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In vivo nutrigenomic effects of virgin olive oil polyphenols within the frame of the Mediterranean diet: A randomized controlled trial


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The aim of the study was to assess whether benefits associated with the traditional Mediterranean diet (TMD) and virgin olive oil (VOO) consumption could be mediated through changes in the expression of atherosclerosis-related genes. A randomized, parallel, controlled clinical trial in healthy volunteers (n=90) aged 20 to 50 yr was performed. Three-month intervention groups were as follows: 1) TMD with VOO (TMD+VOO), 2) TMD with washed virgin olive oil (TMD+WOO), and 3) control with participants' habitual diet. WOO was similar to VOO, but with a lower polyphenol content (55 vs. 328 mg/kg, respectively). TMD consumption decreased plasma oxidative and inflammatory status and the gene expression related with both inflammation [INF-gamma (INFgamma), Rho GTPase-activating protein15 (ARHGAP15), and interleukin-7 receptor (IL7R)] and oxidative stress [adrenergic beta(2)-receptor (ADRB2) and polymerase (DNA-directed) kappa (POLK)] in peripheral blood mononuclear cells. All effects, with the exception of the decrease in POLK expression, were particularly observed when VOO, rich in polyphenols, was present in the TMD dietary pattern. Our results indicate a significant role of olive oil polyphenols in the down-regulation of proatherogenic genes in the context of a TMD. In addition, the benefits associated with a TMD and olive oil polyphenol consumption on cardiovascular risk can be mediated through nutrigenomic effects.
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The FASEB Journal Research Communication
In vivo nutrigenomic effects of virgin olive oil
polyphenols within the frame of the Mediterranean
diet: a randomized controlled trial
Valentini Konstantinidou,*
Maria-Isabel Covas,*
Daniel Mun˜z-Aguayo,*
Olha Khymenets,
Rafael de la Torre,
Guillermo Saez,
Maria del Carmen Tormos,
Estefania Toledo,
Amelia Marti,
Valentina Ruiz-Gutie´ rrez,
Maria Victoria Ruiz Mendez,
and Montserrat Fito*
*Cardiovascular Risk and Nutrition Research Group and
Human Pharmacology and Clinical
Neurosciences Research Group, Institut Municipal dInvestigacio´Me`dica (IMIM-Hospital del Mar),
Centro de Investigación Biomédica Eu R
˙ed (CIBER) de Fisiopatología de la Obesidad y Nutricio´n,
Barcelona, Spain;
PhD Program in Biomedicine, Departament de Ciencies Experimentals i de la Salut,
Pompeu Fabra University, Barcelona, Spain;
Department of Biochemistry and Molecular Biology,
University of Valencia, Valencia, Spain;
Department of Preventive Medicine and Public Health and
Department of Nutrition, Food Science, Physiology, and Toxicology, University of Navarra, Navarra,
Spain; and
Instituto de Nutrition and Lipid Metabolism, Instituto de la Grasa, Seville, Spain
ABSTRACT The aim of the study was to assess
whether benefits associated with the traditional Medi-
terranean diet (TMD) and virgin olive oil (VOO) con-
sumption could be mediated through changes in the
expression of atherosclerosis-related genes. A random-
ized, parallel, controlled clinical trial in healthy volun-
teers (n90) aged 20 to 50 yr was performed. Three-
month intervention groups were as follows: 1) TMD
with VOO (TMDVOO), 2) TMD with washed virgin
olive oil (TMDWOO), and 3) control with partici-
pants’ habitual diet. WOO was similar to VOO, but with
a lower polyphenol content (55 vs. 328 mg/kg, respec-
tively). TMD consumption decreased plasma oxidative
and inflammatory status and the gene expression re-
lated with both inflammation [INF-(INF), Rho
GTPase-activating protein15 (ARHGAP15), and inter-
leukin-7 receptor (IL7R)] and oxidative stress [adren-
-receptor (ADRB2) and polymerase (DNA-di-
rected) (POLK)] in peripheral blood mononuclear
cells. All effects, with the exception of the decrease in
POLK expression, were particularly observed when
VOO, rich in polyphenols, was present in the TMD
dietary pattern. Our results indicate a significant role
of olive oil polyphenols in the down-regulation of
proatherogenic genes in the context of a TMD. In
addition, the benefits associated with a TMD and
olive oil polyphenol consumption on cardiovascular
risk can be mediated through nutrigenomic ef-
fects.—Konstantinidou, V., Covas, M.-I., Mun˜z-
Aguayo, D., Khymenets, O., de la Torre, R., Saez, G.,
del Carmen Tormos, M., Toledo, E., Marti, A.,
Ruiz-Gutie´rrez, V., Ruiz Mendez, M. V., Fito, M. In
vivo nutrigenomic effects of virgin olive oil polyphe-
nols within the frame of the Mediterranean diet: a
randomized controlled trial. FASEB J. 24, 000 000
Key Words: inflammation oxidative stress DNA damage
gene expression IFN
In 1979, Keys ET AL.(1) provided ecological evidence
of a reduced risk for coronary heart disease (CHD)
associated with the Mediterranean diet despite its high
monounsaturated fat content. This diet, when con-
sumed in sufficient amounts, provides all of the known
essential micronutrients (i.e., vitamins and minerals),
fiber, and other plant food substances to promote
health (2). A high degree of adherence to the Mediter-
ranean diet has been associated with a reduced risk of
overall and cardiovascular mortality, cancer incidence
and mortality, and incidence of Parkinson’s disease and
Alzheimer’s disease (3, 4). The most impressive bene-
fits of this diet are, however, related to cardiovascular
morbidity and mortality (5).
Olive oil is the main source of fat in the Mediterra-
nean diet. A large body of knowledge provides evidence
of the benefits of the Mediterranean diet and the
consumption of olive oil on risk factors for CHD, in
particular, on the lipid profile, lipid and DNA oxida-
tion, insulin resistance, and inflammation (6–9). In
experimental studies, olive oil has also been shown to
be able to influence stages of carcinogenesis, cell
membrane composition, signal transduction pathways,
transcription factors, and tumor suppressor genes (10).
The beneficial effects of olive oil on cardiovascular risk
factors are now recognized, but often are attributed
Correspondence: Cardiovascular Risk and Nutrition Re-
search Group, Institut Municipal d’Investigacio´Me`dica
(IMIM-Hospital del Mar), Parc de Recerca Biome`dica de
Barcelona (PRBB), Carrer Dr. Aiguader, 88.08003, Barce-
lona, Spain. E-mail:
doi: 10.1096/fj.09-148452
10892-6638/10/0024-0001 © FASEB
The FASEB Journal article fj.09-148452. Published online February 23, 2010.
only to the high levels of monounsaturated fatty acids
(MUFAs) present in olive oil (11). Olive oil, however, is
a functional food that, besides a high content of
MUFAs, contains other minor biologically active com-
ponents (12). Among them, the best studied are the
polyphenols. In human studies, olive oil polyphenols
have been shown to reduce in vivo lipid oxidative
damage (13), endothelial dysfunction (14), prothrom-
botic profile (15), and inflammatory status (16–18) in
healthy volunteers and patients with stable CHD or
The exact mechanisms by which the Mediterranean
diet and olive oil exert their health effects are not yet
understood. Among these mechanisms, the gene-envi-
ronment and/or gene-diet interaction could play an
important role in the development and/or protection
of chronic degenerative diseases. At present, few data
exist on the in vivo effect of the Mediterranean diet on
human gene expression (19, 20), particularly in healthy
volunteers. Gene expression changes in human periph-
eral blood mononuclear cells (PBMNCs) after virgin
olive oil consumption have been reported (21–23).
However, no data exist concerning the in vivo nutrig-
enomic effects of olive oil polyphenols in humans. The
aim of the present study was to evaluate whether a
traditional Mediterranean diet (TMD) and the poly-
phenols present in olive oil promote changes in athero-
sclerosis-related genes in healthy volunteers.
Study design
A randomized, parallel, controlled clinical trial with 3 dietary
interventions was performed. From October 2007 to October
2008, 99 potential participants were recruited in primary care
centers. Ninety eligible participants were community-dwelling
men and women aged 20 to 50 yr. They were considered
healthy on the basis of a physical examination and routine
biochemical and hematological laboratory determinations.
The institutional ethics committee [IMM Comitè Ètic
d’Investigacio´ Clínica–Institut Municipal d’Assistència Sani-
tària (CEIC-IMAS)] approved the protocol (2004/1827/I),
and the volunteers gave written informed consent before
initiation of the study. This trial was registered in Current
Controlled Trials, London, with the International Standard
Randomized Controlled Trial Number of ISRCTN53283428.
Volunteers were randomly assigned to 3 intervention
groups (n30/group), by means of a computer-generated
random-number sequence. They received the following treat-
ments during 3 mo: group 1, TMD with virgin olive oil
(TMDVOO); group 2, TMD with washed virgin olive oil
(TMDWOO); and group 3, control group with their habit-
ual diet. Volunteers were advised by a dietitian to maintain
their habitual lifestyle. Exclusion criteria were the following:
intake of antioxidant supplements; intake of acetosalicylic
acid or any other drug with established antioxidative proper-
ties; high levels of physical activity (3000 kcal/wk in leisure-
time physical activity); obesity [body mass index (BMI) 30
]; hypercholesterolemia (total cholesterol 8.0 mM or
dyslipidemia therapy); diabetes (glucose 126 mg/dl or
diabetes treatment); hypertension [systolic blood pressure
(SBP) 140 mmHg and/or diastolic blood pressure (DBP)
90 mmHg or antihypertensive treatment]; multiple aller-
gies; celiac or other intestinal diseases; any condition that
could limit the mobility of the subject, making study visits
impossible; life-threatening illnesses or other diseases or
conditions that could worsen adherence to the measurements
or treatments; vegetarianism or a need for other special diets;
and alcoholism or other drug addiction. Fasting blood and
first morning spot urine samples were collected between 8
and 10 AM at study entry and after the 3-mo intervention.
Randomization and Mediterranean diet intervention
The baseline examination included the administration of a
previously validated 137-item food frequency questionnaire
(24); the Minnesota Leisure Time Physical Activity question-
naire, which has been validated for use in Spanish men and
women (25, 26); and a 47-item general questionnaire assess-
ing lifestyle, health conditions, sociodemographic variables,
history of illness, and medication use. The same dietitian
performed the interventions with the 3 randomized groups.
On the basis of the assessment of an individual 14-point
Mediterranean diet score (8), the dietitian gave personalized
advice during a 30-min session to each participant, with
recommendations on the desired frequency of intake of
specific foods. Instructions were directed to upscaling the
TMD score, including the use of olive oil for cooking and
dressing; increased consumption of fruit, vegetables, and fish;
consumption of white meat instead of red or processed meat;
preparation of homemade sauce with tomato, garlic, onion,
aromatic herbs, and olive oil to dress vegetables, pasta, rice,
and other dishes; and, for alcohol drinkers, moderate con-
sumption of red wine. At the end of the intervention (3 mo),
all baseline procedures were repeated.
