Conference PaperPDF Available

Modern dietary patterns based on territorial origin - a review

  • Latvia University of Life Sciences and Technologies (former Latvia University of Agriculture)
Evalds Raits1,2*, Asnate Kirse-Ozolina1
1* Department of Food Technology, Faculty of Food Technology, Latvia University of Life Sciences and Technologies,
Rigas iela 22, Jelgava, Latvia, e-mail:
2 Kronis Ltd., “Ozolnieki”, Codes pag., Bauskas novads, LV-3901, Latvia
There are different dietary patterns around the globe formed on the account of various anthropogenic factors: cultural, economic and
globalization. Human food consumption patterns can be formulated and defined depending on habitat. For example, since Scandinavian
countries are surrounded by seas, fishery was quite developed historically, and even today seafood constitutes a large part of daily
Scandinavian food plate. On the other hand, world globalization has led to the appearance of such unhealthy food consumption patterns
as unbalanced nutrition or refined product excess in daily diet. There is a strong association between unhealthy eating habits and
diseases, which means that healthy eating habits could lower a wide range of such disease emergence possibility as metabolic syndrome,
type 2 diabetes, and cardiovascular disease. The review discusses types of modern dietary patterns around the globe their origins,
main principles and effects on health, comparison of nutrient ratios among the most popular dietary patterns (Nordic diet, Mediterranean
diet, Okinawa diet) and the “unhealthy” Western diet.
Keywords: Nordic diet, Mediterranean diet, Okinawa diet, Western diet
There are different dietary patterns around the globe
formed on account of various anthropogenic factors:
cultural, economic and globalization.
From the biological mechanism point of view,
environment which conditioned human genetic makeup,
i.e., where our ancestors survived, is more favorable for
descendants (Cordain et al., 2005). It is recognized that
industrial revolution and globalization occurred so
recently on the time-scale of evolution, that human
genome cannot be fully adapted to environment
(Carrera-Bastos et al., 2011; Boyd, Eaton, 1985).
The review summarizes types of modern dietary patterns
around the globe their origins, main principles and
effects on health, compares nutrient ratios among the
most popular dietary patterns and the “unhealthy”
Western diet.
1. Nordic diet
Geographical position of Scandinavian (Nordic)
countries (i.e. Denmark, Finland, Norway, Sweden)
provides unique coastal climate and special light
conditions (lack of sunlight in the winter and plenty of
light during the summer period) for plant growth
(Nordic Council of Ministers, 2008).
1.1. Food pyramid
New Nordic Cuisine Manifesto was defined in 2003
with the purpose to popularize Nordic cuisine among the
world (Nordic Council of Ministers, 2008). Principles
and guidelines of the New Nordic Diet were widely
described in the Guidelines for the New Nordic Diet
in 2012. The diet is based on three main cornerstones:
o more calories from plant foods and fewer from
o more foods from the sea and lakes;
o more foods from the wild countryside”
(Mithril et al., 2011).
Compared to the traditional food pyramid, the base of
ND pyramid is given to high vegetable and fruit
consumption (Figure 1).
Figure 1. Nordic diet food pyramid
(made by author, based on Mithril et al., 2013)
Nordic diet (ND) suggests to establish the daily diet on
(in descending order): fruits and vegetables (including
root vegetables, wild berries and potatoes); whole grains
and legumes; nuts and fresh herbs; dairy products;
seafood; seaweed; free-range meat (including game);
sweets, beverages etc. (Mithril et al., 2013).
1.2. Effect on health
High adherence to ND has been strongly associated
with a positive influence on inflammation (De
Mello et al., 2011; Uusitupa et al., 2013), endothelial
dysfunction (De Mello et al., 2011), blood pressure
reduction in people with metabolic syndrome (MetS)
(Brader et al., 2014; Andersen et al., 2015).
