The Mediterranean Diet in the Stroke Belt: A Cross-sectional Study on Adherence and Perceived Knowledge, Barriers, and Benefits (P18-066-19)

Abstract Objectives The Mediterranean diet (MD) is recommended by the current Dietary Guidelines for Americans, yet little is known about the diet in the US, particularly in areas of high chronic disease. Thus, we investigated MD adherence and perceived benefits and barriers to consumption of the MD in the US Stroke Belt. Methods A survey containing 44 validated MD knowledge, barriers, and benefits (KBB) questions, a validated 14-question MD adherence screener, 7 questions based on the Precaution Adoption Model (stages of change), and 7 demographic/anthropometric questions was distributed systematically to US residents using Amazon Mechanical Turk. Responses from the Stroke Belt (SB; n = 304), California (CA; n = 489), and all other US states (OtherUS; n = 439) were obtained. The CA group served as the reference group. A linear model was used to assess KBB question scores in the groups (Model 1), adjusted for sex and age (Model 2), and all other demographic variables (Model 3). Multivariable linear regression analysis was used to assess the differences in total MD adherence scores between the groups adjusted for all covariates. Simple logistic regression for having heard of the MD with demographic variables was examined. Statistical analyses were conducted in R v3.5.2. Results Barriers on MD knowledge, convenience, sensory factors, and health and familiarity with the MD diet were significantly greater in the SB group, but not the OtherUS group, in all models (P < 0.05). Weight loss was found to be a significantly greater benefit in the SB group in all models (P < 0.05). For each point increase in MD adherence, a reduction in 0.32 and 0.48 points (P < 0.05) was observed in the SB and otherUS groups, respectively. In the full cohort, the odds for participants having heard of the MD prior to taking the survey significantly increased 12.50 times (95%CI, 2.56–226) for 65–74 year olds. The odds were also significantly increased (OR 1.68; 95%CI, 1.13–2.47 and OR 2.47; 95%CI, 1.45–4.32) for those with Bachelor's and Master's or professional degrees, respectively, while no significant differences were found with sex or race. Conclusions Our results identify key barriers and benefits of the MD in the SB which can inform targeted MD intervention studies. Funding Sources USDA Hatch Funding Program (MWG) and Haggard Family Annual Award in Nutrition and Dietetics (OJ).

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The Mediterranean Diet in the Stroke Belt: A Cross-Sectional Study on Adherence and Perceived Knowledge, Barriers, and Benefits

Nutrients ◽

10.3390/nu11081847 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1847 ◽

Cited By ~ 1

Author(s):

Caroline J. Knight ◽

Olivia Jackson ◽

Imran Rahman ◽

Donna O. Burnett ◽

Andrew D. Frugé ◽

...

Keyword(s):

Mediterranean Diet ◽

Linear Regression Analysis ◽

Cross Sectional Study ◽

Dietary Guidelines ◽

Sectional Study ◽

Perceived Knowledge ◽

Cross Sectional ◽

The Mediterranean ◽

Stroke Belt ◽

The U.S

The Mediterranean diet (MedDiet) is recommended by the current Dietary Guidelines for Americans, yet little is known about the perceived barriers and benefits to the diet in the U.S., particularly in the Stroke Belt (SB). Thus, the purpose of this study was to examine MedDiet adherence and perceived knowledge, benefits, and barriers to the MedDiet in the U.S. A cross-sectional study was conducted on 1447 participants in the U.S., and responses were sorted into geographic groups: the SB, California (CA), and all other US states (OtherUS). Linear models and multivariable linear regression analysis was used for data analysis. Convenience, sensory factors, and health were greater barriers to the MedDiet in the SB group, but not the OtherUS group (p < 0.05). Weight loss was considered a benefit of the MedDiet in the SB (p < 0.05), while price and familiarity were found to be less of a benefit (p < 0.05). Respondents with a bachelor’s degree or greater education had greater total MEDAS scores (p < 0.05) and obese participants had a lower MedDiet adherence score (p < 0.05). Our results identify key barriers and benefits of the MedDiet in the SB which can inform targeted MedDiet intervention studies.

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Association of the Chronotype Score with Circulating Trimethylamine N-Oxide (TMAO) Concentrations

Nutrients ◽

10.3390/nu13051671 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1671

Author(s):

Luigi Barrea ◽

Giovanna Muscogiuri ◽

Gabriella Pugliese ◽

Chiara Graziadio ◽

Maria Maisto ◽

...