Olive oil characteristics
The WOO used in intervention group 2 was obtained from
the VOO used in intervention group 1 in the Instituto de la
Grasa (Sevilla, Spain). In brief, VOO was placed in a thermo-
static reactor, washed twice with 10% water at 70°C, and
shaken at 125 rpm. Temperature was maintained at 40°C for
20 min at 95 rpm. Oil-phase separation was performed by
centrifugation, repeating the whole procedure 5 times. This
WOO maintained the same characteristics as the VOO, with
the exception of a lower content of polyphenols (55 and 328
mg/kg, respectively). Olive oils were provided to the subjects
of both intervention groups 1 and 2 in a sufficient amount for
the entire family (15 L/volunteer) during the intervention
periods for both cooking and dressing purposes. The VOO
used was of the Hojiblanca variety from Andalucía, Spain.
The composition of the olive oils was as follows: MUFAs, 75%;
polyunsaturated fatty acids (PUFAs), 18.6%; and saturated
fatty acids, (SFAs), 6.4%. Minor components, other than
polyphenols, were -tocopherol (1.47 mg/kg), -carotene
(0.43 mg/kg), and sterols (15.6 mg/kg). The contents of
squalene and terpenes were 4346 and 4026 mg/kg and 48.3
and 61.3 mg/kg for VOO and WOO, respectively. Both olive
oils were stored to avoid exposure to air, light, and high
temperature to prevent oxidation.
Oxidative damage and inflammation biomarkers
Serum glucose, total cholesterol, and triglyceride levels were
measured using standard enzymatic methods, and HDL-
cholesterol (HDL-C) was measured by an accelerator selective
detergent method (ABX-Horiba Diagnostics, Montpellier,
France), in a automated PENTRA-400 autoanalyzer (ABX-
Horiba Diagnostics). LDL-cholesterol (LDL-C) was calculated
2 Vol. 24 July 2010 KONSTANTINIDOU ET AL.The FASEB Journal
by the Friedewald (27) formula whenever triglycerides were
300 mg/dl. Oxidized LDL (oxLDL) was determined in
plasma by a sandwich ELISA procedure using the murine
monoclonal antibody mAB-4E6 as a capture antibody and a
peroxidase-conjugated antibody against oxidized apolipopro-
tein B bound to the solid phase (oxLDL; Mercodia AB,
Uppsala, Sweden). Urine total F2-isoprostanes were deter-
mined by an immunoassay kit (Cayman Chemical, Ann
Arbor, MI, USA). The amount of 7,8-dihydro-8-oxo-2-
deoxyguanosine (8-oxo-dG) in urine was measured by
HPLC with electrochemical detection. Values of isoprostanes
and 8-oxo-dG in urine were normalized against creatinine
concentration. High-sensitivity C-reactive protein (CRP) was
measured by immunoturbidometry (ABX-Horiba Diagnos-
tics). Plasma levels of IFN-, monocyte chemoattractant pro-
tein 1 (MCP-1), soluble P-selectin (s-P-selectin), and soluble
CD40L (sCD40L) were measured by flow cytometry (Bender
MedSystems Co. Ltd., San Diego, CA, USA). All analytical
determinations were performed in the same batch.
Evaluation of the intervention
After 3 mo, all baseline procedures were repeated. Biological
assessment of intervention compliance was performed in all
participants. Tyrosol and hydroxytyrosol, the major polyphe-
nols present in olive oil, were measured in urine by gas
chromatography-mass spectrometry (28).
Gene expression analyses
The selection of candidate genes was performed on the basis
of previous data from our group concerning atherosclerosis-
related responsive genes in peripheral blood mononuclear
cells (PBMNCs) of healthy volunteers after long-term (3 wk)
(21) and short-term (23, 29) VOO consumption, and their
biological plausibility as assessed by literature review (http:// Gene expression analyses
were performed in a subsample of 56 participants (20, 16, and
20 in control, TMDWOO, and TMDVOO groups, respec-
tively). A liquid-liquid method to isolate total RNA from
PBMNCs was performed as described previously (21–23). The
correct quality, quantity, and purity of total RNA were as-
sessed. A total of 100 ng of tRNA in a 20-l reaction was
reverse-transcribed using the High-Capacity cDNA Reverse
Transcription Kit with RNase Inhibitor (Applied Biosystems,
Foster City, CA, USA) according to the manufacturer’s pro-
tocols. An array for gene expression analysis was performed in
duplicate using 384-well Micro Fluidic cards (TaqMan Low
Density Array by Design) for 48 genes (471 control) on the
ABI Prism 7900HT Sequence Detection System (Applied
Biosystems). The human glyceraldehyde-3-phosphate dehy-
drogenase (GADPH) gene was used as an endogenous control
to correct the differences in the amount of total cDNA added
to each reaction. Results from each run were analyzed sepa-
rately using a software-defined baseline and a C
threshold of
0.20. Changes in gene expression were calculated using the
relative quantification (RQ) method and applying the 2
formula (30). Each gene expression was first normalized to
the endogenous reference gene (C
) and
afterward to its untreated control (baseline) (⌬⌬C
). Two
genes, NOX1 (NADPH oxidase 1) and NOX2 (NADPH oxi-
dase 2), did not amplify. Thus, they were excluded from the
analyses. Data obtained were analyzed using SDS 2.1 software.
We used the Functional Classification Tool of the DAVID
Bioinformatics Database (31, 32) to generate a gene-to-gene
similarity matrix.
Statistical analysis
The normality of continuous variables was assessed by normal
probability plots and by means of the Shapiro-Wilk test. The
relationship between continuous variables was measured by
Spearman’s rank correlation coefficient. Non-normally dis-
tributed variables were log-transformed before application of
the ttest or general linear modeling statistics. ANOVA was
used for assessing differences between the control and the
two TMD intervention groups at baseline. Comparisons of the
3-mo changes were performed by a covariance model with
polynomial content, with age and sex as covariates. Statistical
analyses were performed as 2-group analyses with the TMD
global group (TMDVOO and TMDWOO) vs. the control
group and as 3-group analyses, considering the 3 types of
intervention separately (TMDVOO, TMDWOO, and con-
trol). An a priori defined value of P0.05 was considered
statistically significant. All statistical analyses were performed
with SPSS 12.3 software (SPSS Inc., Chicago, IL, USA) for
Windows XP (Microsoft, Redmond, WA). Gene set enrich-
ment analysis was applied to the Functional Classification
Tool to determine whether an a priori defined set of genes
showed statistically significant concordant differences be-
tween the two biological states (before and after the interven-
tion). The enrichment score value was used to highlight the
most overrepresented biological annotation out of thousands
of linked terms and contents.
We excluded 9 of the 99 invited participants before
randomization for various reasons, and 1 participant
dropped out of the study after randomization (Fig. 1).
Table 1 shows the baseline characteristics of the 90
participants (26 men and 64 women) who entered the
study. We observed lower levels of plasma IFN-in the
TMD global and the TMDWOO groups vs. control.
We did not observe differences in general baseline
characteristics among groups (Table 1). Table 2 shows
the changes in energy, nutrient intake, and key food
items at the end of the intervention period. An increase
in vegetable, legume, and fish consumption was ob-
served in both TMD groups. Participants’ compliance
with the supplemented olive oil was good, as reflected
by both the increase in VOO consumption and the
decrease in olive oil (nonvirgin) in the TMDVOO
group, whereas the opposite effect was observed in the
TMDWOO group (Table 2), and the decrease in the
urinary tyrosol and hydroxytyrosol concentrations in
the TMDWOO group and the increase in the
TMDVOO group (P0.007, for quadratic trend)
(Fig. 2). In the two-group analyses (TMD global vs.
control), plasma glucose levels, HDL-C, F
tanes, IFN-, and CRP decreased after 3 mo of TMD
intervention (P0.05;) (Table 3). In the 3-group
analyses (Table 3), total cholesterol, HDL-C, and
LDL-C decreased in the TMDVOO group after 3 mo
of intervention (P0.05), without changes in the total
cholesterol/HDL-C or LDL-C/HDL-C ratios. The de-
crease in plasma IFN-,F
-isoprostanes, and s-P-selec-
tin was significant only after the TMDVOO interven-
tion (P0.05) (Table 3). Similar trends and results
were obtained when the subpopulation involved in
gene expression analyses (n56) was evaluated. When
results were disclosed by sex, in females a decrease in
IFN-in the control group and in CRP in the TMD
global and TMDWOO groups was observed. In addi-
tion, in the TMDVOO group, we observed an in-
crease in HDL-C in females and a decrease in LDL-C in
males (Supplemental Table 1).
Intragroup comparisons showed no significant differ-
ences between pre- and posttreatment values in the
evaluated gene expression in any intervention group.
Table 4 shows the intergroup comparisons of the gene
expression changes in the 2-group analyses (TMD
global vs. control) expressed as the log
ratio of RQ
between posttreatment and basal values. Five genes
-receptor (ADRB2),Rho GTPase-activat-
ing protein 15 (ARHGAP15), IFN-(IFN), IL-7 recep-
tor (IL7R), and polymerase (DNA directed)-(POLK)]
were down-regulated compared with the control group
(P0.05) (Table 4). When the 3-group analyses were
performed, a decreasing linear trend from the control
to the TMDVOO group (P0.05) was observed (Fig. 3)
in ADRB2, ARHGAP15, IL7R, and IFNgene expres-
sion. The down-regulation was statistically significant in
the TMDVOO group vs. control group (P0.05) for
ADRB2, ARHGAP15, and IFNgenes and had border-
line significance (P0.052) in the case of IL7R gene
expression (Fig. 3). No differences in the expression of
Figure 1. Study flow diagram. Gene expression anal-
yses were performed in a subsample of 56 participants
(20, 16, and 20 in control, TMDWOO, and
TMDVOO groups, respectively).
TABLE 1. Volunteer baseline characteristics
Parameter Control, n30 TMD global, n60 TMDWOO, n30 TMDVOO, n30
Age (yr) 43 13 45 10 44 10 45 10
Men (%) 34.5 25 27 23
Weight (kg) 66 16 68 13 69 13 68 14
BMI (kg/m
) 25 4254265254
SBP (mmHg) 117 12 116 15 117 14 114 16
DBP (mmHg) 69 10 72 10 72 10 72 10
Glucose (mg/dl) 85 15 84 12 84 14 84 9
Total cholesterol (mg/dl) 202 54 207 50 200 47 214 54
LDL-C (mg/dl) 127 42 131 44 124 37 138 50
HDL-C (mg/dl) 58 13 60 14 58 13 61 15
Total cholesterol/HDL-C 3.6 1.0 3.6 0.9 3.5 0.6 3.6 1.0
LDL-C/HDL-C 2.2 0.7 2.3 0.8 2.2 0.5 2.3 0.9
Triglycerides (mg/dl) 67 (52, 83) 70 (57, 103) 67 (58, 102) 70 (57, 105)
oxLDL (U/L) 66 29 63 21 62 20 64 22
-isoprostanes in urine
(pg/mmol of creatinine) 42 (39, 79) 67 (39, 83) 54 (41, 79) 72 (39, 85)
IFN-(ng/ml) 0.086 (0.009, 0.124) 0.018 (0.001, 0.073)* 0.001 (0, 0.068)* 0.027 (0, 0.086)
MCP-1 (pg/ml) 282 (203, 369) 217 (170, 307) 240 (195, 349) 174 (143, 243)
s-P-selectin (ng/ml) 935 741 743 493 768 496 710 498
s-CD40L (pg/ml) 937 (586, 2254) 1217 (602, 2354) 1389 (618, 2306) 1001 (558, 2449)
CRP (mg/dl) 0.02 (0.01, 0.09) 0.07 (0.03, 0.18) 0.11 (0.02, 0.25) 0.07 (0.03, 0.11)
8-Oxo-dG in urine (nmol/
mmol creatinine) 10.09 4.07 11.32 4.01 11.10 3.89 11.55 4.19
EEPA (kcal/d) 129 (25, 269) 130 (47, 224) 113 (49, 183) 139 (32, 229)
Values are shown as means sd for normal variables and medians (25th, 75th percentiles) for nonparametric variables. Univariate ANOVA
was used to assess differences between groups for the normal variables; Kruskal-Walls test was used for nonparametric variables. EEPA, energy
expenditure in physical activity in leisure time. *P0.05 vs. control group.