A study in Denmark showed, that there is an evident
connection between adherence to Nordic diet and risk of
type 2 diabetes (T2D), which is explained by the high
content of dietary fibre, which affect the level of glucose
and insulin sensitivity due to low glycemic index (GI)
(Lacoppidan et al., 2015). However, two independent
studies in Finland (Kanerva et al., 2014), a study in
Germany (Galbete et al., 2018) and a study in Sweden
(Shi et al., 2018) did not find association between
Nordic diet score and T2D biomarkers.
2. Mediterranean diet
Mediterranean diet (MD) origins are found in olive
tree growing areas of the Mediterranean basin, which
are considered natural in all countries of the
Mediterranean coast (Ighbareyeh et al., 2018; Sánchez-
Villegas et al., 2018).
2.1. Food pyramid
Principles and guidelines of MD were widely described
in Bach-Faig et al. (2011), focusing on nutritional
aspects. Later, Dernini et al. (2017) characterized the
benefits of MD in four thematic areas:
1) nutrition and health;
2) environment;
3) economy;
4) society and culture.
According to MD principles, 1/3 to 2/3 of every meal
should consist of vegetables, cereals and fruits,
providing macronutrients, low GI carbohydrates and
antioxidants; whole grains, legumes and dairy products
are considered as the main source of protein (Figure 2).
Figure 2. Mediterranean diet food pyramid
(made by author, based on Bach-Faig et al., 2011;
Davis et al., 2015)
Olive oil is considered as the main source of lipids; wine
and other fermented beverages are recommended as a
polyphenol source (1 glass for women, 2 glasses for
men per day) (Bach-Faig et al., 2011; Davis et al.,
2.2. Effect on health
Numerous studies show positive effect of adherence to
MD pattern regarding moderate alcohol consumption on
the risk of CVD (e.g. 40% as found by Ndlovu, Van
Jaarsveld, and Caleb (2019). A 12 year follow-up study
even showed that daily alcohol consumption lowers
cardiovascular disease (CVD) risk for 30 to 35%
for men (Mukamal et al., 2003). As reported by
Ndlovu et al. (2019) the type of alcohol is not of
importance, as it is ethanol which affects the density of
MD has been recognized as a dietary pattern with strong
association with the improvement of MetS risk factors,
body weight reduction in particular (Shai et al., 2008;
Estruch et al., 2016). A randomized controlled trial on
obese postmenopausal women (n=144) with at least one
other MetS criterion, showed a loss of 6.67.6 kg on
average in 16 weeks after energy restricted dietary
intervention (Bajerska et al., 2018).
In the European case-cohort study high adherence to
MD was found to lower possibility of T2D by 12% in
comparison to individuals with low adherence to MD
(Dora Romaguera, 2011). Effects of diet on T2D are
affected by several factors, e.g., low-GI carbohydrates,
low fat dairy, polyunsaturated fatty acids (PUFA) from
vegetable oils, low red meat and processed meat intake
(De Koning et al., 2011).
3. Okinawan diet
As stated by Rosenbaum et al. (2010), residents of
Okinawa prefecture (most southern island chain of
Japan) have a very high life expectancy compared to the
rest of the world. Traditional Okinawan diet (OD) is a
dietary pattern that existed in Okinawa prefecture before
the globalization and westernization after World War II.
It is known for a low-calorie and almost vegetarian
dietary pattern, due to the specific climatic and terrain
conditions (Willcox et al., 2007; Gavrilova, Gavrilov,
2012; Willcox, Willcox, 2014).
3.1. Food pyramid
OD mainly consists of vegetables and legumes, i.e.
sweet potato, cabbages and soy in different variations
(miso, tofu, soy milk etc.), serving as a carbohydrate and
protein source (Figure 3) (Willcox et al., 2014).
Figure 3. Traditional Okinawan diet food pyramid
(made by author, based on Willcox et al., 2014)
3.2. Effect on health
Although seemingly paradoxal, yet historically
established caloric (dietary) restriction is considered to
be a key factor of longevity (Gavrilova, Gavrilov, 2012).
According to Willcox et al. (2007), Okinawan
population have been consuming 11% less calories than
it would be recommended in relation to body weight.
