Abstract: Increasing patient adherence to a Mediterranean Style Diet promises to reduce morbidity and mortality. Reviewing the various methods used to measure or score adherence to this type of diet provides a foundation for creating scoring methods that practitioners may employ during patient visits or that patients may use on their own.
Tools that allow calculation of adherence scores may help increase patient compliance with the Mediterranean Diet guidelines.

Introduction:
Fundamental to our practices as naturopathic physicians is the responsibility to teach our patients to lead healthier lives. Thus often some part of each patient encounter is devoted to life style and diet counseling. The exact nature of what the healthiest possible diet consists of has is not clearly defined; its characteristics likely vary with the personal knowledge and belief of each individual physician. Yet at this point in medical understanding, even practitioners on the far ends of the spectrum of professed dietary theories must agree that there are clearly well proven advantages for most people to follow the general patterns of a Mediterranean Style Diet.

Diet Adherence:
Earlier epidemiologic studies that suggested health benefits for those eating a Mediterranean Diet (MD) have given way in recent years to studies that correlate effects of the degree of adherence to a MD with specific changes in disease risk, morbidity and mortality. For example, in July 2010, the American Journal of Clinical Nutrition published an article by Trichopoulou et al that looked at ‘conformity’ to traditional Mediterranean diet and breast cancer risk. This study was preceded by another article in the same journal in February 2010 that looked at adherence to the MD and risk for gastric cancers. Two months earlier an article in the American Journal of Epidemiology correlated compliance to this diet with coronary heart disease. These are only a few examples of many similar studies published in recent years.

Goal is to score:
It is not the point of this article to review the evidence that supports eating a Mediterranean Diet, rather the focus is to look at the methodologies that have been utilized in measuring adherence or conformity to the Mediterranean Diet and ruminate on how these techniques might be employed within the context of our patient encounters.

Common food groups:
Common to all these papers are the identification of certain key food patterns that are deemed representative of the MD diet. Most follow the rationale of Willet et al’s 1995 paper, and focus on the following 9 food groups:
1. non-refined cereals (whole grain bread, pasta, brown rice, etc)
2. fruit
3. vegetables
4. legumes
5. potatoes
6. fish
7. meat and meat products
8. poultry
9. full fat dairy products

[some but not all studies also track]

10. Olive Oil

11.  Alcohol
Olive Oil and Alcohol:
In addition they considered olive oil and alcohol intake. Some studies have compiled data on more specific food group consumption. For example, a 2009 paper that examined MD adherence in a group of individuals who had previously had myocardial infarctions initially looked at 14 food groups but then combined consumption of citrus fruits, berries, and fruit juices together as fruits and green leafy vegetables, cabbage and other vegetables together and pulses (beans) together with nuts so that in the end they analyzed a somewhat similar list of 9 groups. The main difference in comparing studies is that in some olive oil is considered a food group and potatoes are omitted.

It is recognized that moderate amounts of alcohol have beneficial effects. This is generally set at less than 300 ml of wine (36 gm of ethanol) for men and half that for women. This is about equivalent to 3 glasses of wine for men and 1 ½ for women. Consumption during meals is more beneficial than between meals and red wine better than white wine or beer.

Potatoes:
The inclusion or exclusion of potatoes as a ‘food group’ does seem at odds with our current concern about simple carbohydrate consumption and risk of metabolic disease. Panagiotakos in 2007 paper that examined adherence to a MD as a predictor for hypertension, high cholesterol, diabetes and obesity, argued for inclusion of potatoes as they provide significant amounts of B vitamins and consumption has been associated with lower risk of CVD. Though we may feel hesitant to encourage potato consumption, many of the existent studies on MD award higher points for greater potato consumption.

Oil and other select foods:
Fat intake in these diets may be much higher than we typically encourage. In Greece fats often provide more than 40% of total energy intake, in Italy 30%. Though researchers have focused on the ratio of monounsaturated to saturated fats that make up these fats, other factors may come into play that have not been adequately calculated. For example, the polyphenols in olive oil may exert influence on certain disease processes and thus the ratio of extra virgin olive oil to total lipids may eventually be important to factor in to calculate effect. So too might dark grape consumption as a ratio to total fruit consumption. Although specific foods are only rarely singled out this way in research published to date, it would seem reasonable to encourage patients to consume the ‘variants’ in food categories that are expected to bring greater benefit. Examples might be broccoli, extra virgin olive oil, high polyphenol chocolate, nuts, etc.
Scoring Methods:
Various strategies have been employed to score consumption of these foods in order to yield a single measure of dietary compliance. In all methods, higher scores are given for greater than average consumption of non-refined cereals, fruit, vegetables, legumes, potatoes, fish and olive oil while lower or negative scores are given for above average consumption of meat, poultry, dairy and excess alcohol. The question that must be addressed is how does one best determine average, above average or low levels of consumption.