Keyword(s):

Mediterranean Diet ◽

Metabolic Profile ◽

Cardiometabolic Risk ◽

Linear Regression Analysis ◽

Biological Rhythms ◽

Unhealthy Lifestyle ◽

Gut Dysbiosis ◽

Study Population ◽

The Mediterranean ◽

The Individual

Individual differences in the chronotype, an attitude that best expresses the individual circadian preference in behavioral and biological rhythms, have been associated with cardiometabolic risk and gut dysbiosis. Up to now, there are no studies evaluating the association between chronotypes and circulating TMAO concentrations, a predictor of cardiometabolic risk and a useful marker of gut dysbiosis. In this study population (147 females and 100 males), subjects with the morning chronotype had the lowest BMI and waist circumference (p < 0.001), and a better metabolic profile compared to the other chronotypes. In addition, the morning chronotype had the highest adherence to the Mediterranean diet (p < 0.001) and the lowest circulating TMAO concentrations (p < 0.001). After adjusting for BMI and adherence to the Mediterranean diet, the correlation between circulating TMAO concentrations and chronotype score was still kept (r = −0.627, p < 0.001). Using a linear regression analysis, higher chronotype scores were mostly associated with lower circulating TMAO concentrations (β = −0.479, t = −12.08, and p < 0.001). Using a restricted cubic spline analysis, we found that a chronotype score ≥59 (p < 0.001, R2 = −0.824) demonstrated a more significant inverse linear relationship with circulating TMAO concentrations compared with knots <59 (neither chronotype) and <41 (evening chronotype). The current study reported the first evidence that higher circulating TMAO concentrations were associated with the evening chronotype that, in turn, is usually linked to an unhealthy lifestyle mostly characterized by low adherence to the MD.

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Historical origins of the Mediterranean Diet, Regional Dietary Profiles, and the Development of the Dietary Guidelines

Mediterranean Diet ◽

10.1007/978-3-319-27969-5_4 ◽

2016 ◽

pp. 43-56 ◽

Cited By ~ 1

Author(s):

Nadine R. Sahyoun ◽

Kavitha Sankavaram

Keyword(s):

Mediterranean Diet ◽

Dietary Guidelines ◽

The Mediterranean ◽

Historical Origins

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The Nutrient Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Feasibility Phase

Blood ◽

10.1182/blood-2019-130851 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5380-5380

Author(s):

Laura F. Mendez ◽

Hellen Nguyen ◽

Jenny Nguyen ◽

Alexander Himstead ◽

Melinda R. Lemm ◽

...

Keyword(s):