There is a hypothesis that caloric restriction induces
stress, which triggers the biological pathways that result
in gene encoding which influence longevity, aiding in
metabolism regulation (Willcox, Willcox, 2014).
4. Western diet
There are plenty of scientific papers connecting various
chronic diseases to the so-called Western diet (WD), like
cancer, CVD and diabetes that comprise MetS
(Verboven et al., 2018; WHO, 2014), but what does the
term Western diet actually imply?
According to WHO, overweight individuals composed a
staggering 1.9 billion of all adults. The main cause of
obesity is considered energy intake imbalance with
energy consumption (WHO, 2018).
A study by Serra-Majem et al. (2009) showed
correlation of WD with intake of red and processed
meat, eggs, sauces, fast food, pre-cooked food, whole
dairy products and potatoes. Several other studies
associate WD with high fat and sugar consumption
(Verboven et al., 2018). The breakdown of food groups
in WD is given in Figure 4.
Figure 4. Typical Western diet food pyramid
(made by author, based on Cordain et al., 2005)
According to data presented by Cordain et al. (2005),
based on scientific papers year from year 2001 to 2004,
US diet energy intake constituted of 20.4% refined
grains, 18.6% refined sugars, and 17.6% refined
vegetable oils.
5. Comparison
According to previously mentioned studies, dietary
patterns differ in many ways, e.g. culture of food
consumption, its pattern, physical activity, but
especially in nutrient intake ratios and their “signature”
5.1. Energy intake
According to EFSA (2017), reference intake (RI) is the
amount of macronutrients needed to maintain
physiological functions, usually expressed as % of daily
energy intake.
The comparison of average nutrient intakes (Table 1)
indicates significant variations between types of diets.
While Mediterranean diet has similar amounts of
carbohydrates, protein and saturated fatty acids to
Western diet, average intake of fat it significantly
higher. In this case, however, the type of fat is of
importance. Okinawa diet shows the greatest differences
compared to the rest of diets.
Table 1
Average nutrient energy intake as a percentage of
total energy among presented dietary patterns
Types of diets
Dietary fibre, g
Protein, %
Fat, %
Saturated fatty
acids, %
as low as
ND Nordic diet, MD Mediterranean diet, OD Okinawa
diet, WD Western diet
n.d. not defined
(a) Mithril et al., 2013; (b) Willcox et al., 2014; (c) Paeratakul et
al., 2003; (d) EFSA, 2017
With regards to protein reference intake, the data
presented in Table 1 corresponds to intake 0.80 g per kg
of body weight regardless of gender.
5.2. Signature foods
The term “signature” foods first occurred in (Biltoft-
Jensen et al., 2015) and can be described as foods that
are characteristic to the diet (Andersen et al., 2015;
Biltoft-Jensen et al., 2015).
Signature foods for previously described dietary
patterns are presented in Table 2. WD pattern presents
itself as an unhealthy example of dietary pattern, typical
for most of modern developed countries: fried potatoes,
high amount of salt, refined grain products and simple
sugars (sucrose, glucose) which drastically affect blood
sugar levels. ND, MD and OD dietary patterns have
common food group representatives, all of them
describe whole grains as the main source of dietary fibre
and low-GI carbohydrates. It is recommended to
consider whole grains with legumes as the main source
of protein; sea products as a source for essential amino
acids and PUFAs, fruits and vegetables as the main
source for polyphenols and carbohydrates.
The main differences for MD in comparison to ND and
OD are olives and olive oil as the source of vegetable
lipids, and daily consumption of wine as the source of
polyphenols. ND philosophy implies focus on wild
forest foods, e.g., wild berries, mushrooms and herbs
considered as a source of polyphenols; root vegetables
and cabbage as a source of carbohydrates.