One method by which these point scores have been assigned is illustrated in Panagiotakos’ 2009 paper that examined MD adherence and inflammatory responses in survivors of myocardial infarctions. Having collected dietary data on the 1,003 people enrolled in the study, monthly servings consumed of each food category were calculated and three levels of consumption were assigned based on rankings within the data. Individuals whose level of consumption of a particular food group was in the upper quartile were considered to be high consumers of that food. Those in the lower quartile of consumption were considered low consumers. For those food groups considered beneficial to consume, three points were awarded for each food group for which consumption was ranked as high, that is upper 25%. The foods considered advantageous in this study were: non-refined cereals, fruits and juices, vegetables, olive oil, fish, nuts and beans. Three points were also awarded for ranking in the lower 25 percentile of red meat, poultry or dairy consumption. Two points were awarded for ranking in the mid range.
The highest possible score was 27 and the lowest 9.

Feart et al in their 2009 paper published in JAMA that looked at adherence to a Mediterranean Diet and risk of dementia and cognitive decline took an even simpler approach. Median consumption scores were calculated for each food group and used as the dividing line. Those who consumed amounts above the median of advantageous foods were awarded 1 point for each food group. They receive zero points for food groups of which they ate below average amounts. Inversely they were assigned zero points for the ‘disadvantageous’ foods (meat, poultry, milk, alcohol) that they consumed in amounts above the mean. Thus possible point scores ranged from 0 to 9 in this study.

Systems like these are obviously not easily applicable to individual patients for several reasons. First, there is no way to easily determine percentile rankings or mean consumptions. Secondly, above average or below average consumption does not necessarily reflect ideal or optimal levels of consumption. Third, the limited number of consumption categories allows little room to aspire toward improvement for the many individuals in our patient populations who already eat ‘above average diets.’

A more practical approach for us to consider are methods that utilize a broad range of possible scores for each food category that are based on consumption levels. Scores can be based on either servings per day, per week or per month. Servings per month will provide more accurate categorization but will likely prove to be too challenging for patient compliance or self-assessment. Categorization based on daily or weekly consumption seems the most logical. Panagotakos does this in his 2007 paper that used diet scores to predict prevalence of hypertension, elevated cholesterol, diabetes and obesity that was previously mentioned. In that study, consumption of each food group was ranked into 6 levels of consumption based on servings eaten per week, and points awarded for by rank. Ten food categories were scored as both potatoes and olive oil were included. Possible food category score ranged from 0 to 5; total scores ranged from 0 to 50.
The same authors had tried a somewhat similar approach several years earlier using scores of 0 to 5 but in the earlier studies had used the same number of servings per week of each food group to award similar points. Thus 13-18 servings per week of any advantageous food group was awarded 4 points. In the newer 2007 study the methodology is more refined and consumption of each food is ranked using an appropriate scale that reflects average consumption levels. This later approach seems to offer the most potential for patient use and serves as the basis of the following work sheet.

Extra Credit:
The practitioner may wish to encourage consumption of specific foods that are not typically scored when evaluating Mediterranean Diet adherence. Examples might be mushrooms for post-menopausal women at risk for breast cancer or pomegranate juice for men with prostate cancer. In such a situation, the practitioner might add additional food categories and point values that might be counted as extra credit points. This would provide a way to encourage patients to add disease specific beneficial foods. Below are several possible examples:

Mushrooms/week 0 =0 points and then 1 point per 2 ounces eaten up to 5 points
Nuts/week 0 = 0 and then 1 point /half cup serving up to 5 points.
Many practitioners require their patients to track food consumption by making a daily diet diary. Calculating MD adherence will require different information. The number of weekly servings of each food group consumed will need to be tracked and tallied. Thus instead of a list of menus, it makes better sense to present patients a list of food groups and ask them to track the number of servings they consume of each group. Such a dietary tracking system along with a scoring system can provide a method for encouraging dietary changes in patients that we desire to move toward a Mediterranean Style Diet.
Appendix:
a. Greek Dietary Pyramid and Guidelines
b. Weekly Food Tracker
c. Adherence Score Sheet
Appendix A:
Moving Toward a Mediterranean Diet:

Link to the official description of: Dietary Guidelines for Adults in Greece:

http://www.mednet.gr/archives/1999-5/516.html

Serving Sizes:

 

A total of about 22 to 23 servings are to be consumed daily, in three or four meals, where one serving is approximately:
One slice of bread
4 ounces potatoes
Half a cup of cooked rice or pasta
A cup of raw leafy vegetables or half a cup of other vegetables, cooked or chopped
One apple one banana, one orange, 7 ounce of, 1 ounce of grapes
One cup of milk or yogurt
1 ounce of cheese
1 egg
2 ounces of cooked lean meat or fish
One cup of cooked dry beans.
One drink = 100 ml wine or 12 gram ethanol
Appendix B:
One-week food consumption tracker:
Use this list to track your diet for a week. Add a check mark next to the food group for each serving eaten. At the end of a week, total the servings by food group and use the score sheet to ‘grade’ your diet.
Cereals

Potatoes

Vegetables

Fruits

Beans and nuts

Olive oil

Fish

Red meat

Chicken

Dairy

Alcohol

 

Appendix C:

Adherence to Mediterranean Diet: weekly score sheet

Use this list to score amounts of each food group eaten in a week:

[ok I see that I completely lost my formating on this one.
Food group Weekly servings eaten (servings/points)

Cereals     Never/0 points 1-6 servings/1 point     7-12 /2      13/18/3      19-31/4      >32/5

Potatoes     never/0 points      1-4/1       5-8/2      9-12/3         13-18/4     >18/5

Fruits        never/0 points       1-4/1 pt    5-8/2     9-15/3        16-21/4      >22/5 points

Vegetables Never/0 points    1-6/1 pt    7-12/2   13-20/3       21-32/4     >33/5 points

Legumes    Never/0 points    <1/1 pt     1-2/2      3-4/3          5-6/4         >6/5points
(nuts)
Fish            Never/0 points     <1/1 pt   1-2/2       3-4/4          5-6/5         >6/5points

Olive Oil     Never/0 points       rare /1 pt < 1 time/2    1-3 /3   3-5/4        daily/5 points

Red meat     < or =1 serving/      5 pts 2-3/4 pts      4-5/3     6-7/2    8-10/1    >10/0 points

Poultry       < or + 3 serving/5 pts   4-5/4 pts    5-6/3   7-8/2    9-10/1     >10/0 points

Alcohol (ml/day) <300 ml/5 pts     300 ml/4 pts    400/3     500/2     600/1       >700/ 0 points

[The point values and food consumption servings on this form are derived from: Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C. Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med. 2007 Apr;44(4):335-40.]
References:

Am J Clin Nutr. 2010 Jul 14. [Epub ahead of print]

Conformity to traditional Mediterranean diet and breast cancer risk in the Greek EPIC (European Prospective Investigation into Cancer and nutrition) cohort.
Trichopoulou A, Bamia C, Lagiou P, Trichopoulos D.

The WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece.

Abstract
BACKGROUND: Studies in the United States report inverse associations of the Mediterranean dietary pattern with breast cancer risk, and several studies in Mediterranean countries indicate inverse associations of breast cancer risk with intake of olive oil, a constitutional component of this diet. No study, however, has evaluated the association of the traditional Mediterranean diet with breast cancer in a Mediterranean country.

OBJECTIVE: We studied the relation of conformity to Mediterranean diet with breast cancer risk in the context of the European Prospective Investigation into Cancer and nutrition cohort in Greece.