4 Vol. 24 July 2010 KONSTANTINIDOU ET AL.The FASEB Journal
other evaluated genes were observed, either between
the TMDVOO and TMDWOO groups or between
them and the control group. Gene expression changes
were observed, particularly in the female groups (Sup-
plemental Table 2). Correlation analyses showed that
postintervention IL7R expression values (all volun-
teers) were inversely correlated with urinary tyrosol
(r⫽⫺0.273, P0.044) and hydroxytyrosol (r⫽⫺0.284,
P0.035) levels. In addition, changes in urinary levels
of tyrosol after TMDVOO intervention were inversely
correlated with changes in the expression of IFN
(r⫽⫺0.390, P0.006). Functional annotation cluster-
ing of all 45 genes showed that 3 of the down-regulated
genes, IFN, IL7R, and ADRB2, clustered to the same
functional group (functional group 3, GO:0019219,
regulation of nucleobase, nucleoside, nucleotide, and
nucleic acid metabolic process) (Table 5).
In the present study, we examined whether the adher-
ence to a TMD modulates the expression of atheroscle-
rosis-related genes and systemic oxidative stress and
inflammation markers, focusing on the effect of olive
oil polyphenols. Our results indicate that the TMD
decreased the lipid oxidative and inflammatory status.
The TMD also decreased the expression of genes
TABLE 2. Change in consumption of key foods and nutrients
Change from baseline at 3 mo mean (95% CI)
Control (n29) TMD WOO (n30) TMD VOO (n30)
VOO (g/d) 0.44 (2.9 to 1.9) 8.0 (12.6 to 3.4)
22.2 (15.1 to 29.2)
Olive oil (g/d)
0.88 (5.6 to 3.9) 10.3 (4.7 to 16.0)*
17.3 (24.2 to 10.4)*
Total olive oil (g/d) 13.5 (42.1 to 15.2) 22.9 (11.5 to 57.5) 41.3 (11.9 to 70.7)
Fruits (g/d) 1.0 (0.1 to 1.2) 0.76 (2.84 to 1.33) 1.31 (5.06 to 2.44)
Vegetables (g/d) 1.72 (2.44 to 5.89) 4.51 (1.55 to 10.57) 10.31 (4.50 to 16.12)
Legumes (g/d) 0.02 (0.76 to 0.72) 1.36 (0.47 to 2.25)
2.25 (1.24 to 3.26)
Fish (g/d) 1.93 (1.14 to 5.00) 3.87 (1.79 to 5.94)* 7.93 (2.89 to 12.98)
Nuts (g/d) 1.5 (1.5 to 4.5) 1.2 (0.22.2)* 0.9 (1.7 to 0)*
Dairy products (g/d) 6.28 (6.59 to 19.15) 1.83 (3.50 to 7.16) 2.41 (11.30 to 6.48)
Alcohol (g/d) 0.18 (0.14 to 0.49) 0.17 (0.08 to 0.5) 0.02 (0.02 to 0.061)
Energy (kcal) 20.08 (53.66 to 13.51) 24.88 (13.15 to 62.90)
51.01 (20.30 to 81.73)
Protein (%) 0.17 (0.15 to 0.49) 0.08 (0.45 to 0.28) 0.033 (0.25 to 0.32)
Carbohydrate (%) 0.04 (0.76 to 0.83) 0.57 (1.38 to 0.24) 0.78 (1.27 to 0.29)*
Fat (%) 0.28 (1.35 to 0.79) 0.67 (0.52 to 1.86) 0.80 (0.11 to 1.48)*
MUFAs (%) 0.52 (1.15 to 0.12) 0.47 (0.47 to 1.41) 0.96 (0.06 to 1.86)*
PUFAs (%) 0.10 (0.09 to 0.30) 0.09 (0.22 to 0.39) 0.22 (0.75 to 0.31)
SFAs (%) 0.38 (0.24 to 1.00) 0.43 (1.0 to 0.13)
0.77 (1.24 to 0.29)*
-Linolenic acid (g/d) 0.01 (0.06 to 0.09) 0.04 (0.01 to 0.07)* 0.05 (0.02 to 0.08)*
Marine n–3 fatty acids (g/d) 0.01 (0.004 to 0.03) 0.03 (0.02 to 0.05)* 0.09 (0.02 to 0.17)*
Univariate ANOVA was used to assess differences between groups.
Includes WOO. *P0.05 vs. baseline;
P0.05 vs. TMD WOO;
0.05 vs. control group.
Figure 2. Changes in urinary tyrosol (A) and hydroxytyrosol (B) after the 3-mo interventions. *P0.05 vs. control;
related to inflammation processes (IFN,ARHGAP15,
and IL7R), oxidative stress (ADRB2), and DNA damage
(POLK) in PBMNCs. All of the above-mentioned ef-
fects, with the exception of the decrease in POLK
expression, were particularly observed when VOO, rich
in polyphenols, was present in the TMD pattern. Our
work provides, for the first time, evidence of the in vivo
nutrigenomic effect of olive oil polyphenols down-
regulating proatherogenic genes in humans. In addi-
tion and to the best of our knowledge, the in vivo
human nutrigenomic effect of the Mediterranean diet
in healthy individuals has not been reported previously.
When results were disclosed by sex, the gene
expression changes were particularly lower in the
female groups. In a previous work, we have reported
gender differences in PBMNC gene expression, with
higher expression of SOD1 and SOD2 in healthy
males (31). In the present work, however, the low
number of males in some groups could account for
the gender differences observed. Gene expression
can be considered as a quantitative trait that is highly
heritable. We used the Functional Classification Tool
of the DAVID Bioinformatics Database (32, 33) to
generate a gene-to-gene similarity matrix. Grouping
genes based on functional similarity can help to
enhance the biological interpretation of large lists of
genes derived from high-throughput studies. It has
been shown that disease-related genes tend to inter-
act (34, 35) and display significant functional clus-
tering in the analyzed molecular network. In our
results, after 3 mo of TMDVOO intervention, 3 of
the down-regulated genes (IFN, IL7R, and ADRB2)
were clustered to the same functional group. In a
previous exploratory approach concerning the hu-
man mononuclear cell transcriptome response after
acute and sustained VOO consumption, we observed
gene expression changes in PBMNCs of healthy
volunteers (21–23). In this work (21, 23), the Gene
Ontology analysis of the differentially expressed
genes indicated that consumption of VOO could
elicit changes in the regulation of transcription and
translation activities of human PBMNCs.
The Mediterranean diet, in which the main source of
fat is olive oil, is well known to be associated with a low
prevalence of CVD (2), cancer (36), and inflammatory
diseases (37, 38). Inflammation is heavily involved in
the onset and development of atherosclerosis (39).
Previous data from short- and long-term clinical trials
have shown an anti-inflammatory effect of the Mediter-
ranean-type diet in patients with risks for cardiovascular
disease (8, 40). In these patients, a TMD enriched with
VOO prevented the increase in cyclooxygenase-2
(COX-2) and LDL receptor-related protein (LRP1)
gene expression and reduced monocyte chemoattrac-
tant protein (MCP-1), compared with a TMD enriched
with nuts or with a low-fat diet (19). In experimental
models, the anti-inflammatory effects of polyphenols
and other olive oil minor components have been
described (41). Some of the anti-inflammatory effects
of olive oil polyphenols could be attributed to oleocan-
TABLE 3. Change in biomarkers after 3 mo of intervention
Control, n29 TMD global, n60
Postintervention Change Postintervention Change
Weight (kg) 67 16 0.19 (0.59 to 0.97) 68 14 0.17 (0.72 to 0.37)
BMI (kg/m
) 25 4 0.081 (0.2 to 0.36) 25 40.068 (0.26 to 0.13)
SBP (mmHg) 119 15 1.40 (2.60 to 5.40) 115 15 1.03 (3.76 to 1.7)
DBP (mmHg) 71 10 1.67 (1.23 to 4.58) 72 10 0.17 (1.81 to 2.15)
Glucose (mg/dl) 82 12 2.55 (5.4 to 0.31) 82 10* 2.1 (4.09 to 0.09)
Cholesterol (mg/dl) 202 57 0.12 (8.56 to 8.33) 202 46 4.85 (10.75 to 1.04)
HDL-C (mg/dl) 57 13 1.82 (4.34 to 0.70) 57 13* 2.0 (3.75 to 0.29)
LDL-C (mg/dl) 129 47 2.1 (4.35 to 8.56) 128 40 2.80 (7.22 to 1.63)
Cholesterol/HDL-C 3.6 1.0 0.09 (0.05 to 0.24) 3.6 0.8 0.04 (0.06 to 0.14)
LDL-C/HDL-C 2.3 0.8 0.09 (0.03 to 0.22) 2.3 0.7 0.03 (0.06 to 0.12)
Triglycerides (mg/dl) 62 (49, 98) 2.5 (17, 17.3) 71 (59, 99) 4 (14, 19)
OxLDL (U/L) 70 32 3.38 (2.36 to 9.16) 64 23 2.3 (1.69 to 6.19)
Isoprostanes (pg/mmol of
urine creatine) 39 (34, 65) 2.8 (14, 5.1) 49 (41, 66)* 2.5 (13.7, 6.6)
8-oxo-dG (nmol/mmol of
urine creatine) 8.9 3.8 1.1 (2.5 to 0.26) 10.4 3.9 0.95 (1.89 to 0.003)
IFN-(pg/ml) 61 (0, 113) 11 (52, 5) 0 (0, 46)* 0 (45, 11)
MCP-1 (pg/ml) 247 (211, 317) 36 (119, 27) 202 (176, 305) 0.14 (37, 35)
s-P-selectin (ng/ml) 696 (493, 1063) 78 (286, 323) 578 (346, 808)* 30 (383, 122)
s-CD40L (pg/ml) 1267 (498, 2013) 228 (1109, 789) 943 (587, 2437) 77 (1077, 804)
CPR (mg/dl) 0.04 (0.01, 0.14) 0 (0.01, 0.06) 0.04 (0.02, 0.11)* 0.02 (0.07, 0)
EEPA (kcal/d) 129 (52, 226) 6.8 (23.7 to 37.2) 117 (32, 206) 1.8 (23 to 19)
Postintervention values are presented as means sd for normal variables and as medians (25th, 75th percentiles) for non-normal variables.
Change values are presented as means (95% CI) and medians (25th, 75th percentiles) for non-normal variables. Univariate ANOVA, adjusted
by sex and age, was used to assess differences between groups for the normal variables; Kruskal-Walls test was used for nonparametric variables.
EEPA, energy expenditure in physical activity in leisure time. *P0.05 vs. baseline;
P0.05 vs. control;
P0.05 vs. TMD WOO.