Table 2
Signature food comparison of different dietary patterns
Types of diet
Root vegetables
Whole grain
Whole grain
Whole grain
Refined grain
Sweet potatoes
Potatoes (deep fried)
Sucrose, fructose, glucose
Kale, collard
Shiitake mushrooms
Wild plants
Tofu, soy, legumes
Tree nuts
Sea products
Sea products
Sea products
Game meat
Sea products
Olive oil
Margarine, butter, cooking oils
ND Nordic diet, MD Mediterranean diet, OD Okinawa diet, WD Western diet
(a) Andersen et al., 2015; (b) Bach-Faig et al., 2011; (c) Willcox, Willcox, 2014; (d) Cordain et al., 2005
* not defined
OD also implies cabbages and cruciferous vegetables,
i.e., kale and collard, and yellow-root vegetables. the
time and serves as the main source of protein today as
well. OD is high in legumes, especially in soy beans and
its by-product soy milk. Soy was common in whole
Asia throughout the time and serves as the main source
of protein today as well.
Nutrition is an important aspect in staying healthy
through one’s life. Therefore, chosen dietary patterns
greatly affect the resistance of the human body to those
chronical diseases where diet is one of the main trigger
Adherence to dietary patterns with higher complex
carbohydrate, polyunsaturated fatty acid, fruit and
vegetable content have shown the reduction of health
problems in long term. Whereas, consumption of deep
fried and refined foods, high amount of salt and simple
sugars is associated with such chronical diseases as
metabolic syndrome, type 2 diabetes, and cardiovascular
disease. Even though the residents of Mediterranean
terrain and Okinawa prefecture follow dietary patterns
which suggest higher longevity and health benefits, the
globalisation has had a negative effect on their dietary
patterns which now have become closer to those of the
Western diet.
In order to reap maximal health benefits from nutrition,
consumers should try to incorporate signature foods
from Nordic, Mediterranean and Okinawa diet into their
daily lifestyle in the place to traditional Western diet
staple foods.
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... Over the past few decades, nutrition research has evolved from single nutrient studies focussing on specific components, such as vitamins, dietary sugars and fat, to those analysing dietary patterns that capture complex interactions of different food constituents consumed on a routine basis and the level of adherence (Mozaffarian et al., 2018). Different dietary patterns have been identified globally namely Nordic, Mediterranean and the Western diet, each characterised by varied nutrient sources constituting the 'food pyramid' and showing inherent health benefits and adverse effects (Raits and Kirse-Ozolina, 2019). A Dutch study recruited women undergoing ART and estimated their adherence to Dutch dietary recommendations by calculating the Preconception Dietary Risk score (PDR) and found a positive association between high adherence and on-going pregnancy rates (Twigt et al., 2012). ...
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STUDY QUESTION Is there a difference in dietary patterns among subfertile South Asian women undergoing frozen embryo transfer (FET)? SUMMARY ANSWER Significant regional differences in dietary pattern exist among subfertile South Asian women undergoing FET. WHAT IS KNOWN ALREADY Preconception consumption of certain food groups or adopting specific dietary patterns, such as the ‘Mediterranean diet’, and its level of adherence have been shown to enhance the odds of achieving a successful pregnancy in women undergoing ART. However, differences in geographic location, individual preference, cultural beliefs and local availability contribute to such dietary choices. There is also a predisposition to a vitamin B12 deficiency in those of South Asian ethnicity and a predominant pattern of vegetarian food intake. There is a paucity of studies analysing the type of dietary pattern followed by South Asian women, their vitamin B12 levels and the potential impact on ART treatment outcomes. STUDY DESIGN, SIZE, DURATION This is a cross-sectional study of 159 South Asian women aged 21–37 years, belonging to the Eastern (n = 75) and Southern (n = 84) regions of India plus Bangladesh, and undergoing a FET cycle at a tertiary level infertility clinic between February 2019 and March 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Women underwent dietary assessment using ‘24-hour dietary recall’ to capture daily nutrient consumption. A ‘Food Frequency Questionnaire’ listing commonly consumed foods was used to record frequency of intake. The primary outcome was the characterisation of regional dietary patterns in the cohorts using principal component analysis (PCA). Secondary outcomes included association of vitamin B12 intake and serum levels with clinical and ongoing pregnancy. MAIN RESULTS