Fatty Acids ◽

Disease Progression ◽

Mediterranean Diet ◽

Gut Microbiome ◽

Dietary Pattern ◽

Research Funding ◽

Symptom Burden ◽

Dietary Guidelines ◽

Intervention Phase ◽

The Mediterranean

The Mediterranean diet, characterized by increased consumption of extra virgin olive oil (EVOO), nuts, legumes, vegetables, fruits, fish, and whole grain products, has proven to be beneficial in diseases where chronic subclinical inflammation plays a key role (Calder et al., 2011). For example, the PREDIMED (Prevención con Dieta Mediterránea) study demonstrated that a Mediterranean diet supplemented with EVOO or nuts reduced the incidence of major cardiovascular events (Estruch et. al, 2010). The Mediterranean diet's anti-inflammatory properties are attributed to its richness in phenolic compounds and main nutrients, such as: fiber, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, vitamins C and E, and carotenoids (Casas et al., 2017). Overproduction of pro-inflammatory cytokines like IL-6 and TNF-α is a characteristic feature of Myeloproliferative Neoplasm (MPN) and correlates with high symptom burden and may also play a role in disease progression (Craver et al., 2018). Therefore, reduction of inflammation at the early stages of disease through low-risk interventions such as diet could lessen symptom burden and potentially blunt disease progression. To date, this nutrition trial will be the first to study the effects of the Mediterranean dietary pattern in MPN patients. To initially assess the feasibility of a Mediterranean diet intervention among MPN patients, we developed a prospective interventional proof-of-concept study of 30 MPN patients randomized (1:1) to either a Mediterranean diet supplemented with EVOO or the United States Dietary Guidelines for Americans (USDA). Inclusion and exclusion criteria are listed in Table 1 and study schematic is shown in Figure 1. The primary endpoint for this study is adherence to a Mediterranean diet with our diet curriculum. Exploratory endpoints include reduction in inflammatory biomarkers, reduction in symptom burden, and change in the gut microbiome. All participants meet once at the start of the intervention period (week 3) with a dietician for one-on-one counseling to educate the participant on the central components of the Mediterranean diet or the US Dietary guidelines and tailor the diet to meet each participant's medical needs and or cultural preferences. Participants are emailed 10 weekly installments of educational materials on their respective diet. At weeks 3 and 9, participants in the Mediterranean diet arm are given 750ml of EVOO and participants in the USDA arm receive a $10 grocery gift card. Six unannounced surveys and 24-hour food recalls are collected throughout the duration of the 15-week study. Conformity with the Mediterranean dietary pattern is assessed by the 14-item Mediterranean diet adherence score. Symptom burden is assessed using the MPN symptom assessment form (MPN-SAF). Four biological sample data points are collected during the 15-week study which includes collection of blood, stool, and urine. Complete blood count, Comprehensive Metabolic Panel, Lipid Panel, hsCRP are measured, and plasma is stored for cytokine analysis. Urine is used to quantify urine total polyphenol excretion. Stool samples are used to measure changes in the gut microbiome with diet. Since opening in October 2018, we have screened 44 potential participants. Four did not meet the inclusion criteria, 8 participants did not respond to initial surveys, and thus, did not progress to the intervention phase and were not randomized. Of the 32 participants who were randomized, 2 withdrew due to family illness. Eighteen participants have completed the 15-week study and 12 participants are currently in the active intervention phase. Demographics of the 30 participants who have completed this study or are currently receiving active intervention are shown in Table 2. In summary, this is a feasibility study to evaluate if MPN patients can adhere to a Mediterranean diet when given written curriculum and verbal counseling, and to explore whether a diet rich in anti-inflammatory properties can improve MPN symptoms. Geography was a limitation for this study, participants who were not in Southern California found it difficult to arrange travel for in-person visits. Patients who self-referred were more responsive and engaged than those recruited from clinic. Subsequent trials will test the impact of diet in a larger group of MPN patients, likely with a remotely administered intervention to obviate the need for travel. Disclosures Scherber: Incyte: Consultancy; Blueprint: Other: Ad board; Gilead: Consultancy. Mesa:Genotech: Research Funding; Celgene: Research Funding; Promedior: Research Funding; CTI Biopharma: Research Funding; Incyte: Research Funding; Samus: Research Funding; Novartis: Consultancy; La Jolla Pharma: Consultancy; AbbVie: Research Funding; Sierra Onc: Consultancy. Fleischman:incyte: Speakers Bureau.

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Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study

Public Health Nutrition ◽

10.1017/s1368980010000479 ◽

2010 ◽

Vol 13 (10) ◽

pp. 1614-1621 ◽

Cited By ~ 37

Author(s):

Alexia Katsarou ◽

Stefanos Tyrovolas ◽

Theodora Psaltopoulou ◽

Akis Zeimbekis ◽

Nikos Tsakountakis ◽

...

Keyword(s):

Mediterranean Diet ◽

Dietary Habits ◽

Eastern Mediterranean ◽

Economic Status ◽

Linear Regression Analysis ◽

Mediterranean Islands ◽

Significant Positive Association ◽

Financial Status ◽

Socio Economic Status ◽

The Mediterranean

AbstractObjectiveTo investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet.DesignCross-sectional.SettingAdherence to the Mediterranean diet was measured by the MedDietScore (range: 0–55), whereas SES was estimated using education and financial status.SubjectsDuring 2005–2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65–100 years), free of known chronic diseases, participated in the survey.ResultsMultiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P< 0·01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P= 0·004), as well as financial status (P= 0·001).ConclusionsOlder Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status.

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NHANES 2011–2014 Reveals Cognition of US Older Adults may Benefit from Better Adaptation to the Mediterranean Diet

Nutrients ◽

10.3390/nu12071929 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1929

Author(s):

Matthew K. Taylor ◽

Jonathan D. Mahnken ◽

Debra K. Sullivan

Keyword(s):

