tra gli anziani normali e pre-fragili/fragili nell'adesione alla DM, tranne per il consumo di legumi (P=0,010), frutta e noci (P =0,047), che era inferiore nei pre-fragili/fragili. I pre-fragili/fragili hanno mostrato un deterioramento cognitivo più elevato (test MoCA, media ± DS: 22,1 ± 4,1 vs 23,6 ± 3,5, P=0,023) e una peggiore percezione della qualità della vita correlata alla salute fisica (SF-36 score, media ± DS:41,8 ± 7,1 vs 45 ± 5,8, P=0,0057). I pre-fragili/fragili avevano livelli sierici di colesterolo totale più bassi rispetto ai non fragili (media ± DS: 185,6 ± 38,9 vs 210 ± 43,8 mg/dL, P=0,0004), probabilmente a causa dell’elevato uso di farmaci ipolipidemizzanti. I pre-fragili/fragili presentavano livelli ematici di hs-CRP più alti rispetto ai non fragili (mediana (IRQ): 2,5 (1,0;4,8) vs 1,4 (0,8;3,5) mg/L, P=0,043). Anche i livelli plasmatici dei D-dimeri erano più alti nei pre-fragili/fragili rispetto ai non fragili (mediana (IRQ):298(227;460) vs 254(226;328) ng/mL, P=0,053), evidenziando la coesistenza dell’infiammazione e della coagulazione. Questi risultati suggeriscono la possibilità che, interventi volti al controllo della via infiammazione-coagulazione, possano determinare miglioramenti dello stato di fragilità nella popolazione anziana.
Frailty is a condition of increased vulnerability to stressors due to age-related declines in physiologic reserves across neuromuscular, metabolic and immune systems. Frailty is considered a geriatric syndrome with multiple causes and contributors and it is characterized by diminished strength, power and endurance. In the definition of the frail phenotype a key role could be played by nutrition and inflammation. The aim of this PhD thesis was to screen elderlies from the Moli-sani Study population to identify frail individuals and evaluate a possible relation between frailty, mediterranean diet (MD) and inflammation. The Moli-sani Study is an ongoing, prospective, population based cohort of 24,325 men and women (aged ≥ 35 years) who were randomly recruited from the general population of the Molise region, between March 2005 and April 2010, with the purpose of investigating genetic and environmental risk factors in the onset of cardiovascular, cerebrovascular and tumor diseases. The recall phase of the Moli-sani Study started in March 2017 and a subsample of partecipants aged ≥65 years were selected for the purpose of this PhD thesis. Finally, 226 elderly participants (mean age 72.7±5.5 years) attended the follow-up visit from May 2018 to May 2019. To assess frailty, the Survey of Health, Ageing and Retirement in Europe-Frailty Instrument (SHARE-FI) was used. Two SHARE-FI calculators, one for women and one for men, were used to categorize the population studied into three categories: non-frail, prefrail and frail. Dietary information were collected through the European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire (EPIC-FFQ). Adherence to MD was calculated using the Trichopoulou score. Cognitive impairment and health-related quality of life were studied using two questionnaires: Montreal Cognitive Assessment (MoCA) and Short Form Health Survey (SF-36). Biochemical markers for cardiovascular diseases (total cholesterol, HDL-cholesterol, tryglicerdides, glucose) were tested on serum samples. Additionally, blood inflammation and coagulation biomarkers were determined: high sensitive C Reactive Protein (hs-CRP), blood cell count and D-dimers. Taking into account the inflammation biomarkers, a low-grade inflammation score (INFLA-score) was also calculated. The prevalence of non frail, pre-frail and frail individuals was 78.8%, 15.9% and 5.3%, in the Moli-sani elderly cohort, respectivelly. Pre-frail and frail categories were collapsed to create a dichotomous variable having just two categories: “pre-frail/frail” vs “non frail” individuals. Women were more pre-frail/frail than men (28.2% vs 14.7%, P=0.015). There was no difference between normal and pre-frail/frail elderly people in the adherence to MD, except for legume (P=0.010), fruits and nuts consumption (P=0.047), whose consumption was lower in pre-frails/frails. Pre-frail/frail elderlies showed a higher cognitive impairment (MoCA test, mean ±SD: 22.1±4.1 vs 23.6±3.5, P=0.023) and a worse perception of physical health-related quality of life (SF-36 physical dimension score, mean ±SD: 41.8±7.1 vs 45±5.8, P=0.0057) than non-frails. Pre-frail/frail individuals had lower levels of serum total cholesterol than non-frails (mean ±SD: 185.6±38.9 vs 210±43.8mg/dL, P=0.0004), which could be associated to higher use of lipid-lowering drugs. High blood levels of hs-CRP was found in pre-frails/frails as compared with no-frail elderly people (median (IRQ): 2.5 (1.0;4.8) vs 1.4 (0.8;3.5) mg/L, P=0.043). D-dimers plasma levels were also higher in pre-frails/frails compared to the non-frails (median (IRQ): 298 (227;460) vs 254 (226;328) ng/mL, P=0.053). Pre-frails/frails showed higher levels of blood inflammation (hs-CRP) and coagulation (D-Dimers) biomarkers which confirm the coexistence of the two processes. These findings may be relevant to promote interventions controlling inflammatory pathways to achieve important improvements in the elderly population.

Bibliography: pages 245-268.
Archaeological evidence reveals that a diet consisting of mainly of cereals, pulses and olives, supplemented by fish and with a low percentage of animal products, was consumed on Crete in the Minoan period, as it was up to this century. Modem clinical and biochemical research indicates that this traditional 'Mediterranean diet' offers certain nutritional and health benefits depending on the balances of the components - particularly relating to moderately high carbohydrate intake, low saturated (mainly animal) fatty acids and the presence of beneficial fatty acids of vegetable (especially olive) and fish origin. It has been demonstrated that intake of these latter fatty acids is associated with reduction in cardiac pathology and the development of visual and mental acuity in neonatal infants. Beneficial effects in certain cancers and auto-immune diseases are also being investigated. Lipid analyses of samples of Cretan olive oil and Aegean fish (identified taxonomically from faunal remains and Minoan frescoes) confirm good levels of both essential and other dietary fatty foods. An assessment of the nutritional benefits of the Minoan diet and its possible role in the development of Minoan Crete are investigated, using archaeological, demographic, biochemical and skeletal evidence.

Thesis (MSc)--University of Stellenbosch, 2003.
ENGLISH ABSTRACT: The Mediterranean fruit fly (Medfly), Ceratitis capitata (Wiedemann) (Diptera: Tephritidae) is well-known as a destructive pest of fruit worldwide. Various control methods have been used against this insect. The sterile insect technique (SIT) is used as an important and successful technological method for controlling or eradicating this pest in many countries. A key factor to successfully apply SIT is dependent on the availability of efficient and economical rearing methods. Artificial insect diets with low cost bulking agents have been of interest to many researchers. The present study investigated the use of locally available maize meal as a bulking agent in such diets. Maize meal is used for human consumption (in South Africa) and contains small amounts of protein. This makes the reduction of imported torula yeast as an ingredient of the diet and source of protein possible, thereby reducing the cost of the diet. The larval development of the Medfly reared on artificial diets was studied in small and large-scale tests. The effect of the diets on larval production was evaluated using pupal recovery, pupal weight, flight ability, sex ratio, fecundity and egg fertility. The results of the small-scale tests showed that the diet containing maize meal could be used to produce Medfly more economically than the standard Krige diet used by the ARC Infruitec-Nietvoorbij Research Institute at Stellenbosch. However, in large-scale tests the ingredients quantities of the diets used were not the same as those of small scale-tests. The cost of the modified larval diet was not reduced in large-scale tests. This was ascribed to the number of eggs used in the tests to produce one million of fruit flies. The maize meal with reduced number of eggs require more diet to produce one million flies therefore, making it more expensive and less viable. When similar amounts of eggs were used, the diet appears to be a suitable alternative as the result obtained was almost similar to those of the Krige diet.
AFRIKAANSE OPSOMMING: Die Mediterreens vrugtevlieg ("Medfly"), Ceratitis capitata (Wiedemann) (Diptera: Tephritidae) is wêreldwyd 'n skadelike plaag. Die steriele insek tegniek (SIT) het in baie lande 'n belangrike en suksesvolle manier geword om die plaag te beheer en uit te roei. Die belangrikste voorvereiste vir die suksesvolle toepassing van SIT is die beskikbaarheid van doeltreffende en ekonomiese teelmetodes. Meeste navorsers is geïntereseerd in kunsmatige diëte met 'n goedkoop vulstof. Hierdie studie is ontwerp om die gebruik van plaaslik beskikbare mieliemeel as vulstof te ondersoek. In Suid-Afrika word dit vir menslike gebruik aangewend en bevat klein hoeveelhede proteïene wat 'n vermindering van die ingevoerde torula gis moontlik kan maak, en sodoende die koste van die dieët kan verminder. Die ontwikkeling van Medfly larwes op kunsmatige diëte is bestudeer In kleinskaalse en grootskaalse eksperimente. Die invloed van die diëte op larwale produksie is evalueer deur gebruik te maak van van papie-ontwikkeling, papie-gewig, vliegvermoë, geslagsverhouding, volwasse voortplantingsvermoë en eiervrugbaarheid. Die resultate van die kleinskaalse toetse het aangetoon dat die mieliemeel dieët gebruik kan word om Medfly meer ekonomies as met die standaard Krige dieët, wat in die ARC Infruitec-Nietvoorbij navorsings instituut by Stellenbosch gebruik word, te teel. By die grootskaalse toetse was die koste nie laer nie. Dit word toegeskryf aan die aantal eiers wat gebruik is om 'n miljoen vlieë te produseer. Die mieliemeel dieët met 'n verminderde aantal eiers benodig meer dieët om 'n miljoen vlieë te produseer, wat dit duurder en minder lewensvatbaar maak. Wanneer soortgelyke hoeveelhede eiers gebruik was, het dit geblyk dat die dieët 'n opsie is, want die resultaat was soortgelyk aan dié van die Krige dieët.

