Exposure to toxins causes lasting damaging effects on the body. Numerous studies in humans and animals suggest that diet has the potential to modify the epigenome and these modifications can be inherited transgenerationally, but few studies investigate how diet can protect against negative effects of toxins. Potential evidence in the primary literature supports that caloric restriction, high-fat diets, high protein-to-carbohydrate ratios, and dietary supplementation protect against environmental toxins and strengthen these effects on their offspring's epigenome. Most notably, the timing when dietary interventions are given - during a parent's early development, pregnancy, and/or lifetime - result in similar transgenerational epigenetic durations. This implies the existence of multiple opportunities to strategically fortify the epigenome. This narrative review explores how to best utilize dietary modifications to modify the epigenome to protect future generations against negative health effects of persistent environmental toxins. Furthermore, by suggesting an ideal diet with specific micronutrients, macronutrients, and food groups, epigenetics can play a key role in the field of preventive medicine. Based on these findings, longitudinal research should be conducted to determine if a high protein, high-fat, and low-carbohydrate diet during a mother's puberty or pregnancy can epigenetically protect against alcohol, tobacco smoke, and air pollution across multiple generations.

Low Carbohydrate High Fat (LCHF) diets are popular for weight loss or glucose control. The main source of energy in such diets is fat but the composition of nutrients varies This study aims to investigate dietary variations in a real-world LCHF population and its associations with cardiovascular risk factors.

We recruited 100 volunteers who considered themselves adherent to a LCHF diet. Their last 14 days of dietary intake was assessed using diet history interviews. Validation of energy intake against expenditure was made using activity monitors. Predictive variables for the linear regression models were selected using stepwise bidirectional assessment of Akaike information criterion (AIC).

Energy intake (E%) from carbohydrates was low, 8.7 E%, and fat was the main replacement. Dietary cholesterol was associated with higher total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Dietary sodium intake was associated with higher blood pressure. Protein intake was associated with lower diastolic blood pressure but also with lower HDL. The intake of dietary fibre was associated with lower LDL and total cholesterol but with higher hemoglobin A1c (HbA1c). The intake of carbohydrates and saturated fatty acids (SFA) was not associated with any of the outcome variables.

In this LCHF population, variations in intake of carbohydrates and saturated fatty acids could not predict any aspects of the cardiovascular risk profile. Lower fibre intake and higher cholesterol and sodium intake predicted a less favorable cardiovascular risk profile.

The Dietary Approaches to Stop Hypertension (DASH) diet is designed to lower blood pressure and improve cardiovascular health by reducing sodium and unhealthy fats while increasing nutrients, including potassium, calcium, magnesium, and fibre. While evidence supports its benefits for managing cardiovascular risk factors, gaps remain in understanding its long-term impact on preventing cardiovascular disease (CVD), particularly in terms of hard clinical outcomes such as myocardial infarction and stroke.

To assess the effects of the DASH diet for the primary and secondary prevention of cardiovascular diseases.

We used standard extensive Cochrane search methods. The latest search date was in May 2024.

We included randomised controlled trials (RCTs) comparing a DASH diet intervention to no intervention (including usual care), minimal intervention, or other dietary interventions. In the context of this review, 'minimal intervention' includes brief dietary advice or informational leaflets provided during a medical consultation, without a structured dietary intervention. 'Other dietary interventions' include any other dietary programme besides the DASH diet. Participants were adults with or without CVD. The minimum duration of eligible interventions was eight weeks and the minimum follow-up was three months.

We used standard Cochrane methods. Primary outcomes were myocardial infarction, heart failure, and stroke. Secondary outcomes were the need for coronary revascularisation, carotid revascularisation, peripheral revascularisation, all-cause mortality, cardiovascular mortality, changes in blood pressure, blood lipids, the occurrence of type 2 diabetes, health-related quality of life, and adverse effects. We used GRADE to assess the certainty of evidence for each outcome.