DESIGN: We followed up 14,807 women for an average of 9.8 y and identified 240 incident breast cancer cases. Diet was assessed through a validated food-frequency questionnaire and conformity to Mediterranean diet was evaluated through a score (range = 0-9 points) incorporating the characteristics of this diet. Results: Increasing conformity to Mediterranean diet was not associated with lower breast cancer risk in the entire cohort [hazard ratio (HR) = 0.88 for every 2 points; 95% CI: 0.75, 1.03] or in premenopausal women (HR = 1.01 for every 2 points; 95% CI: 0.80, 1.28), but there was a marginally statistically significant inverse association among postmenopausal women (HR = 0.78 for every 2 points; 95% CI: 0.62, 0.98; P for interaction by menopausal status = 0.05).

CONCLUSIONS: Conformity to the traditional Mediterranean diet may be associated with lower breast cancer risk among postmenopausal women and could explain, in part, the lower incidence of this disease in Mediterranean countries.

PMID: 20631204 [PubMed – as supplied by publisher]

 
Am J Clin Nutr. 2010 Feb;91(2):381-90. Epub 2009 Dec 9.

Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.
Buckland G, Agudo A, Luján L, Jakszyn P, Bueno-de-Mesquita HB, Palli D, Boeing H, Carneiro F, Krogh V, Sacerdote C, Tumino R, Panico S, Nesi G, Manjer J, Regnér S, Johansson I, Stenling R, Sanchez MJ, Dorronsoro M, Barricarte A, Navarro C, Quirós JR, Allen NE, Key TJ, Bingham S, Kaaks R, Overvad K, Jensen M, Olsen A, Tjønneland A, Peeters PH, Numans ME, Ocké MC, Clavel-Chapelon F, Morois S, Boutron-Ruault MC, Trichopoulou A, Lagiou P, Trichopoulos D, Lund E, Couto E, Boffeta P, Jenab M, Riboli E, Romaguera D, Mouw T, González CA.

Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Idibell, Barcelona, Spain.

Abstract
BACKGROUND: The Mediterranean dietary pattern is believed to protect against cancer, although evidence from cohort studies that have examined particular cancer sites is limited.

OBJECTIVE: We aimed to explore the association between adherence to a relative Mediterranean diet (rMED) and incident gastric adenocarcinoma (GC) within the European Prospective Investigation into Cancer and Nutrition study.

DESIGN: The study included 485,044 subjects (144,577 men) aged 35-70 y from 10 European countries. At recruitment, dietary and lifestyle information was collected. An 18-unit rMED score, incorporating 9 key components of the Mediterranean diet, was used to estimate rMED adherence. The association between rMED and GC with respect to anatomic location (cardia and noncardia) and histologic types (diffuse and intestinal) was investigated. A calibration study in a subsample was used to control for dietary measurement error.

RESULTS: After a mean follow-up of 8.9 y, 449 validated incident GC cases were identified and used in the analysis. After stratification by center and age and adjustment for recognized cancer risk factors, high compared with low rMED adherence was associated with a significant reduction in GC risk (hazard ratio: 0.67; 95% CI: 0.47, 0.94). A 1-unit increase in the rMED score was associated with a decreased risk of GC of 5% (95% CI: 0.91, 0.99). There was no evidence of heterogeneity between different anatomic locations or histologic types. The calibrated results showed similar trends (overall hazard ratio for GC: 0.93; 95% CI: 0.89, 0.99).

CONCLUSION: Greater adherence to an rMED is associated with a significant reduction in the risk of incident GC.

PMID: 20007304 [PubMed – indexed for MEDLINE]

 

Am J Epidemiol. 2009 Dec 15;170(12):1518-29. Epub 2009 Nov 10.

Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study.
Buckland G, González CA, Agudo A, Vilardell M, Berenguer A, Amiano P, Ardanaz E, Arriola L, Barricarte A, Basterretxea M, Chirlaque MD, Cirera L, Dorronsoro M, Egües N, Huerta JM, Larrañaga N, Marin P, Martínez C, Molina E, Navarro C, Quirós JR, Rodriguez L, Sanchez MJ, Tormo MJ, Moreno-Iribas C.

Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain.

