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

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.

Download Full-text

Mediterranean Diet: The Need for Cross-Disciplinary Perspectives

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115687 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5687

Author(s):

F. Xavier Medina

Keyword(s):

Mediterranean Diet ◽

Dietary Pattern ◽

The Past ◽

Sustainable Diet ◽

The Mediterranean ◽

Past Half

The notion of the Mediterranean diet has progressively evolved over the past half a century, from a healthy (coronary) dietary pattern to a model of sustainable diet [...]

Download Full-text

Abstract 13: Adherence to Various Dietary Patterns and Risk of Recurrent Coronary Heart Disease and Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.135.suppl_1.13 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

James M Shikany ◽

Monika M Safford ◽

Joanna Bryan ◽

PK Newby ◽

Joshua S Richman ◽

...

Keyword(s):

Racial Differences ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Mediterranean Diet Score ◽

The Mediterranean ◽

Diet Score

Background: We have shown that the Southern dietary pattern, characterized by added fats, fried foods, organ and processed meats, and sugar-sweetened beverages, is associated with a greater risk of incident CHD in REGARDS, a national, population-based, longitudinal cohort. We sought to determine if the Southern pattern, other dietary patterns, and the Mediterranean diet score were associated with CHD events and mortality in REGARDS participants who previously reported CHD. Methods: REGARDS enrolled white and black adults aged ≥45 years between 2003-2007. Data were analyzed from 3,562 participants with CHD at baseline. Participants completed an FFQ at baseline, from which 5 dietary patterns were derived through factor analysis (Table). The Mediterranean diet score was calculated for each participant. Expert-adjudicated CHD events included myocardial infarction and CHD death. Cox proportional hazards regression was used to model the association of the dietary patterns and score with CHD events and death, adjusting for sociodemographics, lifestyle factors, energy intake, anthropometrics, and medical conditions. Results: Over 7 years of follow-up, there were 581 recurrent CHD events and 1,098 deaths. In fully-adjusted analyses, the highest quartile of adherence to the alcohol/salads pattern and highest group of the Mediterranean diet score were associated with lower risk of recurrent CHD compared to the lowest quartile/group (HR: 0.76; 95% CI: 0.59 – 0.98, HR: 0.78; 95% CI: 0.62 – 0.98, respectively). The highest quartile of adherence to the Southern pattern was associated with higher mortality (HR: 1.57; 95% CI: 1.28 – 1.91), while the highest group of the Mediterranean diet score was associated with lower mortality (HR: 0.80; 95% CI: 0.68 – 0.95). Conclusions: While the Southern dietary pattern was not related to risk of recurrent CHD, it was associated with higher mortality in REGARDS participants with existing CHD. Greater adherence to a Mediterranean diet was associated with lower risk of recurrent CHD and mortality.

Download Full-text

From the Table to the Tumor: The Role of Mediterranean and Western Dietary Patterns in Shifting Microbial-Mediated Signaling to Impact Breast Cancer Risk

Nutrients ◽

10.3390/nu11112565 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2565 ◽

Cited By ~ 8

Author(s):

Tiffany M. Newman ◽

Mara Z. Vitolins ◽

Katherine L. Cook

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Gut Microbiome ◽

Western Diet ◽

Diet Pattern ◽

The Mediterranean ◽

The Impact

Diet is a modifiable component of lifestyle that could influence breast cancer development. The Mediterranean dietary pattern is considered one of the healthiest of all dietary patterns. Adherence to the Mediterranean diet protects against diabetes, cardiovascular disease, and cancer. Reported consumption of a Mediterranean diet pattern was associated with lower breast cancer risk for women with all subtypes of breast cancer, and a Western diet pattern was associated with greater risk. In this review, we contrast the available epidemiological breast cancer data, comparing the impact of consuming a Mediterranean diet to the Western diet. Furthermore, we will review the preclinical data highlighting the anticancer molecular mechanism of Mediterranean diet consumption in both cancer prevention and therapeutic outcomes. Diet composition is a major constituent shaping the gut microbiome. Distinct patterns of gut microbiota composition are associated with the habitual consumption of animal fats, high-fiber diets, and vegetable-based diets. We will review the impact of Mediterranean diet on the gut microbiome and inflammation. Outside of the gut, we recently demonstrated that Mediterranean diet consumption led to distinct microbiota shifts in the mammary gland tissue, suggesting possible anticancer effects by diet on breast-specific microbiome. Taken together, these data support the anti-breast-cancer impact of Mediterranean diet consumption.