Five RCTs involving 1397 participants met our inclusion criteria and were included in this review. All five trials contributed at least one intervention arm to one or more of the three prespecified comparisons. In total, 1075 participants across eligible arms were included in the meta-analyses. The difference reflects trial arms that did not meet our prespecified intervention and comparison definitions, and were therefore not analysed, though all participants were randomised within eligible trials and are accounted for in the review total. The trials assessed the DASH diet in a primary prevention setting; none evaluated its effects in secondary prevention. Participants were generally healthy adults aged 18 years or older, without diagnosed cardiovascular disease. The intervention duration ranged from 16 weeks to 12 months, with follow-up periods between 16 weeks and 18 months (medium- and long-term). The trials were conducted in the USA and Poland, with funding from public institutions, including the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the Institute of Cardiology in Poland. DASH diet versus no intervention (including usual care) Myocardial infarction: one trial (144 participants) reported no myocardial infarctions in either group over a one-year follow-up. The GRADE certainty rating was low due to the high risk of performance bias and imprecision. Stroke: one trial (144 participants) reported no strokes in either group over the same follow-up period. The GRADE rating was low for similar reasons. All-cause mortality: one trial (90 participants) reported no deaths over a six-month follow-up. The GRADE rating was very low due to unclear risk of selection bias, high risk of performance bias, and imprecision. No data were available for heart failure or revascularisation needs (coronary, carotid, or peripheral) in this comparison. DASH diet versus minimal intervention Myocardial infarction: two trials (902 participants in total; 629 participants were in trial arms eligible for this comparison, based on our prespecified intervention and comparison definitions) reported limited events, with no clear differences between groups over one year (risk ratio (RR) 2.99, 95% confidence interval (CI) 0.12 to 73.04). The GRADE rating was low due to high risk of performance bias and imprecision. Stroke: two trials (reporting on the same 629 participants) reported no strokes in either group over follow-up periods ranging from six months to one year. The GRADE rating was low due to similar concerns. No data were available for heart failure, revascularisation needs (coronary, carotid, or peripheral), or all-cause mortality in this comparison. DASH diet versus another dietary intervention All-cause mortality: one trial (261 participants) reported no clear difference between the groups over one year (RR 2.98, 95% CI 0.12 to 72.42). The GRADE rating was very low due to multiple risks of bias and imprecision. No data were available for myocardial infarction, stroke, heart failure, or revascularisation needs in this comparison.

The effect of the DASH diet on major cardiovascular outcomes - including myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality - remains inconclusive due to a lack of robust long-term evidence. Additionally, no trials have assessed its impact on heart failure or the need for revascularisation procedures, such as coronary, carotid, or peripheral interventions. While the DASH diet may reduce blood pressure, total cholesterol, and triglyceride levels while increasing high-density lipoprotein (HDL) cholesterol compared to no intervention or usual care, it appears to have little to no effect on low-density lipoprotein (LDL) cholesterol. Evidence comparing the DASH diet to a minimal intervention or alternative dietary approaches remains limited. Although the DASH diet has minimal reported adverse effects, the absence of long-term safety data prevents definitive conclusions on its use in individuals with or without cardiovascular disease. The certainty of evidence is low to very low, primarily due to design limitations such as high risk of bias, small sample sizes, and short follow-up periods in the included trials. Most studies focused on cardiovascular risk factors rather than long-term clinical outcomes, and all eligible trials assessed primary prevention, with no data on secondary prevention. Given these uncertainties, well-designed, long-term randomised controlled trials are needed to evaluate the DASH diet's impact on major cardiovascular events, its effectiveness in secondary prevention, and its long-term safety.

To investigate the impact of retracted trials on the production and use of healthcare evidence in the evidence ecosystem.

Retrospective cohort study based on forward citation searching.

Retraction Watch up to 5 November 2024.

Randomised controlled trials in humans that were retracted for any reason.

Forward citation searching via Google Scholar and Scopus was used to identify evidence synthesis research (21 November 2024) that quantitatively incorporated retracted trials. Data were independently extracted by two groups of researchers. The results of meta-analyses were updated after exclusion of the retracted trials. The proportions of meta-analyses that changed direction of the pooled effect and/or the significance of the P value were estimated. A generalised linear mixed model was used to investigate the association between the number of included studies and the impact, measured by odds ratio and 95% confidence interval (CI). The impact of distorted evidence on clinical practice guidelines was also investigated on the basis of citation searching.

