To discuss present knowledge about the relation between adipose tissue, inflammation and the Mediterranean-style diet.

Review of the literature and personal perspectives.

Recent studies indicate that adipose tissue is an endocrine organ producing numerous proteins, collectively referred to as adipokines, with broad biological activity, which play an important autocrine role in obesity-associated complications. Adipose tissue in general and visceral fat in particular are thought to be key regulators of inflammation which is heavily involved in the onset and development of atherothrombotic disease. Moreover, chronic inflammation may also represent a triggering factor in the origin of the metabolic syndrome and type 2 diabetes mellitus. An increased release of proinflammatory adipokines from the visceral adipose tissue, associated with a reduced secretion of anti-inflammatory adipokines and cytokines, could determine a low-grade chronic inflammatory state which might play a role in the future development of the metabolic syndrome, diabetes and atherosclerosis through both insulin resistance and endothelial dysfunction. Interventions aimed at decreasing weight loss and improving adherence to a Mediterranean-style diet in people with obesity or metabolic syndrome decrease the inflammatory milieu and ameliorate both insulin resistance and endothelial dysfunction.

Appropriate dietary patterns, as those associated with the eating model of Mediterranean-type diets, represent therapeutic strategies to reduce inflammation and the associated metabolic and cardiovascular risk.

To analyse various aspects of the Mediterranean diet in relation to the risk of several common cancers in Italy.

Data from a series of case-control studies conducted in northern Italy between 1983 and 2004 on over 20 000 cases of several major cancers and 18 000 controls.

For most digestive tract cancers, the risk decreased with increasing vegetable and fruit consumption, with relative risks between 0.3 and 0.7 for the highest level of intake, and the population-attributable risks for low intake of vegetables and fruit ranged between 15 and 40%. Less strong inverse relations were observed for other (epithelial) cancers, too. A number of micronutrients contained in vegetables and fruit showed an inverse relation with cancer risk. In particular, flavones, flavonols and resveratrol were inversely related to breast cancer risk. Olive oil, which is a typical aspect of the Mediterranean diet, has also been inversely related to cancers of the colorectum and breast, and mainly of the upper digestive and respiratory tract. Consumption of pizza, one of the most typical Italian foods, was related to a reduced risk of digestive tract cancers, although pizza may simply be an aspecific indicator of the Italian diet.

Adherence to the Mediterranean diet is a favourable indicator of the risk of several common epithelial cancers in Italy. A score summarising the major characteristics of the Mediterranean diet was related to a priori defined reduced risks of several digestive tract neoplasms by over 50%.

In this review, we will discuss the benefits of diets enriched in virgin olive oil, whose effects are probably due not only to its oleic acid content but also to its other potentially health-promoting components.

Traditionally, the benefits of MD were linked to its effect on lipoprotein metabolism, but today we realise that there exists a whole sheaf of other benefits, including the components of haemostasis: platelet function, thrombogenesis and fibrinolysis.

A diet enriched in virgin olive oil can reduce the sensitivity of platelets to aggregation, decreasing von Willebrand and thromboxane B2 plasma levels. Moreover, a particular interest has aroused about its capacity to decrease fasting factor VII plasma levels and to avoid or modulate its postprandial activation. In addition, tissue factor expression in mononuclear cells could be reduced with the chronic intake of virgin olive oil, and finally, studies performed in different experimental situation have shown that it could also increase fibrinolytic activity, reducing plasma concentration of plasma activator inhibitor type-1 (PAI-1).

The MD is an alimentary model with a high content of monounsaturated fats that is capable of inducing a wide range of biological effects on the cardiovascular system. The application of modern focuses of study will dilucidate in the future the biological and clinical interest of these findings.

Assessment of relation between metabolic syndrome (MS) and Mediterranean diet (MD) adherence.

Cross-sectional study. ATP III definition of MS was used. Adherence to MD was assessed with a Food Frequency Questionnaire. Intakes of cereal, fruit, legumes, vegetables, fish, nuts, monounsaturated to saturated ratio, alcohol from red wine, whole-fat dairy products and red meat were considered.

Representative sample of population from the Canary Islands (Spain) participating in the Canarian Nutrition Survey (ENCA).

578 adults>18 years.