6 Vol. 24 July 2010 KONSTANTINIDOU ET AL.The FASEB Journal
thal, an olive oil polyphenol with ibuprofen-like activity
in in vitro models (42). Besides its antioxidant and
anti-inflammatory activity, recent data suggest that hy-
droxytyrosol, a major olive oil phenolic compound,
may exert beneficial effects through stimulation of
mitochondrial biogenesis (43). The in vivo anti-inflam-
matory role of olive oil polyphenols in humans is
supported by several randomized controlled clinical
trials (16, 17, 44).
The decrease in systemic inflammatory markers
and in the expression of genes related with inflam-
matory processes observed in the present study is in
agreement with the above described previous results
concerning the protective effect of Mediterranean
diet and olive oil phenolics on inflammation. The
decrease in IFN-was observed both at phenotypic
and gene expression levels. IFN-is considered to be
a key inflammatory mediator for inducing IL-6, a
prime regulator of CRP synthesis in the liver (45). We
have previously reported a down-regulation of IFN
expression in PBMNCs of healthy volunteers after a
single dose of VOO (22). ARHGAP15 encodes for a
Rho GTPase-activating protein that regulates activity
of GTPases (46). Ras superfamily GTPases have been
identified as strategic molecular targets in statin-
induced T-cell immunosuppression. Statins, besides
being cholesterol-lowering drugs, also harbor strong
anti-inflammatory properties (47). Members of the
Rho GTPase family have been suggested to be medi-
ators of cardiac hypertrophy (48); however to date
little is known about their physiological roles (46).
The protein encoded by the IL7R gene is a receptor
for IL-7, which has been related to inflammatory pro-
cesses (49, 50). IL-7 has been shown to enhance the
expression of chemokines in PBMNCs (51). A recent
study has shown an up-regulation of stress-response
genes, such as IL7R and POLK, in the case of induced
carbon ion irradiation in murine tumor models (52).
POLK is a DNA repair gene that copies undamaged
DNA templates and is unique among human Y-family
DNA polymerases (53). Somatic DNA mutations, pro-
moted by DNA oxidation, are considered to be a crucial
step in carcinogenesis as well as to be involved in
atherosclerotic processes (16, 54). We did not observe
changes in the levels of 8-oxo-dG after the global TMD
interventions, although a decrease was observed after
the TMDVOO intervention. However, the results of
the EUROLIVE study, an intervention study performed
in 200 healthy males with 3 types of similar olive oils,
but with differences in their phenolic content, showed
that daily consumption of 25 ml of olive oil for 3 wk
reduced DNA oxidation, irrespective of the olive oil
polyphenol content (55). In agreement with the
EUROLIVE results, the down-regulation of POLK gene
expression observed in our study was associated with
the TMD intervention, but not with the olive oil poly-
phenol content. All these data suggest a protective role
for the MUFAs or other minor components of the olive
oil on DNA oxidation and damage.
TABLE 3. Continued
TMD WOO, n30 TMD VOO, n30
Postintervention Change Postintervention Change
69 14 0.25 (1.03 to 0.53) 67 14 0.1 (0.86 to 0.67)
26 50.1 (0.38 to 0.18) 25 40.04 (0.31 to 0.24)
116 14 1.63 (5.51 to 2.24) 114 15 0.4 (4.31 to 3.45)
71 90.8 (3.6 to 2.0) 73 10 1.12 (1.69 to 3.93)
82 11 1.76 (4.58 to 1.06) 82 92.43 (5.3 to 0.44)
200 48 0.2 (8.1 to 7.7) 205 45* 10.5 (19.1 to 1.84)
57 12 1.12 (3.5 to 1.3) 58 15* 3.14 (5.54 to 0.53)
126 40 1.4 (4.6 to 7.4) 131 41* 7.5 (13.8 to 1.2)
3.5 0.7 0.06 (0.08 to 0.20) 3.6 0.8 0.02 (0.13 to 0.17)
2.2 0.6 0.06 (0.06 to 0.18) 2.3 0.8 0.003 (0.13 to 0.12)
73 (58, 100) 4.5 (17.3, 18.5) 68 (60, 97) 4 (10, 19)
65 22 2.4 (3.04 to 7.9) 63 24 2.1 (3.68 to 7.83)
52 (43, 66) 1.6 (10.5, 7.4) 47 (35, 75)* 4.3 (18.2, 6.6)
10.7 3.5 0.41 (1.75 to 0.93) 10.1 4.4* 1.48 (2.82 to 0.15)
16 (0, 51) 0 (47, 33) 0 (0, 39)* 2.5 (47, 0)
253 (175, 328) 8 (60, 49) 194 (176, 250) 6(25, 29)
664 (368, 965) 19 (375, 147) 549 (248, 634)* 63 (434, 75)
1256 (706, 2773) 123 (875, 915) 923 (455, 2467) 81 (1435, 602)
0.0 (0.02, 0.12)* 0.03 (0.1, 0) 0.03 (0.02, 0.11)* 0.02 (0.06, 0)
113 (61, 206) 6.7 (23 to 37) 120 (23, 226) 10 (40 to 20)
TABLE 4. Change in expression of atherosclerosis-related genes after 3 mo of intervention
Gene symbol Gene name Control, n20
n36 Pvalue
Cholesterol, lipid
transport, and
ABCA1 ATP-binding cassette, subfamily A, member 1 0.320 0.231 0.051 0.159 0.334
ABCG1 ATP-binding cassette, subfamily G, member 1 0.146 0.127 0.064 0.092 0.608
ANXA1 Annexin A1 0.259 0.229 0.444 0.161 0.160
ARHGAP15 Rho GTPase activating protein 15 0.448 0.175 0.040 0.126 0.043
ARHGAP19 Rho GTPase activating protein 19 0.400 0.151 0.134 0.112 0.166
ARHGEF6 Rac/Cdc42 guanine nucleotide exchange factor 6 0.460 0.144 0.157 0.106 0.099
CD36 CD36 molecule (thrombospondin receptor) 0.197 0.170 0.009 0.126 0.342
CETP Cholesteryl ester transfer protein, plasma 0.262 0.331 0.058 0.257 0.631
MSR1 Macrophage scavenger receptor 1 0.542 0.222 0.253 0.157 0.301
PLA2G4B Phospholipase A2, group IVB 0.148 0.156 0.082 0.109 0.735
SCARB1 Scavenger receptor class B, member 1 0.025 0.078 0.085 0.056 0.261
IFNg Interferon, 1.048 0.464 0.109 0.330 0.049
IL10 Interleukin 10 0.915 0.360 0.609 0.270 0.506
CHUK Conserved helix-loop-helix ubiquitous kinase 0.325 0.192 0.036 0.140 0.236
ADAM17 ADAM metallopeptidase domain 17 (tumor necrosis
factor, , converting enzyme) 0.290 0.153 0.008 0.112 0.148
ADAMTS1 ADAM metallopeptidase with thrombospondin type 1
motif, 1 0.166 0.208 0.120 0.150 0.277
IFNA1 Interferon, 1 0.726 0.356 0.001 0.258 0.117
TNFSF10 Tumor necrosis factor (ligand) superfamily, member 10 0.195 0.219 0.195 0.156 0.157
TNFSF12_13 Tumor necrosis factor (ligand) superfamily, member
12-member 13 0.021 0.102 0.133 0.075 0.235
IL6 Interleukin 6 0.017 0.588 0.356 0.401 0.612
IL7R Interleukin 7 receptor 0.580 0.182 0.095 0.132 0.037
USP48 Ubiquitin specific peptidase 48 0.380 0.179 0.203 0.131 0.431
MPO Myeloperoxidase 0.159 0.121 0.013 0.090 0.343
RGS2 Regulator of G-protein signaling 2, 24 kDa 0.439 0.268 0.289 0.196 0.656
NFKB2 Nuclear factor of light polypeptide gene enhancer in
B-cells 2 0.098 0.082 0.008 0.063 0.315
Nuclear receptors
and fatty acids
NR1H2 Nuclear receptor subfamily 1, group H, member 2 0.081 0.070 0.003 0.050 0.369
NRIH3 Nuclear receptor subfamily 1, group H, member 3 0.166 0.108 0.034 0.077 0.331
PPARA Peroxisome proliferator-activated receptor 0.088 0.123 0.068 0.092 0.897
PPARBP PPAR binding protein 0.341 0.160 0.022 0.105 0.084
PPARG Peroxisome proliferator-activated receptor 0.002 0.242 0.235 0.175 0.463
PPARD Peroxisome proliferator-activated receptor 0.066 0.128 0.010 0.096 0.732
Oxidative stress
LIAS Lipoic acid synthetase 0.228 0.197 0.188 0.148 0.874
PTGS1 Prostaglandin-endoperoxide synthase 1 0.176 0.171 0.170 0.117 0.978
PTGS2 Prostaglandin-endoperoxide synthase 2 0.170 0.545 0.231 0.379 0.557
OLR1 Oxidized low-density lipoprotein (lectin-like) receptor 1 0.521 0.948 0.113 0.580 0.724
OSBP Oxysterol binding protein 0.219 0.130 0.035 0.093 0.260
ADRB2 Adrenergic, -2, receptor, surface 0.225 0.135 0.138 0.098 0.036
OGT O-linked N-acetylglucosamine (GlcNAc) transferase 0.373 0.235 0.014 0.162 0.218
ALDH1A1 Aldehyde dehydrogenase 1 family, member A1 0.101 0.187 0.116 0.135 0.949
DNA repair
CCNG1 Cyclin G1 0.396 0.192 0.004 0.139 0.106
POLK Polymerase (DNA directed) 0.595 0.275 0.115 0.204 0.045
TP53 Tumor protein p53 0.071 0.077 0.048 0.056 0.812
DCLRE1C DNA cross-link repair 1C 0.406 0.169 0.052 0.123 0.100
ERCC5 Excision repair cross-complementing rodent repair
deficiency, complementation group 5 0.401 0.227 0.049 0.169 0.221
XRCC5 X-ray repair complementing defective repair in Chinese
hamster cells 5 (double-strand-break rejoining; Ku
autoantigen, 80 kDa)
0.267 0.152 0.000 0.111 0.166
Gene expression changes, adjusted by age and sex, are presented as means se of the RQ log
ratio (posttreatment vs. basal values).
8 Vol. 24 July 2010 KONSTANTINIDOU ET AL.The FASEB Journal
The ADRB2 gene was also down-regulated after 3
mo of TDM intervention, particularly in the TDM
VOO intervention group. A recent study has demon-
strated that the ADRB2 blockade reduces macro-
phage cytokine production and improves survival
after traumatic injury (56). ADRB2 agonists can affect
glucose homeostasis through the modulation of in-
sulin and glucagon secretion, hepatic glucose pro-
duction, and glucose uptake into muscle (57). In this
sense, we have previously reported up-regulation of
the ADRB2 expression in human PBMNCs at the
postprandial state after ingestion of 50 ml of VOO
(22). This olive oil ingestion promoted a postpran-
dial peak of insulin, lipid oxidative damage, and
triglycerides, and the ADRB2 expression at 6 h post-
prandial was inversely correlated with plasma oxLDL
and triglyceride concentrations (22). Oxidation of
the lipids and apoproteins present in LDL leads to a
change in the lipoprotein conformation by which
LDL is better able to enter the monocyte/macro-
phage system of the arterial wall and promote the
atherosclerotic process (58). In functional studies
the ADRB2 receptor appears to be protective against
oxidative stress (22, 59). In our present study, after 3
mo of TMDVOO intervention, an improvement in
the oxidative status of the volunteers was observed.