Abstract
No known cohort study has investigated whether the Mediterranean diet can reduce incident coronary heart disease (CHD) events in a Mediterranean population. This study examined the relation between Mediterranean diet adherence and risk of incident CHD events in the 5 Spanish centers of the European Prospective Investigation into Cancer and Nutrition. Analysis included 41,078 participants aged 29-69 years, recruited in 1992-1996 and followed up until December 2004 (mean follow-up:10.4 years). Confirmed incident fatal and nonfatal CHD events were analyzed according to Mediterranean diet adherence, measured by using an 18-unit relative Mediterranean diet score. A total of 609 participants (79% male) had a fatal or nonfatal confirmed acute myocardial infarction (n = 468) or unstable angina requiring revascularization (n = 141). After stratification by center and age and adjustment for recognized CHD risk factors, high compared with low relative Mediterranean diet score was associated with a significant reduction in CHD risk (hazard ratio = 0.60, 95% confidence interval: 0.47, 0.77). A 1-unit increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD (95% confidence interval: 0.91, 0.97), with similar risk reductions by sex. Mediterranean diet adherence was associated with a significantly reduced CHD risk in this Mediterranean country, supporting its role in primary prevention of CHD in healthy populations.

PMID: 19903723 [

 

Am J Clin Nutr. 1995 Jun;61(6 Suppl):1402S-1406S.

Mediterranean diet pyramid: a cultural model for healthy eating.
Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D.

Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.

Abstract
We present a food pyramid that reflects Mediterranean dietary traditions, which historically have been associated with good health. This Mediterranean diet pyramid is based on food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s, where adult life expectancy was among the highest in the world and rates of coronary heart disease, certain cancers, and other diet-related chronic diseases were among the lowest. Work in the field or kitchen resulted in a lifestyle that included regular physical activity and was associated with low rates of obesity. The diet is characterized by abundant plant foods (fruit, vegetables, breads, other forms of cereals, potatoes, beans, nuts, and seeds), fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts, normally with meals. This diet is low in saturated fat (< or = 7-8% of energy), with total fat ranging from < 25% to > 35% of energy throughout the region. The pyramid describes a dietary pattern that is attractive for its famous palatability as well as for its health benefits.

PMID: 7754995

 

Int J Epidemiol. 2009 Jun;38(3):856-66. Epub 2009 Feb 24.

Mediterranean diet and inflammatory response in myocardial infarction survivors.
Panagiotakos DB, Dimakopoulou K, Katsouyanni K, Bellander T, Grau M, Koenig W, Lanki T, Pistelli R, Schneider A, Peters A; AIRGENE Study Group.

Collaborators (104)

Peters A, Brueske-Hohlfeld I, Chavez H, Cyrys J, Geruschkat U, Grallert H, Greven S, Ibald-Mulli A, Illig T, Kirchmair H, von Klot S, Kolz M, Illig MM, Kirchmair H, von Klot S, Kolz M, Mueller M, Rueckerl R, Schaffrath Rosario A, Schneider A, Wichmann HE, Holle R, Nagl H, Fabricius I, Greschik C, Günther F, Haensel M, Hahn U, Kuch U, Meisinger C, Pietsch M, Rempfer E, Schaich G, Schwarzwälder I, Zeitler B, Loewel H, Koenig W, Trischler G, Forastiere F, Di Carlo F, Ferri M, Montanari A, Perucci C, Picciotto S, Romeo E, Stafoggia M, Pistelli R, Altamura L, Andreani MR, Baldari F, Infusino F, Santarelli P, Jesi AP, Cattani G, Marconi A, Pekkanen J, Alanne M, Alastalo H, Eerola T, Eriksson J, Kauppila T, Lanki T, Nyholm P, Perola M, Salomaa V, Tiittanen P, Luotola K, Bellander T, Berglind N, Bohm K, Härdén R, Lampa E, Ljungman P, Nyberg F, Ohlander B, Pershagen G, Rosenqvist M, Larsdotter Svensson T, Thunberg E, Wedeen G, Sunyer J, Covas M, Fitó M, Grau M, Jacquemin B, Marrugat J, Muñoz L, Perelló G, Plana E, Rebato C, Schroeder H, Soler C, Katsouyanni K, Chalamandaris A, Dimakopoulou K, Panagiotakos D, Stefanadis C, Pitsavos C, Antoniades C, Chrysohoou C, Mitropoulos J, Kulmala M, Aalto P, Paatero P.

Department of Hygiene and Epidemiology, and Medical Statistics, University of Athens Medical School, Athens, Greece.

Abstract
BACKGROUND: Within the framework of the multi-centre AIRGENE project we studied the association of the Mediterranean diet on plasma levels of various inflammatory markers, in myocardial infarction (MI) survivors from six geographic areas in Europe.