Older Adults ◽

Cognitive Performance ◽

Mediterranean Diet ◽

Ordinary Least Squares ◽

Sensitivity Analyses ◽

Least Squares Regression ◽

Cognitive Measures ◽

The Us ◽

The Mediterranean ◽

Ad Prevention

Although the Mediterranean diet (MedD) has gained interest for potential Alzheimer’s disease (AD) prevention, it is unknown how well US older adults follow a MedD. We used two National Health and Nutrition Examination Survey (NHANES) cycles (2011–2014) to conduct our primary aim of reporting population estimates of MedD adherence among older adults (60+ years) in the US (n = 3068). The mean MedD adherence score for US older adults was 5.3 ± 2.1 (maximum possible = 18), indicating that older adults in the US do not adhere to a MedD. There were various differences in MedD scores across demographic characteristics. We also assessed the cross-sectional relationship between MedD adherence and cognitive performance using survey-weighted ordinary least squares regression and binary logistic regression models adjusted for 11 covariates. Compared to the lowest MedD adherence tertile, the highest tertile had a lower odds ratio of low cognitive performance on three of five cognitive measures (p < 0.05 for each). Sensitivity analyses within participants without subjective memory complaints over the past year revealed similar results on the same three cognitive measures. We conclude that MedD interventions are a departure from usual dietary intake of older adults in the US and are a reasonable approach for AD prevention trials.

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Racial Differences in the Association of Mediterranean Diet with Cognitive Decline (P14-002-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz052.p14-002-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Puja Agarwal ◽

Yamin Wang ◽

Lisa Barnes ◽

Thomas Holland ◽

Denis Evans ◽

...

Keyword(s):

Cognitive Decline ◽

Racial Differences ◽

Mediterranean Diet ◽

Sex Education ◽

Cognitive Assessments ◽

Funding Sources ◽

The Us ◽

Education Participation ◽

The Mediterranean ◽

The Impact

Abstract Objectives The US older population is on the rise and projected to be 42% minority by 2050. Cognitive impairment is one of the major public health concerns of an aging population, and diet is one possible modifiable risk factor. However, we have limited knowledge of diet associations with cognition in minorities as most of the findings are either not reported by race or the data is not available for non-white populations. In a previous study, we found Mediterranean diet associated with slower cognitive decline in the biracial population of Chicago Health and Aging Project (CHAP). In this study, we examined this association in CHAP separately by race (Blacks and Whites). Methods Analyses included 4985 participants of the Chicago Health and Aging Project (63% African American, mean age = 75 ± 6.0 years, mean education = 12.6 ± 3.6 years) who completed a food frequency questionnaire and at least two cognitive assessments (a composite of 4 cognitive tests) over an average follow-up of 6.3 years. Computed scores of adherence to the Mediterranean diet were analyzed in tertiles of intake. We used mixed models adjusted for age, sex, education, participation in cognitive activities, physical activity, and total calories. Results Among Whites, both the middle (β = 0.014, P = 0.06) and highest tertiles of Mediterranean scores (β = 0.022, P = 0.003) were associated with slower cognitive decline compared to the lowest tertile of scores. Among Blacks, only the highest tertile of Mediterranean scores was associated with slower cognitive decline (T3 vs. T1: β = 0.014, P = 0.016; T2 vs. T1: β = −0.004, P = 0.92). The associations remained similar when further adjusted for cardiovascular conditions. Conclusions The Mediterranean diet associations with cognition may vary by race. Further study is required to understand these potential racial differences for the impact of diet on cognition. Funding Sources RFAG054057.

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Food Consumption during Pregnancy and Post-Partum. ECLIPSES Study

Nutrients ◽

10.3390/nu11102447 ◽

2019 ◽

Vol 11 (10) ◽

pp. 2447 ◽

Cited By ~ 7

Author(s):

Cristina Jardí ◽

Estefania Aparicio ◽

Cristina Bedmar ◽

Núria Aranda ◽

Susana Abajo ◽

...

Keyword(s):

Social Class ◽

Pregnant Women ◽

Mediterranean Diet ◽

Food Consumption ◽

Post Partum ◽

Dietary Guidelines ◽

Processed Meat ◽

Maternal Factors ◽

The Mediterranean ◽

Post Partum Period

Inadequate maternal diet can adversely affect mother and child. Our aim was to assess adherence to the Spanish dietary guidelines and to the Mediterranean diet, to analyze changes in diet during pregnancy and post-partum, and to identify maternal factors associated with food consumption. A total of 793 healthy pregnant women were recruited during the first prenatal visit and followed until the post-partum period. Data from the clinical history, anthropometric measurements, and lifestyle habits were collected. Food consumption was evaluated using a food frequency questionnaire. The results show that in pregnant women the consumption of healthy foods did not meet recommendations, whereas consumption of red and processed meat and sweet food exceeded recommendations. The results also show a medium adherence to the Mediterranean diet that remained unchanged throughout pregnancy. A significant decrease was observed in the consumption of fruits, followed by vegetables and then salted and sweet cereals from pregnancy to post-partum. A better adherence to the Mediterranean diet has been reported by pregnant women that are older, of higher social class, and higher education level, and who do not smoke nor drink (p < 0.005). In conclusion, the diet of pregnant women from Spain departs from recommendations, medium adherence to the Mediterranean diet was maintained throughout the pregnancy and post-partum, and a decreasing consumption of healthy food from the first trimester to the post-partum period was observed. Maternal factors such as age, social class, education, and smoking influence diet quality.