Background: The metabolic syndrome is associated with sarcopenia. Decreased serum levels of Vitamin D (VitD) and insulin-like growth factor (IGF)-1 and their mutual relationship were also reported. We aimed to evaluate whether different dietary profiles, containing or not VitD, may exert different effects on muscle and liver. Methods: Twenty-eight male rats were fed for 10 weeks in order to detect early defects induced by different dietary regimens: regular diet (R); regular diet with vitamin D supplementation (R-DS) and regular diet with vitamin D restriction (R-DR); high-fat butter-based diets (HFB-DS and HFB-DR) with 41% energy from fat; high-fat extra-virgin olive oil-based diets (HFEVO-DS and HFEVO-DR) with 41% energy from fat. IL-1beta, insulin-like growth factor (IGF)1, Dickkopf-1 (DKK-1), and VitD-receptor (VDR) expressions were evaluated by immunohistochemistry in both muscle and liver, Collagen type I expression was evaluated in the liver. Muscle fiber perimeter was measured by histology and morphometric analysis. Severity of NAFLD was assessed by NAFLD Activity Score (NAS). Results: Muscle fibers of HEVO-DS rats were hypertrophic, comparable to those of the R-DS rats. An inverse correlation existed between the dietary fat content and the perimeter of the muscle fibers (p < 0.01). In HFB-DR rats, muscle fibers appeared hypotrophic with an increase of IL-1beta and a dramatic decrease of IGF-1 expression. All liver samples showed a NAS between 0 and 2 considered not diagnostic of steatohepatitis. Collagen I, although weakly expressed, was statistically greater in HFB-DS and HFB-DR groups. IL-1beta was mostly expressed in rats fed by HFBs and HFEVOs and R-DR, and almost absent in R and R-DS diets. IGF-1 and DKK-1 were reduced in HFBs and HFEVOs diets and in particular in DR groups. Conclusions: High-fat western diet could impair muscle and damage liver tissue in terms of inflammation and collagen I deposition, putting the basis for the subsequent steatohepatitis, still not identifiable histopathologically. VitD associated with a Mediterranean diet showed trophic action on the muscle fibers. Vitamin D restriction increases inflammation and reduces the expression of IGF-1 in the liver, worsening the fat-induced changing. EVO seems be protective against liver collagen I production.

The aim of the study was to determine the association between Mediterranean diet (MD), folate intake and global DNA methylation in women of childbearing age. A total of 177 women were enrolled in a cross-sectional study. Folate intake and MD were assessed by a validated food frequency questionnaire. LINE-1 methylation level in leukocytes was measured by pyrosequencing. Women reported poor adherence to MD (mean value 4.1) and high prevalence of folate deficiency (83.1%). Mean level of LINE-1 methylation was 65.3%. A strong association between folate deficiency and global hypomethylation, was found: women with folate deficiency had a 4 fold increased risk to be hypometylated compared with women with no folate deficiency (OR = 4; 95% CI: 1.3 11.8). In multivariate analysis, the association decreased with a borderline confidence interval (p=0.053, OR = 3; 95% CI: 1 3.3). Poor adherence to MD was not directly associated with global methylation level, however, women whose consumption of fruit was below the median (201 gr/day) had a 2.8 fold increased risk to be hypometylated in comparison with those women whose consumption was above the median value (OR = 2.8; 95% CI: 1.3 5.8; p=0.019). In multivariate logistic regression analysis, results, adjusted for age, nutritional status, smoking habits and dietary caloric intake, showed a significant relationship between low fruits intake and low methylation level (p = 0.006; OR = 3.8; 95% CI: 1.5 9.7). The inverse association between high consumption of fruit, which represents a mainsource of folate, and DNA hypomethylation, suggests that dietary pattern characterized by a high intake of fruits and, in a broader view, great adherence to MD may protect against DNA hypomethylation.

The current thesis has been developed and realized at the University of Camerino, School of Pharmacy in the Food Chemistry laboratories during my Ph.D course. This thesis provides a comprehensive assessment of the state of chemistry, nutrition and beneficial aspects of legumes, mainly lentils, which are an important food from a nutritional point of view. Whereupon, my research has been divided mainly into three parts. First of all, great attention was focused on the development of analytical instrumental methods for the analysis of important bioactive constituents in legumes, especially in lentils, such as soyasaponins and isoflavones, as well as, the fatty acid composition. The second part of this thesis was developed at the University of Valencia, Faculty of Pharmacy in the Toxicology laboratory. In this joint project, antioxidant properties of soyasaponins and lentil extracts were tested in ''in vitro'' cells to determine the cytoprotective action against mycotoxins such as Alternariol. Finally, the third part of the thesis, was focused on the ''in vivo'' study, in collaboration with Pharmacology research group of the University of Camerino, to test hypocholesterolemic action of lentil extracts rich in soyasaponins. Regarding bioactive constituents present in lentils, great attention was focused on soyasaponins that demonstrated to have health-promoting properties including plasma cholesterol-lowering, anti-carcinogenic, antioxidant and hepato-protective. In the first part of my thesis, an innovative and fast analytical method for the quantification of soyasaponins I and βg in lentils was developed. Samples were extracted using 70 % aqueous ethanol at room temperature and then injected into a high-performance liquid chromatography-tandem mass spectrometry system. The correlation coefficients of calibration curves of the analyzed compounds were ≥ 0.9997. The recoveries obtained by spiking the lentil samples with a standard mixture of soyasaponins I and βg at 50 and 100 mg l-1 were in the range of 96 - 101 and 98 - 103 %, respectively. The validated method was applied to the analysis of 30 lentil samples from central Italy. Soyasaponins I and βg were present in these lentils in concentrations that ranged from 54 to 226 mg kg-1 and from 436 to 1272 mg kg-1, respectively. Our data indicated that lentils cultivated in fields at intermediate altitudes (1142 - 1387 m) showed the highest levels of soyasaponins, a result confirmed by principal component analysis. Successively, a new analytical method for determining five isoflavone compounds, three of which are aglycons, namely daidzein, genistein, biochanin A, and two of which, daidzin and genistin, are glycosilated, in lentils and other legumes, by using an effective clean-up system and HPLC-MS/MS (triple quadrupole) method was developed. The recoveries obtained by spiking the lentil samples with a standard mixture of isoflavones at three levels of fortification (5, 25 and 100 μg kg-1) were in the range of 54.4 - 111.1 %, 68.6 - 91.1 %, and 84.4 - 114 %, respectively. The method was then applied to analyse 48 lentil samples from central Italy and other legumes for determining the isoflavone content which in lentils ranged from 1.1 to 95.6 μg kg-1, while chickpeas sample showed the highest isoflavone content (913.8 μg kg-1). After that, the fatty acid composition of 29 legumes (mostly lentils) after the optimization of the extraction method, was studied. The Folch method and liquid-solid extraction with hexane/isopropanol or with hexane/acetone were investigated, as was the effect of previous hydration of samples. Soxhlet extractions were also evaluated with different solvent mixtures. Results on fatty acids composition obtained using the hexane/isopropanol extraction method were the same in terms of fatty acids composition of the Folch method, but the extraction yield was only around 20 - 40 % of that of the Folch method preceded by hydration. Some types of legumes showed particularly interesting values for the ratio of polyunsaturated fatty acids n-6/n-3, in particular lentils, with the value of 4.0, in which PUFAs ranged from 42.0 to 57.4 %. Concerning the second part of my work, the cytotoxicity of Alternariol (AOH), soyasaponin I (SS I) and soyasaponins-rich extract from lentils was investigated, as well as, the cytoprotective effects of SS I and lentil extracts against AOH induced-cytotoxicity on Caco-2 cells. AOH is a mycotoxin produced by Alternaria spp. that has been found in vegetables such as lentils. Cytotoxic and genotoxic effects of AOH have been demonstrated previously in vitro. In our study, cytotoxicity was carried out using MTT and PC assays (AOH: 3.125 - 100 μM, SS I: 3.125 - 50 μM, and lentil extracts: 1:0 - 1:32) during 24 h of exposure in Caco-2 cells. Only AOH showed cytotoxic effect. The reduction in cell proliferation ranged from 25 % to 47 %, while simultaneous combination of SS I with AOH (1:1) increased cell proliferation (35 %) compared to AOH tested alone. Then SS I and lentil extracts showed synergistic cytoprotective effects against cytotoxicity induced by AOH on Caco-2 cells. Thus food commodities, such as lentils, containing soyasaponins could contribute to diminish the toxicological risk that natural contaminant as AOH, can produce to humans. For what concern the third part of my work, an ''in vivo'' study was realized to test the hypocholesterolemic activity of a lentil extract. However, this part of the thesis concerning the ''in vivo'' study are the basis of Patent Application, and no more details can be provided.