These data are in agreement with those obtained in
the EUROLIVE study, in which a dose-dependent
decrease of the lipid oxidative damage was observed
with the phenol content of the administered olive oil
(13). One of our trial’s strengths is that the study
design is able to provide first-level scientific evidence
(60), reflecting eating habits of community-dwelling
individuals. Compliance of the volunteers was good
as reflected in the changes of olive oil consumption
patterns and urinary tyrosol and hydroxytyrosol. The
lack of significance in the increase in urinary olive oil
phenolics in the TMDVOO group vs. the control
group could be due to the fact that the control group
participants followed their habitual diet, which in
Mediterranean countries includes VOO, or the high
interindividual variation in urinary phenolic values,
particularly in the case of hydroxytyrosol (28). We
worked with whole dietary patterns at real-life doses
of food. Administration of isolated antioxidants (i.e.,
hydroxytyrosol) at high doses has been shown to
promote the atherosclerosis lesion, as well as an
increase in oxidative damage, in apolipoprotein E-
Figure 3. Gene expression changes in adrenergic
-receptor (ADRB2; A), Rho GTPase activating protein 15 (ARHGAP15; B),
INF-(IFN;C), and IL-7 receptor (IL7R; D) genes after the 3-mo interventions. P0.05 for linear trend in all cases; *P0.05
vs. control group.
deficient mice (61). This finding points out the
importance of the matrix and the dose of antioxi-
dants. Changes in gene expression were modest, as
was expected in real-life intervention conditions. The
lack of a washout period at the beginning of the study
could also be one factor responsible for the relative
low gene response observed. We worked against our
own hypothesis, by using the current Spanish dietary
pattern in our control group, to maintain real-life
conditions in all groups. A study limitation was the
inability to assess potential interactions between the
olive oil and other diet components that might affect
the generalization of the results. However, the effects
of food components are subtle and must be consid-
ered in the context of chronic exposure. Whether
additional or different effects would have been ob-
served over longer periods is unknown. A longer
study, however, could have impaired the compliance
of the participants.
In summary, a down-regulation in the expression
of atherosclerosis-related genes occurs in human
PBMNCs after 3 mo of TMD. Our results point out a
significant role of olive oil polyphenols in the down-
regulation of proatherogenic genes in the frame of
the Mediterranean diet. Changes in gene expression
were concomitant with decreases in lipid oxidative
damage and systemic inflammation markers. Our
results support the idea that the benefits associated
TABLE 5. Functional annotation clustering (biological processes level 5)
group Enrichment Gene Ontology Gene symbol
1 3.86 GO:0008203; cholesterol metabolic
process ABCG1, ABCA1, CETP, PPARD, SCARB1 0.001
GO:0016125; sterol metabolic
process ABCG1, ABCA1, CETP, PPARD, SCARB1 0.001
GO:0008202; steroid metabolic
2 2.67 GO:0006915; apoptosis IL6, IFNG, MPO, ERCC5, TP53, IL10,
GO:0042981; regulation of
apoptosis IL6, MPO, ERCC5, TP53, IL10, TNFSF10,
GO:0043066; negative regulation
of apoptosis IL6, MPO, ERCC5, IL10, ANXA1 0.005
GO:0043065; positive regulation of
apoptosis TP53, TNFSF10, ADRB2 0.181
3 2.19 GO:0031325; positive regulation of
cellular metabolic process IL6, IFNG, MED1, TP53, IL10, PPARG,
GO:0045935; ositive regulation of
nucleobase, nucleoside,
nucleotide, and nucleic acid
metabolic process
GO:0045893; positive regulation of
transcription, DNA-dependent IL6, IFNG, MED1, TP53, PPARG, PPARA,
GO:0031324; negative regulation
of cellular metabolic process IL6, TP53, IL10, PPARG, NR1H2, PPARD 0.006
GO:0006357; regulation of
transcription from RNA
polymerase II promoter
GO:0019219; regulation of
nucleobase, nucleoside,
nucleotide, and nucleic acid
metabolic process
4 1.64 GO:0006631; fatty acid metabolic
process CD36, PTGS1, PTGS2, PPARA, PPARD 0.002
GO:0032787; monocarboxylic acid
metabolic process CD36, PTGS1, PTGS2, PPARA, PPARD 0.006
GO:0008544; epidermis
development PTGS2, PPARA, PPARD 0.075
GO:0009888; tissue development PTGS2, PPARA, PPARD, ADRB2 0.084
5 1.58 GO:0048534; hemopoietic or
lymphoid organ development IL6, IL7R, CHUK, IL10, NFkB2 0.003
GO:0002521; leukocyte
differentiation IL6, CHUK, IL10 0.045
GO:0030097; hemopoiesis IL6, CHUK, IL10 0.116
10 Vol. 24 July 2010 KONSTANTINIDOU ET AL.The FASEB Journal
with a Mediterranean-type diet and olive oil polyphe-
nol consumption on CHD risk can be mediated
through changes in the expression of atherosclerosis-
related genes. Data from this study provide further
evidence to recommend the TMD and rich-polyphe-
nol olive oils, such as VOO, as a useful tool for the
prevention of atherosclerosis.
The CIBER de Fisiopatología de la Obesidad y Nutricio´ n is an
initiative of the Instituto de Salud Carlos III, Madrid, Spain. This
work was supported by Fóndo de Investigación Sanitaria–Fóndo
Europeo de Desarrollo Regional (FIS-FEDER; PI041308), by
Sistema National de Salud (SNS) contract Miguel Servet (CP06/
00100) Instituto de Salud Carlos III, and by the Greek State
Scholarship Foundation (Athens, Greece), and partially sup-
ported by the Generalitat of Catalunya (2005 SGR 00577). The
authors declare no conflicting financial interests.
1. Keys, A., Menotti, A., Karvonen, M. J., Aravanis, C., Blackburn,
H., Buzina, R., Djordjevic, B. S., Dontas, A. S., Fidanza, F., and
Keys, M. H. (1986) The diet and 15-year death rate in the seven
countries study. Am. J. Epidemiol. 124, 903–915
2. Trichopoulou, A., Bamia, C., and Trichopoulos, D. (2009)
Anatomy of health effects of Mediterranean diet: EPIC prospec-
tive cohort study. BMJ 338, b2337
3. Trichopoulou, A., Costacou, T., Bamia, C., and Trichopoulos,
D. (2003) Adherence to a Mediterranean diet and survival in a
Greek population. N. Engl. J. Med. 348, 2599–2608
4. Sofi, F., Cesari, F., Abbate, R., Gensini, G. F., and Casini, A.
(2008) Adherence to Mediterranean diet and health status:
meta-analysis. BMJ 337, a1344
5. Parikh, P., McDaniel, M. C., Ashen, M. D., Miller, J. I., Sor-
rentino, M., Chan, V., Blumenthal, R. S., and Sperling, L. S.
(2005) Diets and cardiovascular disease: an evidence-based
assessment. J. Am. Coll. Cardiol. 45, 1379–1387
6. Covas, M. I. (2007) Olive oil and the cardiovascular system.
Pharmacol. Res. 55, 175–186
7. Pe´rez-Jimenez, F., Alvarez de Cienfuegos, G., Badimon, L.,
Barja, G., Battino, M., Blanco, A., Bonanome, A., Colomer, R.,
Corella-Piquer, D., Covas, I., Chamorro-Quiros, J., Escrich, E.,
Gaforio, J. J., Garcia Luna, P. P., Hidalgo, L., Kafatos, A.,
Kris-Etherton, P. M., Lairon, D., Lamuela-Raventos, R., Lopez-
Miranda, J., Lopez-Segura, F., Martínez-Gonza´lez, M. A., Mata,
P., Mataix, J., Ordovas, J., Osada, J., Pacheco-Reyes, R., Perucho,
M., Pineda-Priego, M., Quiles, J. L., Ramírez-Tortosa, M. C.,
Ruíz-Gutie´rrez, V., Sanchez-Rovira, P., Solfrizzi, V., Soriguer-
Escofet, F., Torre-Fornell, R., Trichopoulos, A., Villalba-
Montoro, J. M., Villar-Ortiz, J. R., and Visioli, F. (2005)
International conference on the healthy effect of virgin olive
oil. Eur. J. Clin. Invest. 35, 421–424
8. Estruch, R., Martínez-Gonza´lez, M. A., Corella, D., Salas-Salvado´,
J., Ruíz-Gutie´rrez, V., Covas, M. I., Fiol, M., Gomez-Gracia, E.,
Lo´ pez-Sabater, M. C., Vinyoles, E., Aros, F., Conde, M., Lahoz,
C., Lapetra, J., Saez, G., and Ros, E. (2006) Effects of a
Mediterranean-style diet on cardiovascular risk factors: a ran-
domized trial. Ann. Intern. Med. 145, 1–11
9. Salas-Salvado, J., Fernandez-Ballart, J., Ros, E., Martinez-Gonzalez,
M. A., Fito, M., Estruch, R., Corella, D., Fiol, M., Gomez-Gracia,
E., Aros, F., Flores, G., Lapetra, J., Lamuela-Raventos, R.,
Ruiz-Gutierrez, V., Bullo, M., Basora, J., and Covas, M. I. (2008)
Effect of a Mediterranean diet supplemented with nuts on
metabolic syndrome status: one-year results of the PREDIMED
randomized trial. Arch. Intern. Med. 168, 2449–2458
10. Menendez, J. A., Papadimitropoulou, A., Vellon, L., and Lupu,
R. (2006) A genomic explanation connecting “Mediterranean
diet,” olive oil and cancer: oleic acid, the main monounsatu-
rated fatty acid of olive oil, induces formation of inhibitory
“PEA3 transcription factor-PEA3 DNA binding site” complexes
at the Her-2/neu (erbB-2) oncogene promoter in breast, ovar-
ian and stomach cancer cells. Eur. J. Cancer 42, 2425–2432
11. U.S. Food and Drug Administration. Press Release P04-100.
November 1, 2004. Retrieved March 30, 2009, from http://
12. Covas, M. I., Ruiz-Gutierrez, V., De la Torre, R., Kafatos, A.,
Lamuela-Raventos, R. M., Osada, R. W., and Visioli, F. (2006)
Minor components of olive oil: evidence to date of health
benefits in humans. Nutr. Rev. 64, 20–30
13. Covas, M. I., Nyyssonen, K., Poulsen, H. E., Kaikkonen, J., Zunft,
H. J., Kiesewetter, H., Gaddi, A., de la, T. R., Mursu, J., Baumler,
H., Nascetti, S., Salonen, J. T., Fito, M., Virtanen, J., Marrugat, J.,
and EUROLIVE Study Group. (2006) The effect of polyphenols
in olive oil on heart disease risk factors: a randomized trial. Ann.
Intern. Med. 145, 333–341
14. Ruano, J., Lopez-Miranda, J., Fuentes, F., Moreno, J. A., Bellido,
C., Perez-Martinez, P., Lozano, A., Gomez, P., Jimenez, Y., and
Perez, J. F. (2005) Phenolic content of virgin olive oil improves
ischemic reactive hyperemia in hypercholesterolemic patients.
J. Am. Coll. Cardiol. 46, 1864–1868
15. Ruano, J., Lopez-Miranda, J., de la Torre, R., Delgado-Lista, J.,
Fernandez, J., Caballero, J., Covas, M. I., Jimenez, Y., Perez-
Martinez, P., Marin, C., Fuentes, F., and Perez-Jimenez, F.