Download Full-text

Healthy dietary patterns from food diaries and FFQ are not associated with colorectal cancer risk: results from the UKWCS

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000348 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Petra Jones ◽

Janet Cade ◽

Charlotte Evans ◽

Neil Hancock ◽

Darren Greenwood

Keyword(s):

Colorectal Cancer ◽

Cancer Risk ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

Colorectal Cancer Risk ◽

Mediterranean Diet Score ◽

Bland Altman Method ◽

The Mediterranean ◽

Diet Score

AbstractDietary pattern analyses have most commonly used food frequency questionnaire (FFQ) data for large population studies, whilst food diaries (FD) tend to be used with smaller datasets and followed up for shorter terms, restricting the possibility of a direct comparison. Studies comparing dietary patterns derived from two different assessment methods, in relation to diet and disease are limited. The aims of this study are to assess the agreement between dietary patterns derived from FFQ and FDs and to compare the associations between the Mediterranean dietary pattern and the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) dietary pattern in relation to colorectal cancer incidence.The study population included 2276 healthy middle-aged women – participants of the UK Women's Cohort Study. Energy and nutrient intakes, derived from 4-day FDs and from a 217-item FFQ were compared. A 10 and an 8-component score indicating adherence to the Mediterranean diet and to the 2007 WCRF/AICR cancer prevention recommendations respectively were generated. Agreement was assessed by weighted Kappa statistics and the Bland-Altman method. Cox regression was used to estimate hazard ratios (HRs) for colorectal cancer risk for both the FD and the FFQ patterns, for each score separately.The Bland-Altman method showed that the FFQ gave a higher energy intake compared to the FD with a bias of -525 kcal (95% CI -556, -493) between the two methods. Agreement was slight for the Mediterranean diet score (Κ = 0.15; 95% CI: 0.14, 0.16) and fair for the WCRF/AICR score (Κ = 0.38; 95% CI: 0.37, 0.39). A total of 173 incident cases of colorectal cancer were documented. In the multi-variable adjusted models, the estimates for an association with colorectal cancer were weak: HR = 0.94 (95% CI: 0.83 to 1.06) for a 1-unit increment in the Mediterranean diet score using FD and HR = 1.01 (95% CI: 0.83 to 1.24) for a 1-unit increment in the WCRF/AICR score using FD. For scores derived from the FFQ, estimates were inverse, but weak (HR = 0.80 (95% CI: 0.90 to 1.00) for a 1-unit increment in the Mediterranean diet score using FFQ and HR = 0.84 (95% CI: 0.67 to 1.05) for a 1-unit increment in the WCRF/AICR score using FFQ.There is insufficient evidence of an association of colorectal cancer risk with the Mediterranean dietary pattern or with the WCRF/AICR cancer prevention recommendations, irrespective of the dietary assessment method in this sample. Further studies with larger sample sizes, using FD for diet assessment are warranted.

Download Full-text

A Comparison of Gene Expression Changes in the Blood of Individuals Consuming Diets Supplemented with Olives, Nuts or Long-Chain Omega-3 Fatty Acids

Nutrients ◽

10.3390/nu12123765 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3765

Author(s):

Virginie Bottero ◽

Judith A. Potashkin

Keyword(s):

Gene Expression ◽

Alzheimer’S Disease ◽

Fatty Acids ◽

Transcription Factors ◽

Mediterranean Diet ◽

Differentially Expressed ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

The Mediterranean ◽

Long Chain

Background: The Mediterranean diet, which is rich in olive oil, nuts, and fish, is considered healthy and may reduce the risk of chronic diseases. Methods: Here, we compared the transcriptome from the blood of subjects with diets supplemented with olives, nuts, or long-chain omega-3 fatty acids and identified the genes differentially expressed. The dietary genes obtained were subjected to network analysis to determine the main pathways, as well as the transcription factors and microRNA interaction networks to elucidate their regulation. Finally, a gene-associated disease interaction network was performed. Results: We identified several genes whose expression is altered after the intake of components of the Mediterranean diets compared to controls. These genes were associated with infection and inflammation. Transcription factors and miRNAs were identified as potential regulators of the dietary genes. Interestingly, caspase 1 and sialophorin are differentially expressed in the opposite direction after the intake of supplements compared to Alzheimer’s disease patients. In addition, ten transcription factors were identified that regulated gene expression in supplemented diets, mild cognitive impairment, and Alzheimer’s disease. Conclusions: We identified genes whose expression is altered after the intake of the supplements as well as the transcription factors and miRNAs involved in their regulation. These genes are associated with schizophrenia, neoplasms, and rheumatic arthritis, suggesting that the Mediterranean diet may be beneficial in reducing these diseases. In addition, the results suggest that the Mediterranean diet may also be beneficial in reducing the risk of dementia.

Download Full-text

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

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-066-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Michael Greene ◽

Caroline Knight ◽

Olivia Jackson ◽

Imran Rahman ◽

Donna Burnett ◽

...

Keyword(s):

Mediterranean Diet ◽

Linear Regression Analysis ◽

Demographic Variables ◽

Dietary Guidelines ◽

Amazon Mechanical Turk ◽

Funding Program ◽

The Us ◽

Knowledge Barriers ◽

The Mediterranean ◽

Stroke Belt

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).