This paper reviewed the mechanisms of systemic inflammation and the nutritional status of the individuals who suffer from chronic diseases including rheumatoid arthritis, systemic lupus erythematous, chronic obstructive pulmonary disease, irritable bowel diseases include ulcerative colitis and Crohn’s disease, asthma, and atherosclerosis. Treatment modalities such as diet regimens will also be discussed. The Anti-Inflammatory diet, Mediterranean Diet, and the Dash diet will be discussed. Nutritional status and inflammation go hand in hand according to the findings available today. There is still more research required to completely understand the mechanisms that occur in inflammation.

"Untersuchung kardioprotektiver Wirkungen des Olivenöles und seiner phenolischen Komponenten in einer Gruppe gesunder deutscher Männer"

EINLEITUNG: Epidemiologische Daten belegen, dass die mediterrane Ernährung mit einer niedrigen Inzidenz an mit oxidativen Stress assoziierten kardiovaskulären Erkrankungen einhergeht. Dabei wird vor allem dem Olivenöl, als Hauptfettlieferant in der mediterranen Ernährung, eine kardioprotektive Wirkung zugesprochen. Olivenöl zeichnet sich neben dem hohen Gehalt an einfach ungesättigten Fettsäuren (MUFA) durch ein reichhaltiges Spektrum an phenolischen Verbindungen aus, deren antioxidative Wirkung bereits zahlreichen in in vitro Studien beschrieben wurde. Demnach könnte der Verzehr von phenolreichem Olivenöl auch in vivo vor oxidativen Schädigungen schützen und somit das Risiko für kardiovaskuläre Erkrankungen senken.

ZIELSTELLUNG: Untersuchung der kardioprotektiven Wirkung von Olivenöl und seiner phenolischen Komponenten in einer Gruppe gesunder deutscher Männer.

METHODE: Dazu wurde eine randomisierte cross-over doppelt-verblindete Interventionsstudie an 70 gesunden Männern zwischen 20 - 60 Jahren im Raum Berlin-Brandenburg durchgeführt. In jeweils drei dreiwöchigen Interventionsphasen konsumierten die Probanden täglich 25 ml natives (phenolreich), gemischtes (mittlerer Phenolgehalt) und raffiniertes (annähernd phenolfrei) Olivenöl, was sich ausschließlich im Gehalt an phenolischen Verbindungen unterschied. Das Olivenöl sollte dabei die gewöhnlich verzehrten Fette ersetzen. Die Interventionsphasen waren durch zweiwöchige Wash out-Phasen unterbrochen. Die Erhebung der Blutlipide, Biomarker der Lipidperoxidation und endogene Antioxidantien erfolgte zu Studienbeginn sowie zu Beginn und Ende jeder Verzehrsperiode.

ERGEBNISSE: Bei den Blutlipiden sowie den Biomarkern der Lipidperoxidation und den endogenen Antioxidantien konnte keine signifikante Veränderung in Abhängigkeit vom Phenolgehalt der applizierten Olivenöle nachgewiesen werden. Einzig die Glutathion-Reduktase-Aktivität stieg mit zunehmendem Gehalt an phenolischen Verbindungen (pTrend = 0,041). Unabhängig von der Konzentration der Phenole im Olivenöl wurde bei den Probanden durch den Olivenölverzehr eine Senkung von Gesamtcholesterol (p = 0,007) und Triglyzeride (p = 0,013) im Serum erzielt. Diese Wirkung geht einher mit einem gestiegenen MUFA-Anteil in der Ernährung aufgrund des Olivenölkonsums (p < 0,001).

SCHLUSSFOLGERUNG: Die Hypothese, dass die Phenole im Olivenöl aufgrund ihrer in in vitro und Tierstudien beschriebenen antioxidativen Wirkung dem Olivenöl neben dem einzigartigen Fettsäureprofil eine zusätzliche kardioprotektive Wirkung bescheren, konnte in der vorliegenden Studie nicht gezeigt werden. Dennoch konnte durch den Olivenölverzehr und der damit einhergehenden Erhöhung des MUFA-Anteils in der Ernährung eine vorteilhafte Beeinflussung der Blutlipide erzielt werden. Obgleich Olivenöl nicht das vorwiegend verzehrte Fett in Deutschland darstellt, zeigten die befragten Probanden eine hohe Akzeptanz. Folglich könnte die Integration von Olivenöl in die habituelle Ernährung einen Beitrag zur Senkung des kardiovaskulären Erkrankungsrisikos leisten.
"Cardioprotective effects of olive oil and its phenolic compounds in healthy German men"

BACKGROUND: Epidemiological data show that the Mediterranean diet is related to a low incidence of oxidative stress associated cardiovascular diseases. In particular, olive oil, which is the most consumed alimentary fat in the Mediterranean diet, is discussed to be cardio protective. Besides its high monounsaturated fatty acid content olive oil contains a remarkable amount of phenolic compounds. Results from in vitro and animal studies suggest that these phenols are powerful antioxidants. Thus, consumption of olive oil phenols also could inhibit oxidative damage in vivo and therefore could reduce the risk of cardiovascular diseases.

OBJECTIVE: To investigate the cardioprotective effect of olive oil and its phenolic compounds in healthy German men.

METHODS: Therefore, a randomised, cross-over, double-blind intervention trial in 70 healthy men aged 20 - 60 years from the Berlin-Brandenburg area was conducted. Subjects were randomised for three periods of three weeks to replace their usually consumed fat by daily 25 ml of virgin (high-phenolic), common (medium-phenolic) and refined (low-phenolic) olive oil, which vary only in their content of phenolic compounds. Each intervention was separated by a two-week wash-out period. Blood lipids, lipid peroxidation biomarker and endogenous antioxidants were assessed at study baseline and the beginning and end of each intervention period.

RESULTS: In the total study population, blood lipids, biomarker of lipid peroxidation and endogenous antioxidants were not affected by the phenolic content of the olive oils administered. Solely, a concentration-dependent increase in glutathion-reductase activity could be observed (pTrend = 0.041). A significant reduction in serum total cholesterol (p = 0.007) and triglycerides (p = 0.013) after of olive oil consumption was assessed, which was independent from the content of phenolic compounds in the olive oil. This effect goes along with an increased monounsaturated fatty acids proportion in the habitual diet of the subjects as a result of the olive oil consumption (p < 0.001).