The searches identified 1330 retracted trials and 847 systematic reviews that quantitatively synthesised retracted trials, with a total of 3902 meta-analyses that could be replicated. After the potential clustering effects were accounted for, the exclusion of the retracted trials led to a change in the direction of the pooled effect in 8.4% (95% CI 6.8% to 10.1%), in its statistical significance in 16.0% (14.2% to 17.9%), and in both direction and significance in 3.9% (2.5% to 5.2%) and a >50% change in the magnitude of the effect in 15.7% (13.5% to 17.9%). An obvious non-linear association existed between the number of included studies and the impact on the results, with a lower number of studies having higher impact (eg, for 10 studies versus ≥20 studies, change of direction: odds ratio 2.63, 95% CI 1.29 to 5.38; P<0.001). Evidence from 68 systematic reviews with conclusions distorted by retracted trials was used in 157 guideline documents.

Retracted trials have a substantial impact on the evidence ecosystem, including evidence synthesis, clinical practice guidelines, and evidence based clinical practice. Evidence generators, synthesisers, and users must pay attention to this problem, and feasible approaches that assist with easier identification and correction of such potential contamination are needed.

Open Science Framework (https://osf.io/7eazq/).

This study aims to evaluate the association between the dietary inflammatory index (DII) and stroke risk in hypertensive patients. Data were sourced from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2020, including 23,712 hypertensive patients. DII scores were calculated based on dietary intake data, and stroke diagnoses were determined through self-reported physician diagnoses. The relationship between DII and stroke risk was assessed using multivariable logistic regression models. Dose-response relationships and subgroup differences were explored through stratified analysis and restricted cubic spline (RCS) methods. Key dietary factors associated with stroke were identified using least absolute shrinkage and selection operator (LASSO) regression and incorporated into a risk prediction nomogram model. The model's discriminatory ability for stroke was evaluated using receiver operating characteristic (ROC) curves. After adjusting for confounding factors, the highest DII quartile was associated with an adjusted odds ratio (OR) of 1.44 (95% CI 1.19, 1.74) for stroke compared to the lowest quartile, and each unit increase in DII was associated with an OR of 1.08 (95% CI 1.04-1.13) for stroke prevalence. The RCS curve demonstrated a nonlinear relationship between DII and stroke, with a turning point at 0.29. The nomogram model based on key dietary factors identified by LASSO regression had an area under the curve (AUC) of 70.93% (95% CI 69.81%-72.06%). There is a nonlinear relationship between DII and stroke risk in hypertensive patients. Given the inherent limitations of a cross-sectional study design, further research is needed to establish causality.

Explainable artificial intelligence (XAI) is gaining importance in physiological research, where artificial intelligence is now used as an analytical and predictive tool for many medical research questions. The primary goal of XAI is to make AI models understandable for human decision-makers. This can be achieved in particular through providing inherently interpretable AI methods or by making opaque models and their outputs transparent using post hoc explanations. This review introduces XAI core topics and provides a selective overview of current XAI methods in physiology. It further illustrates solved and discusses open challenges in XAI research using existing practical examples from the medical field. The article gives an outlook on two possible future prospects: (1) using XAI methods to provide trustworthy AI for integrative physiological research and (2) integrating physiological expertise about human explanation into XAI method development for useful and beneficial human-AI partnerships.

Major electrocardiogram abnormalities (MECG) are common in middle-aged and older individuals and could be an important factor in predicting cardiovascular events.

To analyse the association between MECG (Minnesota classification) and CVE independently of classic cardiovascular risk factors (CVRF), and to assess whether they improve the prediction according to the Spanish Coronary Event Risk Function (FRESCO).

1.752 participants included in three nodes of the PREDIMED study aged between 55 and 80 years with medium or high CVRF. Mean follow-up time was 5.1 years. Cumulative CVE incidence was estimated by sex with and without MECG, and hazard ratios by sex were estimated using multivariate Cox regressions adjusted for randomization group and CCRF (FRESCO). Harrel's C Indices, Nam d'Agostino, Net Reclassification Improvement, and Integrated Discrimination Improvement were calculated.