METHODS: From 2003 to 2004, 1003 patients were repeatedly clinically examined. On every clinical visit (on average 5.8 times), blood EDTA-plasma samples were collected. High sensitivity C-reactive protein (CRP), interleukin (IL)-6 and fibrinogen concentrations were measured based on standardized procedures. Dietary habits were evaluated through a semi-quantitative Food Frequency Questionnaire (FFQ), whereas adherence to the Mediterranean diet was assessed by a diet score.

RESULTS: A protective effect of adherence to the Mediterranean diet was found. For each unit of increasing adherence to the Mediterranean diet score there was a reduction of 3.1% in the average CRP levels (95% CI 0.5-5.7%) and of 1.9% in the average IL-6 levels (95% CI 0.5-3.4%) after adjusting for centre, age, sex, body mass index, physical activity, smoking status, diabetes and medication intake. No significant association was observed between the diet score and fibrinogen levels. Moderate intake of red wine (1-12 wine glasses per month) was associated with lower levels of CRP, IL-6 and fibrinogen.

CONCLUSIONS: Adherence to the traditional Mediterranean diet was associated with a reduction of the concentrations of inflammatory markers in MI survivors. This may, in part, explain the beneficial effects of this diet on various chronic diseases such as atherosclerosis and cancer, and expands its role to secondary prevention level.

PMID: 19244256 [PubMed – indexed for MEDLINE]Free Article http://ije.oxfordjournals.org/cgi/reprint/38/3/856

 

Bakopoulos P, Basiaris C, Chatzis J, Dalakas M, Delidis G, Gargalianos P, et al. Dietary guidelines for adults in Greece. MINISTRY OF HEALTH AND WELFARE Supreme Scientific Health Council. Arch Hellen Med, 16(5), September-October 1999, 516-524

J Chromatogr A. 2004 Oct 29;1054(1-2):143-55.

Analysis of biologically active compounds in potatoes (Solanum tuberosum), tomatoes (Lycopersicon esculentum), and jimson weed (Datura stramonium) seeds.
Friedman M.

Western Regional Research Center, Agricultural Research Service, US Department of Agriculture, Albany, CA 94710, USA. mfried.@pw.usda.gov

Abstract
Potatoes and tomatoes, members of the Solanaceae plant family, serve as major, inexpensive low-fat food sources providing for energy, high-quality protein, fiber, vitamins, pigments, as well as other nutrients. These crops also produce biologically active secondary metabolites, which may have both adverse and beneficial effects in the diet. This limited overview, based largely on our studies with the aid of HPLC, TLC, ELISA, GC-MS, and UV spectroscopy, covers analytical aspects of two major potato trisaccharide glycoalkaloids, alpha-chaconine and alpha-solanine, and their hydrolysis products (metabolites) with two, one, and zero carbohydrate groups; the potato water-soluble nortropane alkaloids calystegine A3 and B2; the principal potato polyphenolic compound chlorogenic acid; potato inhibitors of digestive enzymes; the tomato tetrasaccharide glycoalkaloids dehydrotomatine and alpha-tomatine and hydrolysis products; the tomato pigments beta-carotene, lycopene, and chlorophyll; and the anticholinergic alkaloids atropine and scopolamine present in Datura stramonium (jimson weed) seeds that contaminate grain and animal feed. Related studies by other investigators are also mentioned. Accurate analytical methods for these food ingredients help assure the consumer of eating a good-quality and safe diet.

 

Prev Med. 2007 Apr;44(4):335-40. Epub 2006 Dec 30.

Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore.
Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C.

Department of Nutrition-Dietetics, Harokopio University, Athens, Greece. d.b.panagiotakos@usa.net

Abstract
OBJECTIVE: We sought to evaluate the accuracy of a diet score in relation to hypertension, hypercholesterolemia, diabetes and obesity.

METHODS: A diet score (range 0-55) has been developed that assesses adherence to the Mediterranean diet. For the consumption of items presumed to be close to Mediterranean dietary pattern (non-refined cereals, fruits, vegetables, legumes, olive oil, fish and potatoes) scores 0 to 5 for never, rare, frequent, very frequent, weekly and daily consumption were assigned, while for the consumption of foods presumed to be away from this pattern (red meat and products, poultry and full fat dairy products) scores on a reverse scale were assigned. Positive and negative predictive values, in relation to hypertension, hypercholesterolemia, diabetes and obesity status of the ATTICA study participants (n=3042, enrolment 2001-02 in Athens metropolitan area, aged 18-89 years) were calculated and the 10-year CHD risk based on Framingham equations was estimated, too.