Of the subjects, 24.4% presented MS. Once adjusted, MD adherence was not related to MS prevalence, but subjects in the third tertile of adherence presented 70% lower prevalence of the blood pressure criteria and 2.5 times more prevalence of the glycaemia criteria with respect to the first tertile. Red meat intake was associated with higher prevalence of blood pressure criteria. Moderate alcohol intake from red wine was associated with lower prevalence of these criteria in women and lower prevalence of HDL cholesterol criteria in men. Fruit intake showed a protective effect on triglyceride criteria, whereas vegetable intake was associated with higher prevalence of this criterion. Cereals' intake showed a protective effect over insulin resistance measured by high insulinaemia level. Fruit intake showed a significative protective effect over high Homeostasis Model Assessment index. Whole-fat dairy products showed a significant protective effect on the glycaemia criteria. High monounsaturated to saturated fatty acid intake showed a protective effect on insulin resistance.

Some components of the MD showed a protective effect on the MS and its components.

To review and update the most relevant research dealing with the antioxidant properties of fruits which can be useful in Mediterranean and other healthy diets.

Personal perspectives and late data.

International

The evaluation of total antioxidant capacity of fruits is of pivotal importance in assessing the nutritional attributes of these products. By means of specific breeding programmes, it is possible to select antioxidant-enriched fruit varieties. These features are susceptible to be improved through generations in order to release fruits with enhanced nutritional features.

The availability of high quality and nutritionally enriched fruit at competitive costs may be a useful tool in the planning of healthy diets.

The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of B vitamins and w-3 fatty acids. A protective role on depression has been suggested for both nutrients.

Cross-sectional analysis from the SUN (Seguimiento Universidad de Navarra) prospective cohort study. Data from 9670 participants (4211 men and 5459 women) were analised. Logistic regression analyses were fitted to assess the association between B-vitamins and w-3 fatty acids intake (quintiles) and the prevalence of depression.

Folate intake was inversely associated with depression prevalence among men, especially smokers. Among women, B12 vitamin intake was inversely associated with depression, especially among smokers and physically active women. No significant associations were observed for w-3 fatty acids intake.

The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of fruits, nuts, vegetables, cereals, legumes or fish, important sources of nutrients linked to depression prevention.

We examined associations between two Mediterranean diet (MD) adherence indexes (the MD index, MDI, and the MD score, MDS) and several blood biomarkers of diet and disease.

We studied 328 individuals from Catalonia (Northeastern Spain), ages 18–75, who provided fasting blood samples, a subset of the 2346 individuals as part of a larger representative and random sample from the 1992–1993 Catalan Nutritional Survey.

Diet was measured using 24-h recalls. Biomarkers studied were plasma levels of β-carotene, α-tocopherol, retinol, vitamins B12, C and folates as well as serum total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Multivariate linear regression was used to analyse associations of the nutrient biomarkers with the dietary pattern indexes, adjusting for potential confounders.

Subjects with higher MD adherence, as measured by the two dietary indexes, had significantly higher plasma concentrations of β-carotene, folates, vitamin C, α-tocopherol and HDL cholesterol. The most highly significant relationship was that between folates and the adherence to the MD Pattern, as determined by both indexes.

These research findings suggest the potential usefulness of biomarkers as complementary tools for assessing adherence to a dietary pattern. This type of data not only informs the development of robust dietary adherence indexes, but it also provides specific clues about the potential physiological mechanisms that explain the beneficial effects of the MD pattern on chronic disease risk.

To discuss present knowledge about the relation between sexual dysfunction, metabolic factors and the Mediterranean-style diet.

Review of the literature and personal perspectives.

Sexual problems appear to be widespread in society, influenced by both health-related and psychosocial factors, and are associated with impaired quality of life. Epidemiological studies suggest that modifiable health behaviours, including physical activity and leanness, are associated with a reduced risk for erectile dysfunction (ED) among men. Data from other surveys also indicate a higher prevalence of impotence in obese men. Obesity and the metabolic syndrome may be a risk factor for ED. The high prevalence of ED in patients with cardiovascular risk factors suggests that abnormalities of the vasodilator system of penile arteries play an important role in the pathophysiology of ED. We have shown that one-third of obese men with ED can regain their sexual activity after 2 years of adopting health behaviours, including a Mediterranean-style diet associated with regular exercise.

Western societies actually spend a huge part of their health care costs on chronic disease treatment and interventions for risk factors. The adoption of healthy lifestyles can reduce the prevalence of obesity and the metabolic syndrome, and hopefully the burden of sexual dysfunction.

To provide an overview of methodological issues in the design, delivery and evaluation of childhood obesity prevention programmes.

Review of existing literature.

International.

Interventions have varied considerably with regard to their design, subject selection criteria, sample size, attrition rates, intervention components and duration of both the intervention and the follow-up phases. However, overall, there is only a limited body of consistent, high-quality evidence on which valid and generalisable conclusions can be drawn about best practices for the prevention of childhood obesity.