CONCLUSION: The hypothesis, that phenolic compounds in olive oil due to its antioxidative properties reported in in vitro and animal studies provide additional cardioprotective effects besides those attributed to its unique fatty acids profile could not be supported by this study. However, olive oil consumption exert beneficial effects on blood lipids, which could be ascribed to the increased monounsaturated fatty acid content in the diet. Even though olive oil is not the main source of fat in Germany, the interviewed participants showed a high acceptance. Thus, integration of olive oil into the habitual diet could contribute to a risk reduction in cardiovascular diseases among German men.

Alzheimer’s disease (AD), the most common form of senile dementia, currently affects over 35 million people worldwide. While there is no cure or effective treatment, early intervention programs hold considerable promise. Following particular dietary patterns represents one potential intervention strategy accessible to all. Results from previous studies investigating the association of diet, cognition and biomarkers of AD are inconsistent: Positive results have been reported (1-7), whilst others have shown no associations. Prior to this thesis, no study has assessed the relationship of four dietary patterns to cognition, blood-based and neuroimaging biomarkers of AD in a large highly-characterised ageing cohort. Participants drawn from the Australian Imaging, Biomarkers, and Lifestyle study of ageing, provided a fasting blood sample, underwent comprehensive neuropsychological assessment and neuroimaging at baseline, 18 and 36 month follow-up assessments, and completed a Cancer Council of Victoria food frequency questionnaire (used to construct dietary patterns) at baseline. Chapter 3 explored the relationship between dietary pattern adherence and cognition. AD participants demonstrated reduced adherence to the ‘healthy’ Mediterranean (MeDi) and prudent diets, and higher adherence to the ‘unhealthy’ western diet and the inflammatory dietary index compared to cognitively healthy controls (HC). Longitudinal analysis conducted on individuals classified as HC at baseline proposes the importance of adhering to a ‘healthy’ dietary pattern such as the MeDi, with respect to reducing risk for cognitive decline: Executive function and visuospatial functioning appeared most susceptible to the influence of diet. Chapter 4 investigated the potential mechanisms underlying the observed effects of dietary patterns on cognition. A lack of significant associations between the MeDi and western diet patterns and biomarker indexes of metabolic syndrome and cardiovascular disease risk, suggests that modulation of these factors may not underlie the effects of diet on cognition reported in Chapter 3. Consistent with published literature, we found our western dietary pattern to be positively associated with levels of blood-based biomarkers of inflammation and the reverse to be true of our MeDi and prudent diet patterns. Our inflammatory dietary index was also strongly positively correlated with levels of numerous inflammatory biomarkers. The strong associations observed suggest that interplay between diet and elevated chronic inflammation may contribute to the effects of diet on cognition described in this thesis. Chapter 5 assessed the ‘reliability’ (similarity of 12 month dietary intake recalled on different occasions) and ‘validity’ (intake agreement between FFQ and a four-day weighed food record) of the online CSIROFFQ following addition of questions regarding foods of interest in AD research. Our results suggest that the modified CSIROFFQ is ‘reliable’ and a ‘relatively valid’ tool which provides acceptable assessment of long-term dietary intake in Australian older adults, particularly in the context of AD research. To our knowledge, this is the first study extensively comparing MeDi, inflammatory dietary index, western and prudent diet patterns to cognition and biomarkers of AD in an elderly, well-characterised cohort. Our results combined with published data, suggest diet has a role to play in AD prevention; however, it is clear that the complex link requires further characterisation.

Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Ciências da Nutrição
A dieta mediterrânica é um padrão alimentar típico dos países que se localizam no redor do mar mediterrânico, está fortemente associada a uma boa qualidade de vida. Atualmente a saúde intestinal humana encontra-se associada ao desenvolvimento de diversas doenças. Este artigo tem como primordial objetivo a realização de uma revisão da literatura sobre a influência da dieta mediterrânica na microbiota intestinal humana. Este artigo apresenta-se na forma de revisão da literatura sobre a dieta mediterrânica e a microbiota intestinal humana, estabelecendo-se uma ponte entre ambas. Realizaram-se pesquisas bibliográficas nas bases de dados PubMed, Scielo e Science Direct. A riqueza em fibras e hidratos de carbono complexos da dieta mediterrânica parece afetar de forma benéfica a microbiota intestinal humana. A dieta é capaz de promover o desenvolvimento e crescimento dos microrganismos existentes, protegendo o indivíduo do aparecimento de diversas doenças metabólicas. Conclui-se que esta dieta tem a capacidade de modular a microbiota intestinal humana trazendo benefícios para a saúde do hospedeiro, prevenindo o aparecimento de doenças e a melhoria de diversos sintomas relacionados com a disbiose.
The Mediterranean diet is a typical food pattern of countries located around the Mediterranean Sea and it is associated with good quality of life. It is known that diet has influence on human intestinal health and consequently with the development of several diseases. This article aims to review the literature in order to identify the influence of the Mediterranean diet on the human intestinal microbiota. In this sense, a bibliographic search were carried out in the PubMed, Scielo and Science Direct databases. The high content of fibre and complex carbohydrates present on the Mediterranean diet has a strong beneficial effect on intestinal microbiota. Furthermore, this food pattern promote the development and growth of existing microorganisms as well as preventing the appearance of several metabolic diseases. In conclusion the Mediterranean diet is able to positive modulate the intestinal microbiota, preventing it from dysbiosis and bringing benefits to the health of the host.
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O bom funcionamento do organismo está intimamente relacionado com o consumo alimentar, pois através dos alimentos obtemos os nutrientes essenciais para processos biológicos vitais. Várias pesquisas vêm sendo realizadas com a finalidade de se determinar a atividade antioxidante de compostos em alimentos e de forma geral, condutas e hábitos alimentares. Alguns padrões dietéticos são seguidos como modelo, sendo o caso da Dieta Mediterrânea. No presente estudo, avaliou-se a atividade antioxidante de rações alimentares (comumente denominadas dietas) consumidas em duas localidades: 1) estado de São Paulo e 2) Grécia. As rações foram elaboradas com alimentos coccionados e alimentos in natura, inerentes a cada população, obtidos através de relatórios de órgãos oficiais - Instituto Brasileiro de Geografia e Estatística (IBGE) e Eurapean Commission (Health Monitoring Programme - Data Food Networking - DAFNE). Após processamento, esses alimentos foram liofilizados e então, triturados. Para determinação da atividade antioxidante in vitro, alíquotas das rações foram desengorduradas, devido à natureza dos ensaios antioxidantes in vitro. Para determinação da atividade antioxidante in vitro foram realizados dois ensaios: cooxidação β-caroteno/ácido linoléico e 2,2-difenil-picrilhidrazil (DPPH). Além da atividade antioxidante in vitro, foram executados ensaios nas dietas para a determinação da composição centesimal, perfil de ácidos graxos e determinação dos compostos fenólicos totais. Após esse delineamento, realizou-se o ensaio biológico, onde foram utilizados 30 ratos machos, da linhagem Wistar, recém desmamados e submetidos a 30 dias de tratamento, sob condições ambientais controladas, após os quais, os animais foram sacrificados para a retirada de cérebro, fígado e plasma. Ensaios foram realizados nesses tecidos com a finalidade de se avaliar a eficácia da conduta dietoterápica: atividade de enzimas antioxidantes em tecidos alvo (fígado e cérebro), peroxidação de tecidos (fígado, cérebro e plasma) e perfil de ácidos graxos (fígado, cérebro e plasma). Os resultados obtidos indicaram que as duas dietas estudadas mantiveram a integridade orgânica. Um fato relevante é que a dieta do Estado de São Paulo foi composta por alimentos acessíveis e de hábito regular na população nacional estudada, sendo essa equiparada qualitativamente com a Dieta Mediterrânea, uma referência mundial. A Dieta Nacional do Estado de São Paulo (DNSP) possui atividade antioxidante similar à Dieta Mediterrânea (DM), utilizada como modelo de referência.
The good operation of the organism is intimately related with the alimentary consumption , since through the victuals we obtain essential nutrients for vital biological processes. Several researches have been accomplished with the purpose of being determined the antioxidant activity of composed in victuals and of general form, conducts and alimentary habits. Some dietary patterns are followed as model, being the case of the Mediterranean Diet. In the present study, the antioxidant activity of alimentary diets was evaluated (commonly denominated diets) consumed at two places: 1) state of São Paulo and 2) Greece. The diets were elaborated with victuals cooked and victuals in natura, inherent to each population, obtained through reports of official organs - Brazilian Institute of Geography and Statistics (IBGE) and European Commission (Health Monitoring Programme - it Dates Food Networking -DAFNE). After processing, those victuals were Iyophilized and then, triturated. For determination of the activity antioxidant in vitro, aliquots of the rations were degreased, due to the nature of the tests antioxidant in vitro. For determination of the activity antioxidant in vitro two rehearsals were accomplished: co-oxidation of linoléico acid and β-carotene and 2,2-difenil-picrilhidrazil (DPPH). Besides activity antioxidant in vitro, were made executed in the diets for the determination of the centesimal composition, profile of fat acids and determination of compositions total phenolics compounds. After that out line, took place the biological rehearsal, where 30 male mice were used, of the lineage Wistar, recently weaned and submitted to 30 days of treatment, under controlled environmental conditions, after the ones which, the animals were sacrificed for the brain retreat, liver and it shapes. Rehearsals were accomplished in those tissues with the purpose of evaluating the effectiveness of the diets: activity of antioxidant enzymes in woven objective (Iiver and brain), peroxidation of tissues (Iiver, brain and it shapes) and profile of fat acids (Iiver, brain and it shapes). The obtained results indicated that the two studied diets maintained the organic integrity. An important fact is that the diet of the State of São Paulo was composed by accessible victuals and of regular habit in the studied national population, being that comparison qualitative with the Mediterranean Diet, a world reference. The National Diet of the State of São Paulo (DNSP) it possesses similar antioxidant activity to a reference model, Mediterranean Diet (DM).

Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Ciências da Nutrição
A dieta Mediterrânica é um dos padrões alimentares mais saudáveis do mundo. Pelo facto de ser uma dieta muito rica em nutrientes essenciais e substâncias com atividade antioxidante e anti-inflamatória, ela tem sido implicada na manutenção da estabilidade genómica, incluindo o DNA telomérico. A disfunção telomérica tem sido associada à senescência celular, apoptose e cancro. Por isso, a investigação da interação dieta-telómero é relevante para uma melhor compreensão do papel da nutrição na prevenção de doenças crónicas caracterizadas por envelhecimento precoce e instabilidade genómica/disfunção telomérica. Este trabalho de revisão bibliográfica descreve os principais avanços científicos e tecnológicos que estiveram na génese da genómica nutricional. Adicionalmente, ele analisa o papel da dieta Mediterrânica para a manutenção da estabilidade genómica e integridade telomérica, bem como o impacto de variações genéticas humanas específicas na relação nutriente-genoma, especialmente a nível do DNA telomérico. Tratando-se de uma área emergente da genómica nutricional, a continuidade da investigação será fundamental para possibilitar, no futuro, a integração do conhecimento técnico-científico na prática clínica e aconselhamento nutricional.
The Mediterranean diet is one of the healthiest food standards of the world. Because of the abundance in essential nutrients and substances with antioxidant and anti-inflammatory activity, it has been implicated in the maintenance of genomic stability, including telomeric DNA. Telomeric dysfunction has been associated with cell senescence, apoptosis and cancer. Therefore, the research on diet-telomere interaction is relevant for a better understanding of the role of nutrition in the prevention of chronic diseases characterised by premature aging and genomic instability/telomeric dysfunction. In the present work, major technological and scientific advances that led to the development of the Nutritional Genomics field are reviewed. Additionally, the role of the Mediterranean diet on genomic stability/telomere integrity and the modulation of nutrient-genome (mainly telomeric DNA) by specific human genetic variations are analysed. As this is an emergent area of nutritional genomics, ongoing research is crucial to enable, in the future, the integration of technical and scientific knowledge into clinical practice and nutritional counselling.
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Purpose: Evidence suggests that olive oil consumption is associated with a decreased prevalence of cardiovascular disease and certain cancers. The purpose of this study was to assess the intake and knowledge of olive oil and other lipids in a collegiate population. Methods: Using an IRB-approved protocol, volunteered college students (N=56) from the college of Health and Human Sciences at Georgia State University completed a questionnaire on lipid and knowledge and eating behavior. Results were assessed to determine if students were able to accurately answer questions on the contents of different lipids, and also to determine the consumption behaviors of different lipids. Statistical comparisons were made between undergraduate and graduate students, and between students in different academic majors (nutrition, nursing, respiratory therapy, social work, criminal justice, and other). Results: It was hypothesized that eating behaviors would overemphasize unhealthy lipids. Lipids assessed included: olive oil, butter, canola oil, peanut oil, corn oil, margarine, sunflower oil, and soybean oil. There were no statistically significant differences between the ratios of consumed lipids labeled as ‘good’, and lipids labeled as ‘bad’. There were also no statistically significant differences in the presence of ‘good’ to ‘bad’ lipids in the subjects’ kitchens. Therefore, the results of this study were not able to disprove the null hypothesis. Nevertheless, using a Likert scale response scheme, there was a difference (p=0.041) between academic majors in the consumption of canola oil (an oil high in monounsaturated fatty acid), with Nursing majors reporting the highest consumption (X=3.73; SD=1.61) and Respiratory Therapy majors reporting the lowest consumption (X=1.89; SD=1.53). There was no statistically significant difference between graduate and undergraduate students in the presence of lipids in the kitchen. It was hypothesized that subject knowledge of lipid constituents would be poor. The majority of subjects either failed to respond correctly to the constituents of different lipids or reported that they did not know. Based on this result, the study is able to reject the lipid knowledge null hypothesis. There were clear differences in subgroup knowledge of commonly consumed lipids. Most notably, 100% of nutrition students responded correctly to the constituents of olive oil. Conclusions: This study focused on a group of college students in the College of Health and Human Sciences. One might assume that such a population would be sensitive and knowledgeable about key dietary factors that may influence disease risk. Nevertheless, these findings indicate that, except for isolated exceptions, the eating behaviors and lipid knowledge of these students in not at a level that could be considered health promoting. This suggests that, even with students in the health sciences, personal health classes are likely to be beneficial in reducing disease prevalence.