RESULTS: The positive predictive values of the score regarding hypertension, hypercholesterolemia, diabetes and obesity are: 45% (95% CI 43%-48%), 46% (95% CI 44%-49%), 12% (95% CI 11%-14%) and 33% (95% CI 30%-35%), while the negative predictive values are 86% (95% CI 85%-88%), 71% (95% CI 69%-74%), 98% (95% CI 97%-99%) and 97% (95% CI 96%-98%), respectively. Moreover, a 10-unit increase in the diet score is associated with 4% lower 10-year CHD risk (+/-0.1%, p<0.001).

CONCLUSION: The proposed Mediterranean Diet Score may be useful in detecting individuals prone to the development of nutrition-related health conditions and cardiovascular disease.

PMID: 17350085

 

J Agric Food Chem. 2002 Feb 27;50(5):1290-7.

Supplementation of plasma with olive oil phenols and extracts: influence on LDL oxidation.
Leenen R, Roodenburg AJ, Vissers MN, Schuurbiers JA, van Putte KP, Wiseman SA, van de Put FH.

Unilever Health Institute, Unilever Research & Development Vlaardingen, Olivier v. Noortlaan 120, 3133 AT Vlaardingen, The Netherlands. rianna.leenen@unilever.com

Abstract
Phenols present in olive oil may contribute to the health effects of the Mediterranean lifestyle. Olive oil antioxidants increase the resistance of low-density lipoproteins (LDL) against oxidation in vitro, but human intervention studies have failed to demonstrate similar consistent effects. To better mimic the in vivo situation, plasma was incubated with either individual olive oil phenols or olive oil extracts with different phenolic compositions, and LDL was subsequently isolated and challenged for its resistance to oxidation. The results show that the ortho-dihydroxy phenols (hydroxytyrosol and oleuropein-aglycone) are more efficient than their mono-hydroxy counterparts (tyrosol and ligstroside-aglycone) in increasing the resistance of LDL to oxidation. However, the concentration of antioxidants required to inhibit LDL oxidation when added to whole plasma was substantially higher as compared to previous data where antioxidants are directly added to isolated LDL. In conclusion, this study supports the hypothesis that extra virgin olive oil phenols protect LDL in plasma against oxidation. The explanation that in vitro studies show protective effects in contrast to the lack of effect in the majority of human studies may be that the dose of the phenols and thus their plasma concentration in humans was too low to influence ex vivo LDL oxidizability. Further studies are required to gain a better understanding of the potential health benefits that extra virgin olive oil may provide.

PMID: 11853520

 

Prev Med. 2007 Apr;44(4):335-40. Epub 2006 Dec 30.

Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore.
Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C.

Department of Nutrition-Dietetics, Harokopio University, Athens, Greece. d.b.panagiotakos@usa.net

Abstract
OBJECTIVE: We sought to evaluate the accuracy of a diet score in relation to hypertension, hypercholesterolemia, diabetes and obesity.

METHODS: A diet score (range 0-55) has been developed that assesses adherence to the Mediterranean diet. For the consumption of items presumed to be close to Mediterranean dietary pattern (non-refined cereals, fruits, vegetables, legumes, olive oil, fish and potatoes) scores 0 to 5 for never, rare, frequent, very frequent, weekly and daily consumption were assigned, while for the consumption of foods presumed to be away from this pattern (red meat and products, poultry and full fat dairy products) scores on a reverse scale were assigned. Positive and negative predictive values, in relation to hypertension, hypercholesterolemia, diabetes and obesity status of the ATTICA study participants (n=3042, enrolment 2001-02 in Athens metropolitan area, aged 18-89 years) were calculated and the 10-year CHD risk based on Framingham equations was estimated, too.