(2007) Intake of phenol-rich virgin olive oil improves the
postprandial prothrombotic profile in hypercholesterolemic
patients. Am. J. Clin. Nutr. 86, 341–346
16. Bogani, P., Galli, C., Villa, M., and Visioli, F. (2007) Postprandial
anti-inflammatory and antioxidant effects of extra virgin olive
oil. Atherosclerosis 190, 181–186
17. Fito´, M., Cladellas, M., de la Torre, R., Martí, J., Mun˜ oz, D.,
Schro¨ der, H., Alca´ntara, M., Pujadas-Bastardes, M., Marrugat, J.,
Lo´ pez-Sabater, M. C., Bruguera, J., Covas, M. I., and SOLOS
Investigators. (2008) Anti-inflammatory effect of virgin olive oil
in stable coronary disease patients: a randomized, crossover,
controlled trial. Eur. J. Clin. Nutr. 62, 570–574
18. Pacheco, Y. M., Bermudez, B., Lopez, S., Abia, R., Villar, J., and
Muriana, F. J. (2007) Minor compounds of olive oil have
postprandial anti-inflammatory effects. Br. J. Nutr. 98, 260–263
19. Llorente-Corte´s, V., Estruch, R., Mena, M. P., Ros, E., Martínez-
Gonza´lez, M. A., Fito´, M., Lamuela-Ravento´ s, R. M., and
Badimon, L. (2010) Effect of Mediterranean diet on the
expression of pro-atherogenic genes in a population at high
cardiovascular risk. Atherosclerosis 208, 442–450
20. Paniagua, J. A., Gallego de la Sacristana, A., Romero, I., Vidal-Puig,
A., Latre, J. M., Sanchez, E., Perez-Martinez, P., Lopez-Miranda, J.,
and Perez-Jimenez, F. (2007) Monounsaturated fat-rich diet pre-
vents central body fat distribution and decreases postprandial
adiponectin expression induced by a carbohydrate-rich diet in
insulin-resistant subjects. Diabetes Care 30, 1717–1723
21. Khymenets, O., Fito, M., Covas, M. I., Farre, M., Pujadas, M. A.,
Munoz, D., Konstantinidou, V., and de la Torre, R. (2009)
Mononuclear cell transcriptome response after sustained virgin
olive oil consumption in humans: an exploratory nutrigenomics
study. OMICS 13, 7–19
22. Konstantinidou, V., Khymenets, O., Covas, M. I., de la Torre, R.,
Munoz-Aguayo, D., Anglada, R., Farre, M., and Fito, M. (2009)
Time course of changes in the expression of insulin sensitivity-
related genes after an acute load of virgin olive oil. OMICS 13,
23. Konstantinidou, V., Khymenets, O., Fito, M., de la Torre, R.,
Anglada, R., Dopazo, A., and Covas, M. I. (2009) Characteriza-
tion of human gene expression changes after olive oil ingestion:
an exploratory approach. Folia Biol. (Praha) 55, 85–91
24. Martin-Moreno, J. M., Boyle, P., Gorgojo, L., Maisonneuve, P.,
Fernandez-Rodriguez, J. C., Salvini, S., and Willett, W. C. (1993)
Development and validation of a food frequency questionnaire
in Spain. Int. J. Epidemiol. 22, 512–519
25. Elosua, R., García, M., Aguilar, A., Molina, L., Covas, M. I.,
and Marrugat, J. (2000) Validation of the Minnesota Leisure
Time Physical Activity Questionnaire in Spanish women. The
MARATHOM Investigators. Med. Sci. Sports Med. 32, 1431–
26. Elosua, R., Marrugat, J., Molina, L., Pons, S., and Pujol, E.
(1994) Validation of the Minnesota Leisure Time Physical
Activity Questionnaire in Spanish men. The MARATHOM In-
vestigators. Am. J. Epidemiol. 139, 1197–1209
27. Friedewald, W. T., Levy, R. I., and Fredrickson, D. S. (1972)
Estimation of the concentration of low-density lipoprotein cho-
lesterol in plasma, without use of the preparative ultracentri-
fuge. Clin. Chem. 18, 499–502
28. Miro´-Casas, E., Farre´-Albaladejo, M., Covas, M. I., Rodriguez,
J. O., Menoyo-Colomer, E., Lamuela-Ravento´ s, R. M., and de la
Torre, R. (2001) Capillary gas chromatography-mass spectrom-
etry quantitative determination of hydroxytyrosol and tyrosol in
human urine after olive oil intake. Anal. Biochem. 294, 63–72
29. Khymenets, O., Ortuno, J., Fito, M., Covas, M. I., Farre, M., and
de la Torre, R. (2005) Evaluation of RNA isolation procedures
from human blood and its application for gene expression
studies (Sod-1, Sod-2). Anal. Biochem. 347, 156–158
30. Livak, K. J., and Schmittgen, T. D. (2001) Analysis of relative
gene expression data using real-time quantitative PCR and the
) method. Methods 25, 402–408
31. Khymenets, O., Covas, M. I., Farre´, M., Langohr, K., Fito´, M.,
and de la Torre, R. (2008) Role of sex and time of blood
sampling in SOD1 and SOD2 expression variability. Clin. Bio-
chem. 41, 1348–1354
32. Huang, D. W., Sherman, B. T., and Lempicki, R. A. (2009)
Systematic and integrative analysis of large gene lists using
DAVID bioinformatics resources. Nat. Protoc. 4, 44–57
33. Dennis, G., Jr., Sherman, B. T., Hosack, D. A., Yang, J., Gao, W.,
Lane, H. C., and Lempicki, R. A. (2003) DAVID: Database for
Annotation, Visualization, and Integrated Discovery. Genome Biol. 4, P3
34. Goh, K. I., Cusick, M. E., Valle, D., Childs, B., Vidal, M., and
Barabasi, A. L. (2007) The human disease network. Proc. Natl.
Acad. Sci. U. S. A. 104, 8685–8690
35. Feldman, I., Rzhetsky, A., and Vitkup, D. (2008) Network
properties of genes harboring inherited disease mutations. Proc.
Natl. Acad. Sci. U. S. A. 105, 4323–4328
36. Benetou, V., Trichopoulou, A., Orfanos, P., Naska, A., Lagiou,
P., Boffetta, P., and Trichopoulos, D. (2008) Conformity to
traditional Mediterranean diet and cancer incidence: the Greek
EPIC cohort. Br. J. Cancer 99, 191–195
37. Choi, H. K. (2005) Dietary risk factors for rheumatic diseases.
Curr. Opin. Rheumatol. 17, 141–146
38. Chrysohoou, C., Panagiotakos, D. B., Pitsavos, C., Das, U. N.,
and Stefanadis, C. (2004) Adherence to the Mediterranean diet
attenuates inflammation and coagulation process in healthy
adults: the ATTICA Study. J. Am. Coll. Cardiol. 44, 152–158
39. Fuster, V., Badimon, L., Badimon, J. J., and Chesebro, J. H.
(1992) The pathogenesis of coronary artery disease and the
acute coronary syndromes (2). N. Engl. J. Med. 326, 310–318
40. Esposito, K., Marfella, R., Ciotola, M., Di Palo, C., Giugliano, F.,
Giugliano, G., D’Armiento, M., D’Andrea, F., and Giugliano, D.
(2004) Effect of a Mediterranean-style diet on endothelial
dysfunction and markers of vascular inflammation in the meta-
bolic syndrome: a randomized trial. JAMA 292, 1440–1446
41. Martinez-Dominguez, E., de la Puerta, R., and Ruiz-Gutierrez, V.
(2001) Protective effects upon experimental inflammation
models of a polyphenol-supplemented virgin olive oil diet.
Inflamm. Res. 50, 102–106
42. Beauchamp, G. K., Keast, R. S., Morel, D., Lin, J., Pika, J., Han, Q., Lee,
C. H., Smith, A. B., and Breslin, P. A. (2005) Phytochemistry: ibupro-
fen-like activity in extra-virgin olive oil. Nature 437, 45–46
43. Hao, J., Shen, W., Yu, G., Jia, H., Li, X., Feng, Z., Wang, Y.,
Weber, P., Wertz, K., Sharman, E., and Liu, J. (2009) Hydroxy-
tyrosol promotes mitochondrial biogenesis and mitochondrial
function in 3T3–L1 adipocytes. [E-pub ahead of print] J. Nutr.
Biochem. 10.1016/j.jnutbio.2009.03.012
44. Visioli, F., Caruso, D., Grande, S., Bosisio, R., Villa, M., Galli, G.,
Sirtori, C., and Galli, C. (2005) Virgin Olive Oil Study (VOLOS):
vasoprotective potential of extra virgin olive oil in mildly dyslip-
idemic patients. Eur. J. Nutr. 44, 121–127
45. Coppack, S. W. (2001) Pro-inflammatory cytokines and adipose
tissue. Proc. Nutr. Soc. 60, 349–356
46. Seoh, M. L., Ng, C. H., Yong, J., Lim, L., and Leung, T. (2003)
ArhGAP15, a novel human RacGAP protein with GTPase bind-
ing property. FEBS Lett. 539, 131–137
47. Ghittoni, R., Patrussi, L., Pirozzi, K., Pellegrini, M., Lazzerini,
P. E., Capecchi, P. L., Pasini, F. L., and Baldari, C. T. (2005)
Simvastatin inhibits T-cell activation by selectively impairing the
function of Ras superfamily GTPases. FASEB J. 19, 605–607
48. Laufs, U., Kilter, H., Konkol, C., Wassmann, S., Bohm, M., and
Nickenig, G. (2002) Impact of HMG CoA reductase inhibition
on small GTPases in the heart. Cardiovasc. Res. 53, 911–920
49. Mobini, R., Andersson, B. A., Erjefalt, J., Hahn-Zoric, M.,
Langston, M. A., Perkins, A. D., Cardell, L. O., and Benson, M.
(2009) A module-based analytical strategy to identify novel
disease-associated genes shows an inhibitory role for interleukin
7 receptor in allergic inflammation. BMC Syst. Biol. 3, 19
50. Gregory, S. G., Schmidt, S., Seth, P., Oksenberg, J. R., Hart, J.,
Prokop, A., Caillier, S. J., Ban, M., Goris, A., Barcellos, L. F.,
Lincoln, R., McCauley, J. L., Sawcer, S. J., Compston, D. A.,
Dubois, B., Hauser, S. L., Garcia-Blanco, M. A., Pericak-Vance,
M. A., and Haines, J. L. (2007) Interleukin 7 receptor chain
(IL7R) shows allelic and functional association with multiple
sclerosis. Nat. Genet. 39, 1083–1091
51. Damas, J. K., Waehre, T., Yndestad, A., Otterdal, K., Hognestad, A.,
Solum, N. O., Gullestad, L., Froland, S. S., and Aukrust, P. (2003)
Interleukin-7-mediated inflammation in unstable angina: possible
role of chemokines and platelets. Circulation 107, 2670–2676
52. Imadome, K., Iwakawa, M., Nojiri, K., Tamaki, T., Sakai, M.,
Nakawatari, M., Moritake, T., Yanagisawa, M., Nakamura, E.,
Tsujii, H., and Imai, T. (2008) Upregulation of stress-re-
sponse genes with cell cycle arrest induced by carbon ion
irradiation in multiple murine tumors models. Cancer Biol.