Although the rationale for targeting children and adolescents through primary prevention is now compelling, effective obesity prevention remains elusive. There is increasing consensus that prevention of childhood obesity necessitates multifaceted health promotion interventions based on population health principles. By definition, such interventions should have a range of outcome indicators of effectiveness, generalisability and sustainability, not just the traditional ones focused on individual lifestyle behaviour change. Given the complexity and intricacy of population-based intervention programmes, multiple methods of data collection which combine both qualitative and quantitative approaches will need to be fully exploited in order to move towards evidence-based practice in the future.

In recent decades, the prevalence of non-communicable diseases (NCDs), such as obesity, diabetes and cardiovascular disorders has increased worldwide; the objective here is to describe the situation in southern Mediterranean countries.

Data derived from surveys in the region countries showed that in 2002 more than 60% of all deaths in the southern Mediterranean region are attributed to NCDs. Cardiovascular diseases (CVD) caused from about 34.3 to 52% of all deaths, making it the major killer among NCDs. In almost all of the southern Mediterranean countries, CVD risk factors increased with age, affected more women and urban area and were significantly associated with obesity. The Mediterranean dietary pattern, generally recognised, as a healthy diet is still the model for southern Mediterranean population; however, following the rapid process of urbanisation, southern Mediterranean populations have changed their lifestyle and food habits and tend to shift from traditional food habit. Indeed, intake trends illustrate the fall in whole-grain intake with a rise in animal sources and vegetable oils. Dietary energy has been steadily increasing by approximately 1000 kcal per capita per day between 1965 and 2000, exceeding per caput energy requirements. Protein and carbohydrate contribution to the energy intake show only small deviations and fat contribution to the energy intake is low, whereas fibre intake is generally low and that of SFA is high. Also, sedentarity appears to play a critical role in the development of body fat and may be a risk indicator for features of metabolic syndrome.

The major goal to prevent CVD should begin by preventing obesity through physical exercise and healthy nutrition. The nutritional prevention policy required should encourage population to adhere to the Mediterranean model.

Analyse the importance of components of Mediterranean diet in functional feeding.

We have based the study in a bibliographic review.

Many of the characteristic components of the traditional Mediterranean diet (MD) are known to have positive effects on health, capacity and well-being, and can be used to design functional foods. Vegetables, fruits and nuts are all rich in phenols, flavonoids, isoflavonoids, phytosterols and phytic acid—essential bioactive compounds providing health benefits. The polyunsaturated fatty acids found in fish effectively regulate haemostatic factors, protect against cardiac arrhythmias, cancer and hypertension, and play a vital role in the maintenance of neural functions and the prevention of certain psychiatric disorders. Accumulating evidence suggests that olive oil, an integral component of the MD, may have health benefits, including the reduction of the risk of coronary heart disease, the prevention of several types of cancer and the modification of the immune and inflammatory responses. Olive oil is known for its high levels of monounsaturated fatty acids and is a good source of phytochemicals, such as polyphenolic compounds, squalene and α-tocopherol.

In the context of the MD, the benefits associated with the consumption of several functional components may be intensified by certain forms of food preparation. In addition, the practice of more physical activity (once common among Mediterranean populations) and the following of other healthy lifestyle habits may have additive effects.

The identification of the active constituents of the MD is crucial in the formulation of appropriate dietary guidelines. Research into the pharmacological properties of the minor components of this diet (vitamins, sterols, polyphenols, etc.) is very active and could lead to the formulation of functional foods and nutraceuticals.

As a qualitative problem solving method, to manage the accelerating phenomenon of overweight and obesity among children and adolescents as well as to promote the Mediterranean Diet and the diversity of the Mediterranean Food Cultures heritage, it is presented a creative interdisciplinary approach through art.

Taking into account that young generations are becoming the highest majority of the consumer population in the Southern and Eastern Mediterranean countries, it is reported the artist practice and the creative community-based interdisciplinary experience of Plexus International, a network of artists and scientists of various nationalities and disciplines.

Mediterranean Region and International.

Young Populations.

Through the Ark of the Well Being project, artists and scientists have collaborate together, promoting The 2005 Rome Call for a Common Action in the Mediterranean and raising more attention on the erosion of the cognitive capacities of young generations by hunger and malnutrition.

A creative interdisciplinary approach was developed to transmit through art Mediterranean food culture with the aim to achieve a broader nutritional well being.