AND THE ROLE OF CHANCE Four components contributing to overall variance in dietary pattern were identified, namely: meat, poultry and seafood; green leafy vegetables and root tubers; fruits, dairy and sugar; nuts and oilseeds. PCA analysis showed a significantly higher consumption of two components in the East—meat, poultry and fish (P < 0.001); green leafy vegetables and root tubers (P < 0.001). All women reported taking preconception oral folic acid supplementation. The dietary intake of vitamin B12 and serum concentration correlated, showing a good validity of measured dietary intake (r = 0.398; P ≤ 0.001). Compared to the Southern region, participants from the East showed a higher daily median intake of vitamin B12 (1.11 versus 0.28 mcg, respectively; P < 0.001) and a higher serum vitamin B12 levels (441 versus 239 pg/ml, respectively; P < 0.001). Ongoing pregnancy showed no association with dietary vitamin B12 intake (relative risk 0.90; 95% CI, 0.68 to 1.19) or serum vitamin B12 levels (relative risk 0.99; 95% CI, 0.73 to 1.33) after adjustments for female age, body mass index (BMI) and geographic differences. Women belonging to different quartiles of serum vitamin B12 concentration had a similar likelihood of ongoing pregnancy. LIMITATIONS, REASONS FOR CAUTION Self-reported dietary assessment is prone to measurement errors owing to its subjective nature and recall bias. The study was not adequately powered to detect the impact of geographic differences in vitamin B12 intake and serum levels on FET treatment outcomes, the second objective. We adjusted for potential confounders, such as female age and BMI, but it is possible that residual confounders, such as physical activity, stress and use of dietary supplements, may have influenced the results. Extrapolation of the study findings to women undergoing ART in other populations should be made with caution. WIDER IMPLICATIONS OF THE FINDINGS Our study findings suggest important differences in local dietary patterns within the South Asian region. Hence a personalised approach to dietary assessment and intervention when undergoing ART based on population dynamics is warranted. The geographic differences in the vitamin B12 intake or serum levels did not have an impact on the FET outcomes. There is also a need to further investigate the impact of such dietary differences on ART treatment outcomes in a large study population. STUDY FUNDING/COMPETING INTEREST(S) No grant from funding agencies in the public, commercial, or not-for-profit sectors was obtained. The authors have nothing to disclose. TRIAL REGISTRATION NUMBER N/A
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Background: Epidemiologic evidence on the association of a healthy Nordic diet and future type 2 diabetes (T2D) is limited. Exploring metabolites as biomarkers of healthy Nordic dietary patterns may facilitate investigation of associations between such patterns and T2D. Objectives: We aimed to identify metabolites related to a priori-defined healthy Nordic dietary indexes, the Baltic Sea Diet Score (BSDS) and Healthy Nordic Food Index (HNFI), and evaluate associations with the T2D risk in a case-control study nested in a Swedish population-based prospective cohort. Design: Plasma samples from 421 case-control pairs at baseline and samples from a subset of 151 healthy controls at a 10-y follow-up were analyzed with the use of untargeted liquid chromatography-mass spectrometry metabolomics. Index-related metabolites were identified through the use of random forest modelling followed by partial correlation analysis adjustment for lifestyle confounders. Metabolite patterns were derived via principal component analysis (PCA). ORs of T2D were estimated via conditional logistic regression. Reproducibility of metabolites was assessed by intraclass correlation (ICC) in healthy controls. Associations were also assessed for 10 metabolites previously identified as linking a healthy Nordic diet with T2D. Results: In total, 31 metabolites were associated with BSDS and/or HNFI (-0.19 ≤ r ≤ 0.21, 0.10 ≤ ICC ≤ 0.59). Two PCs were determined from index-related metabolites: PC1 strongly correlated to the indexes (r = 0.27 for BSDS, r = 0.25 for HNFI, ICC = 0.45) but showed no association with T2D risk. PC2 was weakly associated with the indexes, but more strongly with foods not part of the indexes, e.g., pizza, sausages, and hamburgers. PC2 was also significantly associated with T2D risk. Predefined metabolites were confirmed to be reflective of consumption of whole grains, fish, or vegetables, but not related to T2D risk. Conclusions: Our study did not support an association between healthy Nordic dietary indexes and T2D. However, foods such as hamburger, sausage, and pizza not covered by the indexes appeared to be more important for T2D risk in the current population.