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Mediterranean diet and mental distress: “10,001 Dalmatians” study

British Food Journal ◽

10.1108/bfj-06-2018-0339 ◽

2019 ◽

Vol 121 (6) ◽

pp. 1314-1326 ◽

Cited By ~ 3

Author(s):

Fiorella Pia Salvatore ◽

Ajka Relja ◽

Ivona Šimunović Filipčić ◽

Ozren Polašek ◽

Ivana Kolčić

Keyword(s):

Mental Health ◽

Mediterranean Diet ◽

Mental Distress ◽

Linear Regression Analysis ◽

Community Dwelling ◽

Multivariate Linear Regression Analysis ◽

Inverse Association ◽

Content Type ◽

The Mediterranean ◽

The Impact

PurposeThe impact of eating habits on mental health is gaining more attention recently. The purpose of this paper is to investigate the association between mental distress and the Mediterranean diet (MD) in a community-dwelling adult population of Dalmatia, Croatia.Design/methodology/approachParticipants from the “10,001 Dalmatians” study from the Island of Korcula and the City of Split were included (n=3,392). Lifestyle habits were investigated using a self-administered questionnaire, while mental distress was evaluated using the General Health Questionnaire-30 (GHQ-30) in a cross-sectional design. MD compliance was assessed using the Mediterranean Diet Serving Score. Multivariate linear regression analysis was used in the analysis.FindingsMD compliance was associated with lesser mental distress (ß=−1.96, 95% CI −2.75, −1.17;p<0.001). Inverse association was found between mental distress and higher intake of fruits (ß=−0.64; 95% CI −0.89, −0.39;p<0.001), vegetables (ß=−0.39; 95% CI −0.65, −0.13;p=0.003), olive oil (ß=−0.30; 95% CI −0.56, −0.04;p=0.022) and legumes (ß=−0.83; 95% CI −1.66, 0.00;p=0.049). Mental distress was more intense in women, older participants, those with worse material status, subjects with previously diagnosed chronic diseases and in current smokers.Originality/valueThis study suggests beneficial association of MD and overall mental health, offering important implications for public health provisions. Since the literature search did not reveal any previous study on the association between the MD and GHQ-based mental distress in the general population, this study delivers interesting results and fills this knowledge gap.

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Effects of the Mediterranean Lifestyle During the COVID-19 Lockdown in Spain: Preliminary Study

Frontiers in Nutrition ◽

10.3389/fnut.2021.683261 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ana Zaragoza-Martí ◽

Miriam Sánchez-SanSegundo ◽

Rosario Ferrer-Cascales ◽

Eva Maria Gabaldón-Bravo ◽

Ana Laguna-Pérez ◽

...

Keyword(s):

Nutritional Status ◽

Mediterranean Diet ◽

Intervention Program ◽

Dietary Guidelines ◽

Control Group ◽

Beneficial Effects ◽

Before And After ◽

Post Test ◽

Group A ◽

The Mediterranean

We aim to assess the beneficial effects of the Mediterranean style-diet before and after the period of confinement due to COVID-19 in a sample of 51 older patients who were part of a clinical trial of the Instituto de Investigación sanitaria y Biomédica de Alicante (ISABIAL, CEIM). Participants were randomly assigned to two conditions: experimental vs. a control group. A pre-test survey assessment was conducted before confinement, while a post-test survey was conducted after the confinement period. Adherence to Mediterranean Diet and nutritional status were evaluated through self-reported questionnaires. Individuals who initiated the Mediterranean Diet intervention program before confinement increased 3.5% their level of adherence to the Mediterranean Diet and maintained their nutritional status after the confinement. In the case of BMI, there no were statistically significant differences between groups before and after confinement. These results suggest that adherence to the Mediterranean Diet may play an important role in the establishment of appropriate dietary guidelines in confinement situations such as the COVID-19.

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