Ther. 7, 208–217
53. Kunkel, T. A., Pavlov, Y. I., and Bebenek, K. (2003) Functions of
human DNA polymerases ,and suggested by their proper-
ties, including fidelity with undamaged DNA templates. DNA
Repair (Amst.) 2, 135–149
54. Cooke, M. S., Evans, M. D., Dizdaroglou, M., and Lunec, J.
(2003) Oxidative DNA damage: mechanisms, mutation, and
disease. FASEB J. 17, 1195–1214
55. Machowetz, A., Poulsen, H. E., Gruendel, S., Weimann, A., Fito,
M., Marrugat, J., de la Torre, R., Salonen, J. T., Nyyssonen, K.,
Mursu, J., Nascetti, S., Gaddi, A., Kiesewetter, H., Baumler, H.,
Selmi, H., Kaikkonen, J., Zunft, H. J., Covas, M. I., and Koebnick,
C. (2007) Effect of olive oils on biomarkers of oxidative DNA stress
in northern and southern Europeans. FASEB J. 21, 45–52
56. Rough, J., Engdahl, R., Opperman, K., Yerrum, S., Monroy,
M. A., and Daly, J. M. (2009)
Adrenoreceptor blockade
attenuates the hyperinflammatory response induced by trau-
matic injury. Surgery 145, 235–242
57. Philipson, L. H. (2002) -Agonists and metabolism. J. Allergy
Clin. Immunol. 110, S313–S317
58. Witztum, J. L. (1994) The oxidation hypothesis of atherosclero-
sis. Lancet 344, 793–795
59. Takahata, Y., Takarada, T., Iemata, M., Yamamoto, T., Naka-
mura, Y., Kodama, A., and Yoneda, Y. (2008) Functional expres-
sion of
adrenergic receptors responsible for protection
against oxidative stress through promotion of glutathione syn-
thesis after Nrf2 upregulation in undifferentiated mesenchymal
C3H10T1/2 stem cells. J. Cell. Physiol. 218, 268–275
60. Woolf, S. H., Battista, R. N., Anderson, G. M., Logan, A. G., and
Wang, E. (1990) Assessing the clinical effectiveness of preven-
tive maneuvers: analytic principles and systematic methods in
reviewing evidence and developing clinical practice recommen-
dations. A report by the Canadian Task Force on the Periodic
Health Examination. J. Clin. Epidemiol. 43, 891–890
61. Acín, S., Navarro, M. A., Arbone´s-Manar, J. M., Guille´n, N.,
Sarría, A. J., Carnicer, R., Surra, J. C., Oman, I., Segovia, J. C., de
la Torre, R., Covas, M. I., Ferna´ndez-Bolan˜os, J. F., Ruiz-
Gutierrez, V., and Osada, J. (2006) Hydroxytyrosol administra-
tion enhances atherosclerotic lesion development in ApoE
deficient mice. J. Biochem. 140, 383–391
Received for publication October 28, 2009.
Accepted for publication January 21, 2010.
12 Vol. 24 July 2010 KONSTANTINIDOU ET AL.The FASEB Journal
... Few studies have examined gene expression in blood after a dietary intervention [11][12][13][14]. And even fewer are those who have studied the effect of a diet with a Mediterranean profile [15][16][17], without having evaluated obese patients without cardiovascular risk in these studies. One of the dietary patterns with the greatest beneficial effect on biochemical parameters after weight loss is the Mediterranean diet pattern [18,19]. ...
... Castañer et al. [16] evaluated a subsample of PREDIMED study in high 3 Disease Markers cardiovascular-risk patients, patients who received a diet with Mediterranean style supplemented with nuts for 3 months changed the expression of 241 genes, and those who received extravirgin olive changed the expression of 312 genes, and the most relevant pathways were associated to hypertension and atherosclerosis. Konstatntinidou et al. [17] demonstrated in a 3-month study in patients with high cardiovascular risk a modification of pathways related to oxidation and inflammation when using a diet with a Mediterranean pattern and olive oil. Our work was carried out in an obese population with low cardiovascular risk and with an intervention lasting 6 months, being able to explain the gene expression in different metabolic pathways that were observed. ...
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Background: Few studies have examined gene expression in peripheral blood mononuclear cells (PBMCs) after a dietary intervention. Objective: Our study is aimed at evaluating in a pilot study the peripheral blood gene expression in obese patients after weight loss secondary to a hypocaloric Mediterranean diet. Design: A sample of 11 obese subjects without metabolic syndrome was enrolled. Biochemical, anthropometric parameters and microarray analysis were performed at baseline and after 6 months of dietary intervention. Results: The mean age was 43.1 ± 6.3 years, and the mean body mass index (BMI) was 38.6 ± 8.1 kg/m2. All the next improvements were statistically significant: body weight -7.4 ± 1.9 kg, BMI -2.5 ± 0.2 kg, fat mass -5.7 ± 1.2 kg, waist circumference -5.8 ± 1.2 cm, triglycerides -17.4 ± 6.5 mg/dl, C-reactive protein -3.1 ± 1.5 mg/dL, insulin -2.1 ± 1.0 mUI/L, and HOMA-IR -0.7 ± 0.2 units. We identified 634 differentially expressed genes: 262 genes with relative higher expression levels and 372 with lower expression levels. Cluster analysis showed 35 genes in nutritional disease and 17 genes in endocrine system. The most relevant gene was thyroid peroxidase (TPO), and this gene was overexpressed, and the next genes carbonic anhydrase VI (CA6), caveolin protein 1 (CAV1) and solute carrier family type 12 (SLLC12A3), soluble carrier family type 12 (SLLC12A3), beta 3 receptor (ADRB3), and glutamate receptor ionotropic N methyl D aspartate 2 A (GRIN2A) were all underexpressed. Conclusion: In PBMC from obese patients after a diet with a Mediterranean pattern, the expression of 634 genes, of the endocrine system and of nutritional disease, is modified.
... The lipophilics include tocopherols, while the hydrophilics include flavonoids, phenolic alcohols and acids, secoiridoids and their metabolites. Various studies indicate that EVOO phenolic compounds have antioxidant, anti-inflammatory, antimicrobial activity, by modulating gene expression of proteins involved in the inflammation process, the oxidative stress resistance and in lipid metabolism (Covas et al., 2006;Konstantinidou et al., 2010). Our results showed a higher content of unsaponifiable components like polyphenols in EVOO and OOHF which might contribute to olive oil's beneficial effect. ...
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Olive Oil is a fundamental ingredient of the Mediterranean diet for its healthy properties. The aim of this study was to determine i) the most relevant quality parameters (Free acidity, K232, K270 and PV) of chemlali olive oil samples ii) to evaluate fatty acids and antioxidant content of chemlali olive oil and its hydrophilic (OOHF) and lipophilic (OOLF) fractions iii) to compare the chemical characterization between olive oil and its fractions. OOHF was extracted from olive oil using water by centrifugation process. OOLF was obtained by filtration process through a hydrophobic composite ceramic membrane. According to quality parameters, all our oil samples were classified in the category "extra virgin olive oil". Our results showed that EVOO and OOLF fatty acid analyses revealed the same amount of MUFA. EVOO and OOHF contained a higher content of unsaponifiable components like polyphenols, which might contribute to olive oil's beneficial effect.
... In 2011, the European Food Safety Authority (EFSA) issued a Scientific Opinion accepting the benefits of the daily intake of 5 mg of hydroxytyrosol and its derivatives from EVOO to prevent oxidation of LDL particles in the general population [173]. In randomized, blinded, and crossover clinical trials, the addition of polyphenol-rich EVOO was shown to reduce the expression of genes related to inflammation, atherogenesis, oxidation, metabolic syndrome, dyslipidemia, and DM2 in different clinical populations [158,[174][175][176], as well as increasing the expression of genes involved in cholesterol efflux to HDL particles in people with hypertension [177]. Similarly, polyphenol-rich EVOO has the highest capacity to improve the number, proportions, and morphology of lipoproteins [178,179], due to the incorporation of ingested polyphenols into these particles [180]. ...
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Extra virgin olive oil (EVOO) is a cornerstone of the Mediterranean diet (MedD). In this narrative review, we synthesize and illustrate the various characteristics and clinical applications of EVOO and its components—such as oleic acid, hydroxytyrosol, and oleuropein—in the field of clinical nutrition and dietetics. The evidence is split into diet therapy, oleic acid-based enteral nutrition formulations and oral supplementation formulations, oleic acid-based parenteral nutrition, and nutraceutical supplementation of minor components of EVOO. EVOO has diverse beneficial health properties, and current evidence supports the use of whole EVOO in diet therapy and the supplementation of its minor components to improve cardiovascular health, lipoprotein metabolism, and diabetes mellitus in clinical nutrition. Nevertheless, more intervention studies in humans are needed to chisel specific recommendations for its therapeutic use through different formulations in other specific diseases and clinical populations.
... In addition, published studies reported a reduction in the levels of 8-oxodG and a modulation of DNA repair gene expression [9]. In particular, three studies reported a decrease in 8-oxo-dG levels in urine [57], plasma [58], stools [59], or peripheral blood leukocytes [60] after an MD intervention alone or in combination with other food/dietary components, while only one study failed to report significant effects [61]. Conversely, one study reported a significant reduction in the levels of oxidatively induced, but not endogenous, DNA damage [62]. ...
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Oxidative stress (OS) and inflammation have been related to colorectal cancer (CRC), but the influence of the Mediterranean diet (MD) on these parameters is unknown. Therefore, the aim of this study was to determine the association between adherence to the MD and markers of OS and DNA damage in CRC patients and to study the influence of adherence to the MD on metabolic and tumor-related factors. This prospective observational study included a total of 80 patients diagnosed with CRC. Adherence to the MD was estimated by the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire. The levels of OS markers (catalase, glutathione peroxidase, and glutathione system in serum; 8-oxo-7′8-dihydro-2′-deoxyguanosine and F2-isoprotanes in urine) and tumor and metabolic factors were determined. A total of 51.2% of our CRC patients showed a high adherence to the MD. These patients presented decreased levels of 8-oxodG, increased GPX and HDL–cholesterol levels, and a downward trend in the GSSG/GSH ratio with respect to patients with low adherence to the MD. In addition, a high adherence to the MD was associated with a lower histological grade of the tumor and a lower presence of synchronous adenomas. We conclude that a high adherence to the MD has a protective role against metabolic and oxidative DNA damage and improves antioxidant systems in CRC patients.
... LRP1 is multi ligand transmembrane receptor that binds to low-density lipoproteins (LDL) and is involved in lipid metabolism, cellular migration and immune response. [65] Reduced LRP1 expression through diet has already been reported in a study by Konstantinidou et al. after intake of olive oil, [66] further supporting the anti-inflammatory capacity of CF. ...