Download Full-text

Higher adherence to the Mediterranean Diet is associated with weight loss maintenance: the MedWeight study

Proceedings of The Nutrition Society ◽

10.1017/s0029665120002888 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Dimitrios Poulimeneas ◽

Katerina Zoupi ◽

Eirini Mamalaki ◽

Eirini Bathrellou ◽

Costas Anastasiou ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Mediterranean Diet ◽

Dietary Pattern ◽

Weight Loss Maintenance ◽

Activity Level ◽

Obesity Management ◽

Maximum Weight ◽

The Mediterranean ◽

Current Weight

AbstractIntroductionAdherence to the Mediterranean dietary pattern has been associated with numerous health benefits in non-communicable diseases, including obesity management. However, the associations of the Mediterranean Diet with weight loss maintenance remain to be evaluated.MethodsWe analyzed data from 500 participants (61% women) of the MedWeight study. Eligible volunteers were men and women 18–65 years old, reporting an intentional weight loss of at least 10%, starting from a BMI ≥ 25 kg/m2. Based on their current weight, participants were characterized as maintainers (current weight ≤ 90% of maximum weight), or regainers (current weight > 95% of maximum weight). Socio-demographics, lifestyle measurements and weight history were recorded. Dietary intake was assessed by 2 telephone 24-hour recalls. Adherence to the Mediterranean Diet was assessed with the MedDietScore (range 0–55, greater scores showing higher adherence). Physical activity levels were assessed with the International Physical Activity Questionnaire-short form. Results are expressed as means ± SD, frequencies (%) or Odds Ratio [OR; 95%Confidence Interval].ResultsCompared to regainers (31%), maintainers were younger (31.4 ± 10.0 vs. 36.6 ± 10.8 years, p < 0.001), had lower BMI (25.7 ± 4.3 vs. 31.4 ± 5.1 kg/m2, p < 0.001), and had greater initial body weight loss (25.5 ± 8.6% vs. 18.4 ± 6.9%, p < 0.001). Sex and years of formal education were not significantly different between maintainers and regainers (p > 0.05). Being in the highest MedDietScore quintile (vs. the lowest) was associated with 91% higher odds of being a maintainer [crude OR = 1.91; 1.05–3.45]. This association remained significant after adjusting for sex, age, physical activity level (METŸminutes/week) and energy intake (kcal/day) [adjusted OR = 2.01; 1.05–3.83].DiscussionHigher adherence to the Mediterranean Diet was independently associated with 2-fold increased likelihood of weight loss maintenance. Our results highlight the favorable effects of a prudent dietary pattern in long-term obesity management, as well as novel targets for diet planning during weight loss maintenance.

Download Full-text

Changes in food supply in Mediterranean countries from 1961 to 2001

Public Health Nutrition ◽

10.1079/phn2005757 ◽

2006 ◽

Vol 9 (1) ◽

pp. 53-60 ◽

Cited By ~ 89

Author(s):

Reina Garcia-Closas ◽

Antoni Berenguer ◽

Carlos A González

Keyword(s):

Olive Oil ◽

Mediterranean Diet ◽

Food Supply ◽

Dietary Pattern ◽

Fruits And Vegetables ◽

Geographical Differences ◽

Mediterranean Countries ◽

The Mediterranean ◽

Traditional Mediterranean Diet ◽

The 1960S

AbstractObjectiveTo describe geographical differences and time trends in the supply of the most important food components of the traditional Mediterranean diet.DesignFood supply data collected from national food balance sheets for the period 1961–2001.SettingSelected Mediterranean countries: Spain, Italy, France, Greece, Algeria, Morocco, Tunisia and Turkey.ResultsDifferences of almost 30-fold and five-fold were found in the supply of olive oil and fruits and vegetables, respectively, among the Mediterranean countries studied during the 1960s. A favourable increasing trend for the supply of fruit and vegetables was observed in most Mediterranean countries. However, an increase in the supply of meats and dairy products and a decrease in the supply of cereals and wine were observed in European Mediterranean countries from 1961 until 2001. Only in African and Asiatic Mediterranean countries were cereals the base of food supply. During the 1990s, Greece's food supply pattern was closest to the traditional Mediterranean diet, while Italy and Spain maintained a high availability of fruits, vegetables and olive oil, but were losing the other typical components. Among African and Asiatic Mediterranean countries, only Turkey presented a traditional Mediterranean dietary pattern except with respect to olive oil, the supply of which was very low. France showed a Western dietary pattern, with a high supply of animal products and a low supply of olive oil.ConclusionsDietary supplies in the Mediterranean area were quite heterogeneous in the 1960s and have experienced a process of Westernization, especially in European Mediterranean countries.

Download Full-text