A dieta Mediterrânea (DM) tem sido amplamente estudada do ponto de vista epidemiológico porém, o efeito pleno específico da DM, bem como os mecanismos pelos quais esse padrão dietético contribui para redução do risco cardiovascular em prevenção secundária, são desconhecidos. Isso ocorre, em parte, devido à dificuldade de aderência observada em ensaios clínicos de intervenção dietética, especialmente estudos comparativos com dietas hipolipemiantes, por exemplo, a dieta TLC, Therapeutic Lifestyle Changes Diet (TLCD) do National Cholesterol Education Program-ATPIII. Assim, realizamos um estudo clínico, controlado, não randomizado, comparando o perfil de risco cardiovascular de dieta Mediterrânea (DM) versus dieta TLC (DTLC) em 40 pacientes com doença arterial coronariana, homogeneamente selecionados (45-65 anos de idade, homens, que tiveram ao menos um evento coronariano nos 2 últimos anos) e intensamente medicados. Uma questão paralela foi entender os efeitos de ambas as dietas nos processos de inflamação, disfunção endotelial e do estresse oxidativo, fatores-chave na aterogênese e particularmente importantes na prevenção secundária. Os hábitos culturais e dietéticos foram relevantes para alocação dos pacientes nos grupos de dieta Mediterrânea (n = 21; dieta rica em grãos integrais, vegetais, frutas, oleaginosas 10 g/dia, azeite de oliva extra-virgem 30 g/dia e vinho tinto 250 ml/dia) ou dieta TLC (n = 19; suplementada com fitosteróis 2g/dia através de creme vegetal 20 g/dia). Escores de aderência validados na literatura e específicos às dietas mostraram resultado > 90% no índice de aderência aos dois padrões dietéticos. Alguns efeitos foram comuns à dieta Mediterrânea e à dieta TLC. Com ambas, houve redução significativa de peso, índice de massa corporal (kg/m²), variáveis de composição corporal e pressão arterial. Além disso, ambas as dietas promoveram redução dos níveis plasmáticos de ADMA e da relação L-arginina/ADMA. A reatividade da artéria braquial dependente do endotélio permaneceu inalterada em ambos os grupos; no entanto, pacientes sob DM e sob DTLC melhoraram a velocidade de fluxo no momento basal (pré-hiperemia vascular). Outros efeitos foram específicos a cada padrão dietético. Com a DM, foram observados diminuição na contagem total de leucócitos versus DTLC (p =0.025) e aumento nos níveis de HDL-colesterol em 3 mg/dL (p = 0.053) versus DTLC, que mantiveram níveis de HDL-C inalterados. O diâmetro basal da artéria braquial aumentou com a DM, mas não com a DTLC. Com a DTLC, houve redução estatisticamente significante versus DM nas variáveis lipídicas colesterol total, LDL-colesterol (p < 0.05) e LDL oxidada (p = 0.009), embora a razão LDL oxidada/LDL total não tenha se alterado. Níveis séricos/plasmáticos de apolipoproteína A-1, lipoproteína(a), glicose, mieloperoxidase, sICAM, sVCAM, e as razões glutationa reduzida/oxidada em plasma e eritrócitos não se alteraram em ambos os grupos. Em conjunto, estes dados indicam um perfil de efeitos da DM e DTLC compatíveis com redução do risco cardiovascular, mesmo em pacientes intensamente medicados, em prevenção secundária. Embora estes efeitos tenham sido equivalentes entre DM e DTLC, eles parecem ser mediados tanto por alguns mecanismos comuns, como alguns mecanismos específicos de cada dieta
The Mediterranean Diet (MD) has been widely studied with respect to epidemiology, but mechanisms whereby the Mediterranean Diet (MD) is cardioprotective are unclear. This is partly because of the difficulties of adherence in clinical trials of dietary intervention, particularly trials comparing it to traditional lipid-restraining diets, e.g., Therapeutic Lifestyle Changes Diet (TLCD) from National Cholesterol Education Program ATPIII. We performed a controlled, non-randomized clinical trial comparing the cardiovascular risk profile of the Mediterranean Diet (MD) versus the TLC Diet (TLCD) in 40 selected, highly-homogeneous, and intensively medicated patients with coronary heart disease (45-65 years, males, at least one coronary event over prior 2 years). In addition, we sought to investigate both diets effects on inflammation, endothelial dysfunction and oxidative stress, all key factors in atherogenesis and particularly important in secondary prevention. Dietary/cultural habits were the basis to allocate patients for 3 months to either MD (n = 21; rich in whole grains, vegetables, fruits, nuts 10g/day, extra-virgin olive oil 30g/day, red wine 250ml/day) or TLCD (n = 19; plus phytosterols 2g/day). Specific scores showed that both diets had >90% adherence. Some effects were common to both diets. Patients in both groups showed a significant reduction in weight, body mass index, body composition and blood pressure. Also, both groups presented a reduction in plasma levels of ADMA and L-arginine/ADMA ratio. Endothelial-dependent brachial artery reactivity remained unaltered in both groups. However, patients under MD and TLCD improved flow velocity at baseline (prior to hyperemia). Nevertheless, other effects were specific to each diet. With MD, there was significant decrease in leukocyte count vs. TLCD (p = 0.03) and average increase in HDL-cholesterol by 3 mg/dL (p = 0.053) versus TLCD. The brachial arterials basal diameter increased with MD but not with TLCD. However, with TLCD there was a statistically significant reduction of lipid variables: total cholesterol, LDL-cholesterol (p < 0.05) and oxidized LDL (p = 0.009) vs. MD even though the ratio of oxidized / total LDL remained unaltered. Plasma and serum levels of apolipoprotein A-1, lipoprotein(a), glucose, myeloperoxidase, sICAM, sVCAM, and glutathione reduced/oxidized ratio in plasma and erithrocytes also remained unaltered in both groups. Together, these results demonstrate a pattern of effects of MD and TLCD compatible with cardiovascular risk reduction, in secondary prevention, even in intensely medicated patients. Although these effects were equivalent between MD and TLCD, they seem to be mediated by some common mechanisms, as well as by each diets specific mechanisms

Background: The global burden of kidney disease continues to rise but important gaps exist in our understanding of the prevalence of CKD and its complications globally and by region. Scarcity of evidence to guide public health decisions about CKD presents a serious challenge. There is a critical need to identify patterns of disease prevalence, risk factors and potential treatments. Methods: This thesis, based on contemporary evidence, has reported various epidemiological indices in kidney disease at a global and regional level, and explored whether regional dietary patterns might be associated with improved clinical outcomes. This research programme has utilised a series of quantitative methodologies, including meta-analysis of published randomised control trials (RCTs) and observational studies. Results: This research programme included a pooled analysis of disparate data sources to estimate the global burden of ESKD, the development of a novel collaboration among leading researchers in the field of nephrology in Asia: the Asian Renal Collaboration (ARC). Through a series of meta-analyses and pooled data analyses, the main findings of this thesis are that 1) 2.62 million people received RRT in 2010, but at least that many more did not have access to it and died prematurely due to ESKD, 2) 370 million adults have earlier stage CKD in Asia, 3) renal anaemia prevalence increased with progressively worsening CKD and treatment patterns varied dramatically, 4) a major shortage of evidence in exploring the Mediterranean diet as a potential therapeutic intervention for CKD, 5) potential beneficial effects of the Mediterranean diet on cardiovascular outcomes, 6) a lack of systematic data recording system in most countries in Asia. Conclusion: This thesis highlights the importance of kidney disease as a global and regional problem, and the urgent need for a standardised data collection system for kidney disease to inform public health and clinical strategies. It also highlights the need for improved access to treatment for ESKD, and for methods to standardise evidence based care for the complications of kidney disease. Future research and resources to develop methods for prevention, early detection, and delay progression of CKD will also be key. The Mediterranean diet has shown moderate beneficial effects for multiple determinants of vascular risk, exploring the role of the Mediterranean diet in the onset and progression of CKD may be an important area of future research.

Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Ciências da Nutrição
O conceito de Dieta Mediterrânica, proposto por Ancel Keys nos anos cinquenta do Século XX, está associado à prevenção de doenças e ao aumento da longevidade. No entanto, este conceito vai muito além dos hábitos alimentares, uma vez que estes constituem apenas um dos factores que a representam. Estes refletem as tradições, a cultura e a economia de cada região, caracterizando a identidade e individualidade da mesma. O objetivo deste trabalho é compreender, através da análise de receitas tradicionais portuguesas de duas regiões distintas, se o receituário tradicional português se aproxima ou afasta da Dieta Mediterrânica. Deste modo, para a seleção das receitas tradicionais, foi utilizado como referência o livro de culinária Portuguesa da autora Maria de Lourdes Modesto, “Cozinha Tradicional Portuguesa”. Após esta seleção, os alimentos presentes nas receitas foram analisados com recurso às categorias de alimentos constantes na pirâmide mediterrânica descrita por Bach-Faig, A.et al. Para cada receita foi efetuada uma análise qualitativa dos ingredientes pertencentes às diferentes categorias, e através de recurso a um cálculo simples, a frequência de aparecimento de cada categoria. Verificou-se com estes dados que as receitas analisadas para a região do Algarve apresentam uma frequência de aparecimento superior a 50% das categorias de alimentos cereais, hortícolas, azeite, ervas aromáticas, pescado, sal e especiarias e abaixo dos 50% as categorias outros (azeitonas, gordura vegetal, caracóis, açúcar, gordura animal), carne branca, carne vermelha, ovo, leguminosas e carne processada. Nas receitas analisadas para a região de Trás-os-Montes e Alto Douro verifica-se uma frequência de aparecimento acima dos 50% das categorias dos cereais, carne processada, azeite, sal e especiarias, e uma frequência abaixo dos 50% das categorias outros (castanhas, azeitonas, gordura vegetal, cogumelos, temperos) ovo, pescado, leguminosas, carne branca, gordura animal, hortícolas, batata, ervas aromáticas e carne vermelha. De acordo com os resultados obtidos neste trabalho, o receituário tradicional da região do Algarve é a que mais se aproxima da Dieta Mediterrânica, comparativamente com a região de Trás-os-Montes e Alto Douro. Deste modo, importa promover este tipo de dieta, não só pelos benefícios que apresenta, como também por forma a preservar este património.
The concept of the Mediterranean Diet, proposed by Ancel Keys in the fifties of the 20th century, is associated with disease prevention and increased longevity. However, this concept goes far beyond eating habits, since these are only one of the factors that represent it. These reflect the traditions, culture and economy of each region, characterizing the identity and individuality of it. The objective of this work is to understand, through the analysis of traditional Portuguese recipes from two different regions, if the traditional Portuguese recipe approaches or departs from the Mediterranean Diet. Thus, for the selection of traditional recipes, the Portuguese cookbook of the author Maria de Lourdes Modesto, "Traditional Portuguese Cuisine" was used as reference. After this selection, the foods present in the recipes were analyzed using the food categories in the Mediterranean pyramid described by Bach-Faig, A. et al. For each recipe a qualitative analysis of the ingredients belonging to the different categories was carried out, and through a simple calculation, the frequency of appearance of each category. It was verified with this data that the analyzed revenues for the Algarve region present a frequency of appearance of more than 50% of the categories of food cereals, vegetables, olive oil, herbs, fish, salt and spices and below 50% other categories (olives, vegetable fat, snails, sugar, animal fat), white meat, red meat, egg, legumes and processed meat. In the analyzed revenues for the region of Trás-os-Montes and Alto Douro there is a frequency of appearance of more than 50% of the categories of cereals, processed meat, olive oil, salt and spices, and a frequency below 50% (nuts, olives, vegetable fat, mushrooms, seasonings) egg, fish, legumes, white meat, animal fat, vegetables, potatoes, herbs and red meat. According to the results obtained in this work, the traditional recipe of the Algarve region is the one closest to the Mediterranean Diet, compared to the region of Trás-os-Montes and Alto Douro. Therefore, it is important to promote this type of diet, not only for the benefits it presents, but also in order to preserve this patrimony.
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O hábito alimentar tornou-se objeto de intensa pesquisa em relação ao envelhecimento cognitivo, com potencial para proteger e maximizar a função cognitiva. O objetivo desse estudo foi investigar a relação entre o grau de adesão à dieta do Mediterrâneo (MED) e ao padrão dietético MIND (Mediterranean-Dash Intervention for Neurodegenerative Delay) com o desempenho cognitivo em idosos com diferentes perfis cognitivos. Trata-se de um estudo transversal, feito com uma amostra composta por 96 idosos, com idade igual ou acima de 60 anos, de ambos os sexos, residentes na região leste de São Paulo. Os participantes foram classificados em três grupos conforme perfil cognitivo, sendo 36 considerados controles saudáveis, 30 com diagnóstico de comprometimento cognitivo leve (CCL) e 46 pacientes com doença de Alzheimer (DA). Os instrumentos utilizados foram a Bateria Breve de Rastreio Cognitivo, Mini Exame do Estado Mental, a coleta da antropometria e a aplicação de questionário de frequência alimentar com 98 itens. Posteriormente houve o cálculo dos escores do grau de adesão à MED e à MIND. Os participantes eram em sua maioria mulheres, com baixa escolaridade e baixa renda. Os grupos diagnósticos mostraram-se semelhantes para a maior parte das características avaliadas, com a exceção da idade, renda e cor da pele. Houve maior número de indivíduos mais velhos e de cor branca entre os idosos com DA e maior renda no grupo CCL. Não houve diferença significativa entre os grupos clínicos quanto ao grau de adesão às dietas, entretanto, somente entre os controles saudáveis maior adesão à MED e MIND se associou positivamente, com maior escore no MEEM e no escore de memória de Aprendizado da BBRC. Os resultados sugerem que mesmo um grau modesto de adesão aos padrões dietéticos MED e MIND pode exercer impacto sobre o desempenho cognitivo de idosos sem alterações cognitivas. Considerando que o hábito alimentar das pessoas sobre forte influência de fatores socioculturais é importante que estudos sobre o padrão de consumo alimentar e cognição sejam conduzidos em diferentes países
Dietary habits have become the subject of intense research in relation to cognitive aging, with the potential to protect and maximize cognitive function. The aim of this study was to investigate the relationship between the degree of adherence to the Mediterranean diet (MED) and the Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) with cognitive performance in elderly people with different cognitive profiles. This was a cross-sectional study, with a sample composed of 96 individuals, aged 60 years and over, of both sexes, residents in the eastern region of São Paulo. Participants were classified into three groups according to their cognitive profile, 36 were classified as healthy controls, 30 as having mild cognitive impairment (MCI) and 46 with Alzheimer\'s disease (AD). The instruments used were the Brief Cognitive Screening Battery, Mini Mental State Examination, anthropometry assessment and the application of a food frequency questionnaire with 98 items. Subsequently, the scores to indicate the degree of adherence to MED and MIND were calculated. Participants were mostly women, with low schooling and low income. Diagnostic groups were similar for most of the evaluated characteristics, with the exception of age, income, and skin color. There were more older and white individuals among participants with AD and higher income in the MCI group. There were no significant differences among the groups as to level of adherence to the diets, however, only among healthy controls higher adherence to MED and MIND was positively associated with a higher score in the MMSE and in the BBRC Learning Score. The results suggest that even a modest degree of adherence to MED and MIND dietary patterns may have an impact on the cognitive performance of seniors without cognitive impairment. Considering that people\'s eating habits are strongly influenced by sociocultural factors, it is important that studies on the pattern of food consumption and cognition are conducted in different countries

Este trabalho avalia o efeito da regularização do caudal pela presença de barragens na disponibilidade alimentar do meio aquático e consequentemente na dieta e actividade alimentar do barbo do Norte. Exemplares adultos foram capturados em rios com características hidrológicas distintas. Barbos do sistema permanente apresentaram uma dieta mais diversificada, principalmente nos períodos de aumento do caudal. Barbos dos rios temporários tiveram uma dieta mais uniforme, sobretudo nos períodos secos do ano. A regularização do caudal afeta de modo diferente os componentes do rio em ambos os sistemas, porém os efeitos sobre os recursos alimentares e sobre a dieta foram semelhantes. A mudança na dieta e atividade alimentar em ambos os sistemas está fortemente associada à variabilidade sazonal dos componentes de caudal e à redução da variabilidade do fluxo causada pela regulação da barragem. Os resultados obtidos podem orientar a implementação de programas de minimização da alteração antropogénica do caudal; Abstract: Determination of the effect of hydrological regime and the regulation of flow in the trophic ecology of the northern Iberian barbel (Luciobarbus bocagei Steindachner 1864) This study evaluates the effect of flow regulation by the presence of dams in food availability in the aquatic environment and consequently in diet and feeding activity of barbel North. Adult specimens were caught in rivers with different hydrological characteristics. Barbels from the permanent system showed a more diverse diet, especially during periods of increased flow. Barbels from temporary rivers had a more uniform diet, especially during dry periods of the year. Flow regulation affects different the components of the river on both systems, but the effects on food resources and fish diet were similar. A change in diet and feeding activity in both systems is strongly associated with seasonal variability of flow components, and reduced flow variability caused by dam regulation. The results can guide the implementation of programs to minimize the anthropogenic alteration of the flow.