At baseline, 25% of the participants shows major electrocardiogram abnormalities (AMECG). During follow-up, there were 112 cardiovascular events (16 cardiovascular deaths, 15 acute myocardial infarctions, 38 anginas, 43 strokes). MECG were significantly associated with the onset of CVE. In men, left ventricular hypertrophy (LVH) criteria were associated with T-wave inversion (HR: 17.88, 95% CI: 5.51-58.03, pvalor<.001) and QT interval prolongation (HR: 2.41, 95% CI: 1.38-4.21, pvalor=.002); in women, atrial fibrillation (HR: 5.7, 95% CI: 1.76-18.72, pvalor=.006) and ST-segment depression (HR: 3.24, 95% CI: 1.36-7.71, pvalor<.001) were associated. No significant improvement in MECG prediction compared to FRESCO was observed.

MECG are independently associated with the occurrence of CVE, but do not improve risk prediction beyond traditional risk factors.

This study was conducted to examine the dose-related effects over time of oleuropein on the proliferation and area of tumor spheroids in hepatocellular carcinoma cells.

We examined the possible effects of 100 to 500 μM dose concentrations of oleuropein on HepG2 cell proliferation using a real-time cell analyzer. A 3-dimensional hepatocellular carcinoma tumor spheroid model was established by seeding HepG2 cells at a density of 160 cells/well in custom 96-well microplates with low attachment surfaces and culturing for 3 days. Tumor spheres were treated with increasing oleuropein doses for 72 hours, and images were captured every 24 hours. The dose-dependent effects of oleuropein on tumor sphere size were analyzed by measuring the area of tumor spheres with ImageJ software. We conducted oleuropein viability and cytotoxicity analyses using calcein acetoxymethyl ester-based and propidium iodide-based staining in the tumor model.

Oleuropein inhibited cell proliferation; as the dose concentration of oleuropein increased, so did its capacity to inhibit cell proliferation (P < .001). The size of untreated tumor spheres increased at 72 hours (P < .001). However, treatment with 100 to 500 μM oleuropein reduced tumor size by 63.56% to 88.06% compared with untreated cells at the end of 72 hours (P < .001). With increasing concentrations, oleuropein inhibited the viability of tumor spheres, eliminating necrotic death caused by tumor hypoxia.

Overall, oleuropein reduced the size of tumors by inhibiting tumor proliferation and viability. In this context, oleuropein could be a candidate molecule for further extensive studies to reduce hepatocellular carcinoma tumors to meet Milan criteria for liver transplant.

Metabolic syndrome (MetS) is a cluster of interrelated metabolic abnormalities that significantly elevate the risk of cardiovascular disease, obesity, and diabetes. Flavonoids, a diverse class of bioactive polyphenolic compounds found in plant-derived foods and beverages, have garnered increasing attention as potential therapeutic agents for improving metabolic health. This review provides a comprehensive analysis of the therapeutic effects of flavonoids in the context of the MetS, with a particular focus on their modulation of the AMP-activated protein kinase (AMPK) pathway. AMPK serves as a central regulator of cellular energy balance, glucose metabolism, and lipid homeostasis, making it a critical target for metabolic intervention. Through a systematic review of the literature up to April 2024, preclinical studies across various flavonoid subclasses, including flavonols, and flavan-3-ols, were analysed to elucidate their mechanistic roles in metabolic regulation. Many studies suggests that flavonoids enhance glycolipid metabolism by facilitating glucose transporter 4 (GLUT4) translocation and activating the AMPK pathway, thereby improving glycemic control in diabetes models. In obesity-related studies, flavonoids demonstrated significant inhibitory effects on lipid synthesis, reduced adipogenesis, and attenuated proinflammatory cytokine secretion via AMPK activation. These findings show the broad therapeutic potential of flavonoids in addressing the MetS and its associated disorders. While these preclinical insights highlight flavonoids as promising natural agents for metabolic health improvement, it is important to note that their excessive concentrations may disrupt these pathways, potentially leading to metabolic imbalance and cytotoxicity. Further studies and clinical trials are essential to determine optimal dosing regimens, formulations, and the long-term safety and efficacy of flavonoids. This review highlights the importance of flavonoids for natural interventions targeting MetS and its comorbidities, offering a foundation for future translational research.