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Scope: While cocoa flavanol (CF) consumption improves cardiovascular risk biomarkers, molecular mechanisms underlying their protective effects are not understood. Objective: To investigate nutri(epi)genomic effects of CF and identify regulatory networks potential mediating vascular health benefits. Methods and results: Twenty healthy middle-aged men consumed CF (bi-daily 450mg) or control drinks for 1 month. Microarray analysis identified 2235 differentially expressed genes (DEG) involved in processes regulating immune response, cell adhesion or cytoskeleton organization. Distinct patterns of DEG correlated with CF-related changes in endothelial function, arterial stiffness and blood pressure. DEG profile negatively correlated with expression profiles of cardiovascular disease patients. CF modulated DNA methylation profile of genes implicated in cell adhesion, actin cytoskeleton organization or cell signaling. In silico docking analyses indicated that CF metabolites have the potential of binding to cell signaling proteins and transcription factors. Incubation of plasma obtained after CF consumption decreased monocyte to endothelial adhesion and dose-dependently increased nitric oxide-dependent chemotaxis of circulating angiogenic cells further validating the biological functions of CF metabolites. Conclusion: In healthy humans, CF consumption may mediate vascular protective effects by modulating gene expresion and DNA methylation towards a cardiovascular protective effect, in agreement with clinical results, by preserving integrity of immunological-endothelial barrier functions. This article is protected by copyright. All rights reserved.
... Pathophysiological mechanisms by which MD exhibits the above-noted protective effects on the CV system are diverse [29]. Although not completely elucidated, the richness of MD nutrients in anti-oxidant and anti-inflammatory molecules is likely to be relevant [30,31]. Nutrients can either have intrinsic anti-oxidant capacity or modulate gene and protein expression. ...
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Background: In recent years, American Diabetes Association started to strongly advocate the Mediterranean diet (MD) over other diets in patients with diabetes mellitus (DM) because of its beneficial effects on glycemic control and cardiovascular (CV) risk factors. Tissue levels of advanced glycation endproducts (AGEs) emerged as an indicator of CV risk in DM. Skin biopsy being invasive, the use of AGE Reader has been shown to reflect tissue AGEs reliably. Aim: To examine the association between adherence to MD and AGEs in patients with DM type II. Methods: This cross-sectional study was conducted on 273 patients with DM type II. A survey questionnaire was composed of 3 separate sections. The first part of the questionnaire included general data and the habits of the participants. The second part aimed to assess the basic parameters of participants' diseases and associated conditions. The third part of the questionnaire was the Croatian version of the 14-item MD service score (MDSS). AGEs levels and associated CV risk were measured using AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). Results: A total of 27 (9.9%) patients fulfilled criteria for adherence to MD, with a median score of 8.0 (6.0-10.0). Patients with none/limited CV risk had significantly higher percentage of MD adherence in comparison to patients with increased/definite CV risk (15.2% vs 6.9%, P = 0.028), as well as better adherence to guidelines for nuts (23.2% vs 12.6%, P = 0.023) and legumes (40.4% vs 25.9%, P = 0.013) consumption. Higher number of patients with glycated hemoglobin (HbA1c) < 7% adhered to MD when compared to patients with HbA1c > 7% (14.9% vs 7.3%, P = 0.045). Moreover, those patients followed the MDSS guidelines for eggs (33.0% vs 46.8%, P = 0.025) and wine (15.6% vs 29.8%, P = 0.006) consumption more frequently. MDSS score had significant positive correlation with disease duration (r = 0.179, P = 0.003) and negative correlation with body mass index (BMI) values (r = -0.159, P = 0.008). In the multiple linear regression model, BMI (β ± SE, -0.09 ± 0.04, P = 0.037) and disease duration (β ± SE, 0.07 ± 0.02, P < 0.001) remained significant independent correlates of the MDSS score. Patients with HbA1c > 7% think that educational programs on nutrition would be useful for patients in significantly more cases than patients with HbA1c < 7% (98.9% vs 92.6%, P = 0.009). Conclusion: Although adherence to MD was very low among people with diabetes, we demonstrated that adherence to MD is greater in patients with lower CV risk, longer disease duration, and well-controlled glycaemia.
... It has been reported that salidroside has a protective effect on the kidney of DN rats. Salidroside, tyrosol, and hydroxytyrosol have hypoglycemic, anti-inflammatory, and hypolipidemic effects [36][37][38]. Oleuropein, a component of iridoid glycosides in LLF, also has strong antioxidant effect [39]. Specnuezhenide and salidroside are characteristic components of WLL, which have been used as content determination indexes for quality control of Pharmacopeia 2020 [3]. ...
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Ligustri Lucidi Fructus (LLF), the dry and ripe fruit of Ligustrum lucidum W. T. Aiton (Oleaceae), is a traditional Chinese medicine for nourishing the liver and kidney in clinics for thousands of years. Wine-steamed Ligustri Lucidi Fructus (WLL) can alleviate coolness and smoothness of LLF and enhance the function of nourishing the liver and kidney, so ancient and modern medicine usually used it in clinics. First of all, we prepared the extracts of different polar fractions of WLL to explore the effective fractions and potential mechanisms of WLL in the treatment of diabetic nephropathy (DN). Then, HPLC method was used to determine the contents of 12 active components in WLL and its different polar components. Finally, the potential relationship between 12 active components and physicochemical parameters of DN rats was explored. The pharmacological experiments showed that WLL, ethyl acetate (EtOAc), and n-butanol (n-BuOH) extracts not only significantly alleviated the clinical symptoms and kidney damage of DN rats but also had obvious anti-inflammatory and antioxidant effects. In addition, the results of HPLC analysis showed that the 12 active components of WLL mainly existed in the extracts of EtOAc and n-BuOH. The Pearson correlation analysis showed 12 active components and physicochemical parameters had different degrees of correlation. In conclusion, we proved that the extracts of EtOAc and n-BuOH were the effective fractions of WLL in treating DN in rats, and they could regulate the levels of inflammatory cytokines and decrease oxidation stress, which provides a basis for further research on the mechanism of WLL in treating DN and provides a pharmacological and chemical foundation for the development of new anti-DN drugs.
The Mediterranean diet is among the most well researched dietary patterns for the prevention of cardiovascular (CV) disease with study types ranging from large scale observational studies to randomized controlled clinical trials. The diet is predominantly comprised of plant-based foods and whole grains, with lesser amounts of dairy products, fish, poultry, eggs, olive oil, and wine. The diet has been associated with an overall lifestyle pattern that also includes physical activity and communal gatherings making it difficult to separate out the health benefit of any individual dietary or lifestyle component. Overall, the diet has been associated with improvement in CV risk factors (lipids, blood pressure, glucometabolic state, weight), metabolic syndrome, systemic inflammation, oxidative stress, endothelial function, and CV events. With a large body of evidence for the Mediterranean diet and significant overlap with other diets shown to have benefit for CV disease reduction, dietary counseling encouraging the main components of the diet should be at the core of CV care.
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DAVID bioinformatics resources consists of an integrated biological knowledgebase and analytic tools aimed at systematically extracting biological meaning from large gene/protein lists. This protocol explains how to use DAVID, a high-throughput and integrated data-mining environment, to analyze gene lists derived from high-throughput genomic experiments. The procedure first requires uploading a gene list containing any number of common gene identifiers followed by analysis using one or more text and pathway-mining tools such as gene functional classification, functional annotation chart or clustering and functional annotation table. By following this protocol, investigators are able to gain an in-depth understanding of the biological themes in lists of genes that are enriched in genome-scale studies.
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Objective: To systematically review all the prospective cohort studies that have analysed the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases in a primary prevention setting. Design: Meta-analysis of prospective cohort studies. Data sources: English and non-English publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1966 to 30 June 2008. Studies reviewed Studies that analysed prospectively the association between adherence to a Mediterranean diet, mortality, and incidence of diseases; 12 studies, with a total of 1 574,299 subjects followed for a time ranging from three to 18 years were included. Results: The cumulative analysis among eight cohorts (514,816 subjects and 33,576 deaths) evaluating overall mortality in relation to adherence to a Mediterranean diet showed that a two point increase in the adherence score was significantly associated with a reduced risk of mortality (pooled relative risk 0.91, 95% confidence interval 0.89 to 0.94). Likewise, the analyses showed a beneficial role for greater adherence to a Mediterranean diet on cardiovascular mortality (pooled relative risk 0.91, 0.87 to 0.95), incidence of or mortality from cancer (0.94, 0.92 to 0.96), and incidence of Parkinson's disease and Alzheimer's disease (0.87, 0.80 to 0.96). Conclusions: Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson's disease and Alzheimer's disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.
Questionnaires are frequently used for measuring physical activity. The aim of this study was to validate the Spanish version of the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) in Spanish men. Healthy men (n = 187) aged 20–60 years were recruited. The MLTPAQ was administered to assess the quantity (total activity metabolic index) and quality (heavy, moderate, and light) of physical activity performed in the last year, quarter, month, and week. Fitness was assessed with an exercise test. Spearman's correlation coefficients between the total activity metabolic index and exercise test duration, time to maximal theoretical heart rate, and caloric intake were 0.57, 0.46, and 0.40, respectively. The intraclass correlation coefficients between the total activity metabolic indexes in the last year and in the last quarter, month, and week were 0.62, 0.46, and 0.35, respectively. In multiple linear regression, the heavy, moderate, and light activity metabolic index, age, body mass index, and basal heart rate explained 40% of the variability of time to the maximum theoretical heart rate. The Spanish version of the MLTPAQ is a valid instrument to measure the quantity and quality of physical activity performed in the last year (also in periods shorter than 1 year) by Spanish men aged 20–60 years. Only heavy physical activity is related to cardiorespi-ratory fitness.
Background: Virgin olive oils are richer in phenolic content than refined olive oil. Small, randomized, crossover, controlled trials on the antioxidant effect of phenolic compounds from real-life daily doses of olive oil in humans have yielded conflicting results. Little information is available on the effect of the phenolic compounds of olive oil on plasma lipid levels. No international study with a large sample size has been done. Objective: To evaluate whether the phenolic content of olive oil further benefits plasma lipid levels and lipid oxidative damage compared with monounsaturated acid content. Design: Randomized, crossover, controlled trial. Setting: 6 research centers from 5 European countries. Participants: 200 healthy male volunteers. Measurements: Glucose levels, plasma lipid levels, oxidative damage to lipid levels, and endogenous and exogenous antioxidants at baseline and before and after each intervention. Intervention: In a crossover study, participants were randomly assigned to 3 sequences of daily administration of 25 mL of 3 olive oils. Olive oils had low (2.7 mg/kg of olive oil), medium (164 mg/kg), or high (366 mg/kg) phenolic content but were otherwise similar. Intervention periods were 3 weeks preceded by 2-week washout periods. Results: A linear increase in high-density lipoprotein (HDL) cholesterol levels was observed for low-, medium-, and high-polyphenol olive oil: mean change, 0.025 mmol/L (95% Cl, 0.003 to 0.05 mmol/L), 0.032 mmol/L (Cl, 0.005 to 0.05 mmol/L), and 0.045 mmol/L (Cl, 0.02 to 0.06 mmol/L), respectively. Total cholesterol-HDL cholesterol ratio decreased linearly with the phenolic content of the olive oil. Triglyceride levels decreased by an average of 0.05 mmol/L for all olive oils. Oxidative stress markers decreased linearly with increasing phenolic content. Mean changes for oxidized low-density lipoprotein levels were 1.21 U/L (Cl, -0.8 to 3.6 U/L), -1.48 U/L (-3.6 to 0.6 U/L), and -3.21 U/L (-5.1 to -0.8 U/L) for the low-, medium-, and high-polyphenol olive oil, respectively. Limitations: The olive oil may have interacted with other dietary components, participants' dietary intake was self-reported, and the intervention periods were short. Conclusions: Olive oil is more than a monounsaturated fat. Its phenolic content can also provide benefits for plasma lipid levels and oxidative damage.