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We conducted a randomized controlled trial to examine the effect of two energy-restricted diets on body weight (BW), visceral fat (VF) loss, and the risk factors for metabolic syndrome. A total of 144 centrally obese postmenopausal women were assigned to the moderate in fat Mediterranean diet (MED) or to the Central European diet (CED), which is moderate in carbohydrates and high in dietary fiber (DF), for 16 weeks. BW, waist circumference and VF were significantly reduced by 8.8%, 7.0%, and 24.6%, respectively, over the trial (P < 0.001), with no difference between groups. A similar trend was seen for total cholesterol, triglycerides, glucose, and blood pressure. Within each diet group, the more adherent participants lost significantly more BW than did their less adherent counterparts. VF was significantly reduced only in women who were more adherent to the CED, and the reduction in VF correlated with an increase in the proportion of DF. Short-term dietary treatment with the CED or the MED was associated with similar improvements in some anthropometric, lipid, and nonlipid parameters; however, adequate adherence to the prescribed diet is important in weight loss success and in achieving improvements in metabolic health.
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Background: The Mediterranean Diet (MedDiet) has been acknowledged as a healthy diet. However, its relation with risk of major chronic diseases in non-Mediterranean countries is inconclusive. The Nordic diet is proposed as an alternative across Northern Europe, although its associations with the risk of chronic diseases remain controversial. We aimed to investigate the association between the Nordic diet and the MedDiet with the risk of chronic disease (type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer) in the EPIC-Potsdam cohort. Methods: The EPIC-Potsdam cohort recruited 27,548 participants between 1994 and 1998. After exclusion of prevalent cases, we evaluated baseline adherence to a score reflecting the Nordic diet and two MedDiet scores (tMDS, reflecting the traditional MedDiet score, and the MedPyr score, reflecting the MedDiet Pyramid). Cox regression models were applied to examine the association between the diet scores and the incidence of major chronic diseases. Results: During a follow-up of 10.6 years, 1376 cases of T2D, 312 of MI, 321 of stroke, and 1618 of cancer were identified. The Nordic diet showed a statistically non-significant inverse association with incidence of MI in the overall population and of stroke in men. Adherence to the MedDiet was associated with lower incidence of T2D (HR per 1 SD 0.93, 95% CI 0.88-0.98 for the tMDS score and 0.92, 0.87-0.97 for the MedPyr score). In women, the MedPyr score was also inversely associated with MI. No association was observed for any of the scores with cancer. Conclusions: In the EPIC-Potsdam cohort, the Nordic diet showed a possible beneficial effect on MI in the overall population and for stroke in men, while both scores reflecting the MedDiet conferred lower risk of T2D in the overall population and of MI in women.
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Olive (oleae europaea L.)is one of the most important agricultural crops production and plays a role in the Palestinian economy, we analyzed the mean monthly temperature and precipitation using data from nine weather stations from the Palestine Meteorological Department, recordedin the period from 1993-2008, with the same years plant production (rain-fed) from the Palestinian Central Bureau of Statistics (PCBS). Statistical tests included a bioclimatic analysis of Palestinian meteorological stations for the period previous by using bioclimatic classification of the Earth of Salvador Rivas Martinez, with regard to bioclimate factors as simple continentality index, compensated thermicity index, and annual ombrothermic index. In concluded, when we applied a correspondence analysis Bethlehem, Jerusalem and Ramallah areas were influenced by the annual ombrothermic index and simple continentality index, while Jenin, Nabuls, Tubas, Tulkareem and Salfite were affected by compensated thermicity index with large a proportion of the variance explained by axes 1 (84.98 %). We indicated that in the upper inframediterranean to mesomediterranean environments, the optimum for the olive production is achieved with value of annual ombrothermic index 3.6, simple continentality index value between 15-22 and compensated thermicity index value between 280-450.