The anti-atherogenic effects ascribed to a Mediterranean-type diet rich in monounsaturated
fatty acids (MUFAs) from virgin olive oil are due, partly, to an increase in, or maintenance of,
plasma concentrations of high density lipoprotein (HDL) cholesterol. However, the underlying
mechanisms that may explain these concentrations are not well characterised, to-date.
Apolipoprotein (apo) A-I (apoA-I) is the major HDL apo and its kinetic parameters, such as
production rate and catabolic rate, reflect the kinetics of the HDL particle. Our working
hypothesis is as follows: a Mediterranean-type diet rich in MUFAs from virgin olive oil,
compared to a STEP II diet, increases or preserves HDL cholesterol concentrations due to an
increase in apoA-I production and not to a decrease in apoA-I catabolism. Kinetic studies
using stable isotopes are, perhaps, the best approach in physiologically evaluating apo
production and catabolism in humans. This methodology has not as yet been implemented in
Spain. Objectives: to implement the necessary methodology to perform kinetic studies of apo
B-100 and, especially, of apoA-I and apoA-II in volunteers in vivo using stable isotopes to
label proteins in vivo. Further, we used this methodology to analyse the overall effects of a
Mediterranean-type diet rich in monounsaturated fatty acids from virgin olive oil compared
with a low-fat, STEP II diet, on HDL and low density lipoprotein (LDL) metabolism. Design:
we conducted a crossover, randomised study with dietary intervention periods of 4 weeks,
interspersed with a washout period between diets. A total of 10 healthy, moderately
hypercholesterolaemic, male volunteers consumed the two diets. The project was approved
by the Clinical Research Ethical Committee of the Hospital Universitari de Sant Joan, Reus.
Instrumentation: kinetic studies were performed at the end of each diet using a 16h primed
constant infusion of stable isotope
2
H3-L-leucine. Lipoprotein fractions were separated using
ultracentrifugation technique. Stable isotope incorporated into proteins was measured using
GC-MS. The data obtained were analysed applying multi-compartmental modelling technique
with the SAAM II program. ApoA-I and A-II kinetic studies were conducted in our Research
Unit in Reus. Apo B-100 kinetic studies and kinetic parameter modelling were performed in
collaboration with Dr. Caslake and Professor Packard of the Vascular Biochemistry Section,
Division of Cardiovascular & Medical Sciences, Royal Infirmary, University of Glasgow,
Glasgow, Scotland. Results: the Mediterranean diet, compared to the STEP II diet,
significantly increases apoA-I plasma concentrations. A total of 17 kinetic studies have been
performed but, due to methodological complexity, only the results of 7 kinetic studies (4
following a Mediterranean diet and 3 following a STEP II diet) that have been analysed in a
GC-MS to-date, are presented in this thesis. Despite the limitation of the low number of
kinetic studies analysed, we are able to document that the Mediterranean diet induces a high
apoA-I HDL production rate compared to the STEP II diet. Also, the Mediterranean diet
induces a high apo B-100 LDL production rate and fractional catabolic rate compared to the
STEP II diet. Conclusions: we have, for the first time in Spain, implemented the necessary
methodology to perform apo B-100, apoA-I and A-II kinetic studies in vivo using stable
isotopes in human subjects. A high apoA-I production rate is the main determinant of high
plasma concentrations of apoA-I, and not variations in its catabolism. Lipoprotein kinetic
studies enable the monitoring of lipoprotein metabolic parameters and the investigation of
nutritional and pharmacologic interventions in the primary and secondary prevention of
cardiovascular disease targets.
Els efectes antiaterogènics atribuïts a una dieta de tipus mediterrani, rica en àcids grassos
monoinsaturats (AGM), aportats per oli d'oliva verge, són deguts, en part, a l'augment o al
manteniment de les concentracions plasmàtiques de colesterol de les lipoproteïnes d'alta
densitat (HDL). No obstant i fins al moment, no es coneixen del tot els mecanismes que
expliquen aquestes concentracions. L'apolipoproteïna (apo) A-I (apoA-I) és l'apolipoproteïna
majoritària de les HDL i els seus paràmetres cinètics, com ara la taxa de producció i la taxa
de catabolisme, reflexen la cinètica de les partícules d'HDL. La nostra hipòtesi de treball és la
següent: una dieta Mediterrània rica en AGM aportats per oli d'oliva verge, comparada amb
una dieta STEP II, incrementa o manté els nivells de colesterol de les HDL degut a un
augment de la producció i no a una disminució de la degradació d'apoA-I. Possiblement, la
realització d'estudis de cinètiques utilitzant isòtops estables és la forma més fisiològica
d'avaluar la producció i la degradació d'apolipoproteïnes en l'home. Objectiu: Implementar la
metodologia necessària per realitzar cinètiques d'apo B-100 i, especialment, d'apoA-I i
d'apoA-II en voluntaris in vivo utilitzant isòtops estables com a marcatge de les proteïnes.
Aplicar aquesta metodologia per comparar els efectes d'una dieta Mediterrània rica en oli
d'oliva verge amb una dieta pobra en greixos STEP II sobre el metabolisme de les HDL i de
les lipoproteïnes de baixa densitat (LDL). Disseny: Estudi creuat randomitzat de 4 setmanes
d'intervenció dietètica, amb un període de rentat entre elles. 10 voluntaris, homes sans,
moderadament hipercolesterolèmics van seguir ambdues dietes. Aquest estudi va ser
aprovat pel Comitè d'Ètica i d'Investigació Clínica de l'Hospital Universitari de Sant Joan de
Reus. Instrumentalització: Estudi cinètic mitjançant la injecció i perfusió d'isòtop estable 2H3-
L-leucina en forma d'un bolus inicial i de perfusió durant 16h al final de cada dieta. Les
diferents fraccions lipoproteïques es van separar per ultracentrifugació. La detecció d'isòtop
incorporat va ser mitjançant GC-MS. Les dades obtingudes es van analitzar amb models
multicompartimentals i el programa SAAM II. Els estudis cinètics d'apoA-I i d'apoA-II es van
posat a punt i realitzat a la nostra Unitat de Recerca a Reus. Els estudis d'apo B-100 i la
modelització de les dades cinètiques es van realitzar en colClaboració amb el grup de recerca
de la Vascular Biochemistry Section, Division of Cardiovascular & Medical Sciences, Royal
Infirmary, University of Glasgow, Glasgow). Resultats: La dieta Mediterrània, comparada
amb la dieta STEP II, incrementa significativament la concentració plasmàtica d'apoA-I.
S'han realizat 17 cinètiques però, degut a la complexitat de la metodologia, en aquesta tesis
es presenten els resultats de les 7 cinètiques (4 després de la dieta Mediterrània i 3 després
de la dieta STEP II) analitzades per GC-MS fins ara. A pesar de l'escàs nombre de cinètiques,
s'observen certes tendències. La dieta Mediterrània, comparada amb la dieta STEP II,
presenta una major taxa de producció d'apoA-I de les HDL, així com una major taxa de
producció i de catabolisme de l'apo B-100 de les LDL. Conclusions: S'ha implementat la
metodologia dels estudis de cinètiques amb isòtops estables de l'apoA-I i l'apoA-II de les
HDL i de l'apo B-100 de les VLDL1, VLDL2, IDL i LDL. El determinant de les concentracions
més elevades d'apoA-I en plasma és una major taxa de producció d'aquesta apo i no
diferències en el seu catabolisme. Les aportacions de las cinètiques de les lipoproteïnes
permetran avançar en els mecanismes lipídics involucrats en les malalties vasculars i aportar
nous aspectes sobre les dianes nutricionals i farmacològiques.

Hi ha un risc de malnutrició elevat en la població anciana i aquest risc és més gran en els pacients amb Malaltia d'Alzheimer (MA). La finalitat d'aquesta investigació va ser avaluar l'estat nutricional dels pacients amb MA en les diferents etapes de la malaltia i explorar com aquest estat es correlaciona amb les variables cognitives, funcionals, conductuals i el nivell de sobrecàrrega dels cuidadors. Es va realitzar un estudi observacional descriptiu prospectiu. La mostra estudiada en la valoració inicial va ser de 101 pacients i de 73 a la revaloració. Es va evidenciar que hi ha un risc de malnutrició elevat en els pacients amb MA i aquest pitjor estat nutricional es va correlacionar amb la situació cognitiva, conductual, funcional i el grau de sobrecàrrega del cuidador. L'escassa adhesió a la dieta mediterrània obliga a incrementar l'educació dietètica en aquest grup de pacients per millorar, en la mesura del possible, el seu pronòstic.
Existe un riesgo de malnutrición elevado en la población anciana y este riesgo es mayor en los pacientes con Enfermedad de Alzheimer (EA). La finalidad de esta investigación fue evaluar el estado nutricional de los pacientes con EA en las diferentes etapas de la enfermedad y explorar cómo este estado se correlaciona con las variables cognitivas, funcionales, conductuales y el nivel de sobrecarga de los cuidadores. Se realizó un estudio observacional descriptivo prospectivo. La muestra estudiada en la valoración inicial fue de 101 pacientes y de 73 en la revaloración. Se evidenció que existe un riesgo de malnutrición elevado en los pacientes con EA y este peor estado nutricional se correlacionó con la situación cognitiva, conductual, funcional y el grado de sobrecarga del cuidador. La escasa adhesión a la dieta mediterránea obliga a incrementar la educación dietética en este grupo de pacientes para mejorar, en la medida de lo posible, su pronóstico.
There is a high risk of malnutrition in the elderly population and this risk is higher in patients with Alzheimer's disease (AD). The purpose of this investigation was to evaluate the nutritional status of patients with AD in the different stages of the disease and to explore how this state correlates with the cognitive, functional, and behavioral variables and the level of overload of the caregivers. A prospective descriptive observational study was carried out. The sample studied in the initial assessment was 101 patients and 73 in the reassessment. It was evidenced that there is a high risk of malnutrition in patients with AD and this worse nutritional status was correlated with the cognitive, behavioral, functional situation and the degree of overload of the caregiver. The lack of adherence to the Mediterranean diet requires increasing dietary education in this group of patients to improve, as far as possible, their prognosis.