RESULTS: The positive predictive values of the score regarding hypertension, hypercholesterolemia, diabetes and obesity are: 45% (95% CI 43%-48%), 46% (95% CI 44%-49%), 12% (95% CI 11%-14%) and 33% (95% CI 30%-35%), while the negative predictive values are 86% (95% CI 85%-88%), 71% (95% CI 69%-74%), 98% (95% CI 97%-99%) and 97% (95% CI 96%-98%), respectively. Moreover, a 10-unit increase in the diet score is associated with 4% lower 10-year CHD risk (+/-0.1%, p<0.001).

CONCLUSION: The proposed Mediterranean Diet Score may be useful in detecting individuals prone to the development of nutrition-related health conditions and cardiovascular disease.

PMID: 17350085

 

Nutr Cancer. 2010 May;62(4):476-83.

Dietary mushroom intake and the risk of breast cancer based on hormone receptor status.
Shin A, Kim J, Lim SY, Kim G, Sung MK, Lee ES, Ro J.

National Cancer Center, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.

Abstract
Although many studies have documented the antitumor activities of mushrooms, the association between mushroom intake and breast cancer, defined by hormone receptor status, has received minimal empirical investigation. This study evaluated the association between mushroom intake and the risk of breast cancer according to hormone receptor status among Korean women. Mushroom intake and breast cancer risk were examined among 358 breast cancer patients and 360 cancer-free controls. Intake of mushrooms was assessed using a quantitative food frequency questionnaire. Greater mushroom intake was related to lower risk of breast cancers among premenopausal women (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13-0.91 for the highest vs. the lowest quartile intake). The association was stronger for premenopausal women with estrogen receptor (ER)+/progesterone receptor (PR) + tumors (OR = 0.30, 95% CI = 0.11-0.79 for the highest vs. the lowest quartile intake) than those with ER-/PR- tumors. Our results suggest that high consumption of mushrooms might be related to lower risks for breast cancers among premenopausal women; this association may be more robust among women with hormone receptor positive tumors.

PMID: 20432168

 

Clin Cancer Res. 2006 Jul 1;12(13):4018-26.

Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer.
Pantuck AJ, Leppert JT, Zomorodian N, Aronson W, Hong J, Barnard RJ, Seeram N, Liker H, Wang H, Elashoff R, Heber D, Aviram M, Ignarro L, Belldegrun A.

Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095-1738, USA. apantuck@mednet.ucla.edu

Abstract
PURPOSE: Phytochemicals in plants may have cancer preventive benefits through antioxidation and via gene-nutrient interactions. We sought to determine the effects of pomegranate juice (a major source of antioxidants) consumption on prostate-specific antigen (PSA) progression in men with a rising PSA following primary therapy.

EXPERIMENTAL DESIGN: A phase II, Simon two-stage clinical trial for men with rising PSA after surgery or radiotherapy was conducted. Eligible patients had a detectable PSA > 0.2 and < 5 ng/mL and Gleason score < or = 7. Patients were treated with 8 ounces of pomegranate juice daily (Wonderful variety, 570 mg total polyphenol gallic acid equivalents) until disease progression. Clinical end points included safety and effect on serum PSA, serum-induced proliferation and apoptosis of LNCaP cells, serum lipid peroxidation, and serum nitric oxide levels.

RESULTS: The study was fully accrued after efficacy criteria were met. There were no serious adverse events reported and the treatment was well tolerated. Mean PSA doubling time significantly increased with treatment from a mean of 15 months at baseline to 54 months posttreatment (P < 0.001). In vitro assays comparing pretreatment and posttreatment patient serum on the growth of LNCaP showed a 12% decrease in cell proliferation and a 17% increase in apoptosis (P = 0.0048 and 0.0004, respectively), a 23% increase in serum nitric oxide (P = 0.0085), and significant (P < 0.02) reductions in oxidative state and sensitivity to oxidation of serum lipids after versus before pomegranate juice consumption.

CONCLUSIONS: We report the first clinical trial of pomegranate juice in patients with prostate cancer. The statistically significant prolongation of PSA doubling time, coupled with corresponding laboratory effects on prostate cancer in vitro cell proliferation and apoptosis as well as oxidative stress, warrant further testing in a placebo-controlled study.

PMID: 16818701

 

Bakopoulos P, Basiaris C, Chatzis J, Dalakas M, Delidis G, Gargalianos P, et al. Dietary guidelines for adults in Greece. MINISTRY OF HEALTH AND WELFARE Supreme Scientific Health Council. Arch Hellen Med, 16(5), September-October 1999, 516-524

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