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Objective: To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns. Design: A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined. Results: The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet. Conclusions: By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.
Background: Because of the high density of fat, high-fat diets are perceived as likely to lead to increased bodyweight, hence health-care providers are reluctant to recommend them to overweight or obese individuals. We assessed the long-term effects of ad libitum, high-fat, high-vegetable-fat Mediterranean diets on bodyweight and waist circumference in older people at risk of cardiovascular disease, most of whom were overweight or obese. Methods: PREDIMED was a 5 year parallel-group, multicentre, randomised, controlled clinical trial done in primary care centres affiliated to 11 hospitals in Spain. 7447 asymptomatic men (aged 55-80 years) and women (aged 60-80 years) who had type 2 diabetes or three or more cardiovascular risk factors were randomly assigned (1:1:1) with a computer-generated number sequence to one of three interventions: Mediterranean diet supplemented with extra-virgin olive oil (n=2543); Mediterranean diet supplemented with nuts (n=2454); or a control diet (advice to reduce dietary fat; n=2450). Energy restriction was not advised, nor was physical activity promoted. In 2016, we reported the 5 year changes in bodyweight and waist circumference, but because of a subsequently identified protocol deviation (including enrolment of household members without randomisation, assignment to a study group without randomisation of some participants at one of 11 study sites, and apparent inconsistent use of randomisation tables at another site; 866 [11·6%] participants were affected in total), we have withdrawn our previously published report and now report revised effect estimates based on reanalyses that do not rely exclusively on the assumption that all the participants were randomly assigned. In this analysis of the trial, we measured bodyweight and waist circumference at baseline and yearly for 5 years in the intention-to-treat population. The PREDIMED trial is registered with, number ISRCTN35739639. Findings: After a median 4·8 years (IQR 2·8-5·8) of follow-up, participants in all three groups had marginally reduced bodyweight and increased waist circumference. After multivariable adjustment, including adjustment for propensity scores and use of robust variance estimators, the difference in 5 year changes in bodyweight in the Mediterranean diet with olive oil group was -0·410 kg (95% CI -0·830 to 0·010; p=0·056) and in the nut group was -0·016 kg (-0·453 to 0·421; p=0·942), compared with the control group. The adjusted difference in 5 year changes in waist circumference was -0·466 cm (-1·109 to 0·176; p=0·154) in the Mediterranean diet with olive oil group and -0·923 cm (-1·604 to -0·241; p=0·008) in the nut group, compared with the control group. Interpretation: A long-term intervention with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with no significant difference in bodyweight and some evidence of less gain in central adiposity compared with a control diet. These results lend support to advice not restricting intake of healthy fats for bodyweight maintenance. Funding: Spanish Government, CIBERobn, Instituto de Salud Carlos III, Hojiblanca, Patrimonio Comunal Olivarero, California Walnut Commission, Borges SA, and Morella Nuts.
The determination of appropriate dietary strategies for the prevention of chronic degenerative diseases, cancer, diabetes, and cardiovascular diseases remains a challenging and highly relevant issue worldwide. Epidemiological dietary interventions have been studied for decades with contrasting impacts on human health. Moreover, research scientists and physicians have long debated diets encouraging alcohol intake, such as the Mediterranean and French-style diets, with regard to their impact on human health. Understanding the effects of these diets may help to improve in the treatment and prevention of diseases. However, further studies are warranted to determine which individual food components, or combinations thereof, have a beneficial impact on different diseases, since a large number of different compounds may occur in a single food, and their fate in vivo is difficult to measure. Most explanations for the positive effects of Mediterranean-style diet, and of the French paradox, have focused largely on the beneficial properties of antioxidants, among other compounds/metabolites, in foods and red wine. Wine is a traditional alcoholic beverage that has been associated with both healthy and harmful effects. Not withstanding some doubts, there is reasonable unanimity among researchers as to the beneficial effects of moderate wine consumption on cardiovascular disease, diabetes, osteoporosis, and longevity, which have been ascribed to polyphenolic compounds present in wine. Despite this, conflicting findings regarding the impact of alcohol consumption on human health, and contradictory findings concerning the effects of non-alcoholic wine components such as resveratrol, have led to confusion among consumers. In addition to these contradictions and misconceptions, there is a paucity of human research studies confirming known positive effects of polyphenols in vivo. Furthermore, studies balancing both known and unknown prognostic factors have mostly been conducted in vitro or using animal models. Moreover, current studies have shifted focus from red wine to dairy products, such as cheese, to explain the French paradox. The aim of this review is to highlight the contradictions, misconceptions, and scientific facts about wines and diets, giving special focus to the Mediterranean and French diets in disease prevention and human health improvement. To answer the multiplicity of questions regarding the effects of diet and specific diet components on health, and to relieve consumer uncertainty and promote health, comprehensive cross-demographic studies using the latest technologies, which include foodomics and integrated omics approaches, are warranted.
Diabetes mellitus (DM) is a major problem worldwide. Within this patient group, cardiovascular diseases are the biggest cause of morbidity and mortality. Diabetic cardiomyopathy (DCM) is defined as diabetes-associated structural and functional changes in the myocardium, not directly attributable to other confounding factors such as coronary artery disease or hypertension. Pathophysiology of DCM remains unclear due to a lack of adequate animal models reflecting the current pandemic of diabetes, associated with a high increased sugar intake and the 'Western' lifestyle. The aim of this study was to develop an animal model mimicking this 'Western' lifestyle causing a human-like phenotype of DCM. Twenty-four Sprague-Dawley rats were randomly assigned into a normal or a 'Western' diet group for 18 weeks. Glucose and insulin levels were measured with an OGTT. Heart function was assessed by echocardiography and hemodynamic measurements in vivo. Cardiac fibrosis and inflammation were investigated in vitro. 'Western' diet given to healthy rats for 18 weeks induced hyperglycemia together with increased AGEs levels, insulin levels and hypertriglyceridemia. Heart function was altered with increased end-diastolic pressure, left ventricle hypertrophy. Changes in vivo were associated with increased collagen deposition and increased PAI-1 levels in the heart. High-sugar diet or 'Western' diet causes T2DM and the hallmarks of DCM in rats, reflecting the phenotype of the disease seen in patients. Using this new model of T2DM with DCM might open new insight in understanding the pathophysiology of DCM and on a long term, test targeted therapies for T2DM with DCM patients.
OBJECTIVE: To study the association between adherence to the Mediterranean dietary pattern (MDP) and risk of developing type 2 diabetes, across European countries. RESEARCH DESIGN AND METHODS: We established a case-cohort study including 11,994 incident type 2 diabetic case subjects and a stratified subcohort of 15,798 participants selected from a total cohort of 340,234 participants with 3.99 million person-years of follow-up, from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The relative Mediterranean diet score (rMED) (score range 0-18) was used to assess adherence to MDP on the basis of reported consumption of nine dietary components characteristic of the Mediterranean diet. Cox proportional hazards regression, modified for the case-cohort design, was used to estimate the association between rMED and risk of type 2 diabetes, adjusting for confounders. RESULTS: The multiple adjusted hazard ratios of type 2 diabetes among individuals with medium (rMED 7-10 points) and high adherence to MDP (rMED 11-18 points) were 0.93 (95% CI 0.86-1.01) and 0.88 (0.79-0.97), respectively, compared with individuals with low adherence to MDP (0-6 points) (P for trend 0.013). The association between rMED and type 2 diabetes was attenuated in people