No study has examined the relationship between the presence of hypertension and the Mediterranean diet (MeDi) concerning other cardiometabolic risk factors. We conducted a retrospective study to evaluate the presence of lower adherence to the Mediterranean diet in hypertensive subjects and analyze the correlation between adherence to the Mediterranean Diet and other cardiovascular risk factors.

We analyzed the records and collected the data of the patients admitted to our Internal Medicine ward from 2010 to 2020 with a discharge diagnosis of metabolic syndrome according to the NCEP ATP-III criteria. We divided patients in two groups: hypertensive and no hypertensive. The Mediterranean Diet Score was used to evaluate the consumption and frequency of the foods characterizing a Mediterranean-type diet.

Hypertensive patients were older (73 ± 11.5 vs. 57.2 ± 5.7; p < 0.0005) and had a higher mean BMI (29.9 ± 5.2 vs. 25 ± 2.4, p < 0.0005) compared to control group. The degree of adherence to the Mediterranean diet, evaluated by the Mediterranean diet score (MDS), was significantly higher in the control group than in the hypertensive group (3.8 ± 1.6 vs 6.9 ± 1.5; p < 0.0005). Various comorbidities were more prevalent in hypertensives, such as type 2 diabetes mellitus, heart failure, ischemic heart disease, and chronic renal failure. Lower adherence to the Mediterranean diet was significantly associated with an increased prevalence of dyslipidemia, cardiovascular diseases, chronic renal insufficiency, and PAD/carotid atherosclerosis, and significantly worse lipid profiles.

Our findings show that a lower adherence to a Mediterranean Diet Style is associated with a worse cardiovascular risk factor profile in hypertensive patients. Thus, Mediterranean diet adherence in hypertensive subjects is associated with a wider cardiometabolic scenario.

We systematically evaluated effects of Mediterranean diets (MED) on cardiovascular (CV) disease and risk factors in overweight or obese adults. Five engines and two registries were searched until October 2023 for randomized controlled trials (RCTs) evaluating any type of MED compared to other diets or advice in adults. Outcomes of interest were clinical outcomes and CV risk factors (anthropometric, lipids, blood pressure, glucose metabolism, liver function). Inverse variance random effects models were used for meta-analyses; effects of MED were described as mean differences (MDs) and their 95% confidence intervals (CIs). Quality of evidence (QoE) per outcome was evaluated using GRADE methodology. Twenty-six RCTs (n = 10,352) were included. Four RCTs evaluated only obese patients and 22 evaluated overweight and obese patients. Clinical outcomes were only described in the revised 2018 PREDIMED trial where MED was associated with 35% lower risk of myocardial infarction, stroke, or CV death vs advice (hazard ratio, 0.65; 95% CI, 0.50-0.85). MED significantly reduced the values of body mass index (MD, -0.61 kg/m2; 95% CI, -1.14 to -0.09; 17 RCTs), waist circumference (MD, -2.48 cm; 95% CI, -3.99 to -0.96; 17 RCTs), triglycerides (MD, -7.93 mg/dL; 95% CI, -13.48 to -2.39; 19 RCTs), and fatty liver index (MD, -12.26; 95% CI, -23.96 to -0.56; 3 RCTs) compared with controls. MED did not significantly change any other CV risk factors. QoE was very low for most of the outcomes; 85% of RCTs had some concerns or high risk of bias. In overweight or obese adults, MED significantly decreased body mass index, waist circumference, triglycerides, and fatty liver index score but no other CV risk factors when compared with other diets or advice. There was paucity of data on effects of MED on clinical outcomes.

Stroke is a leading cause of morbidity and mortality worldwide, and dietary patterns have emerged as a significant modifiable factor in stroke prevention. The Mediterranean diet, characterized by high intake of fruits, vegetables, whole grains, nuts, olive oil, and fish, has been widely recognized for its cardiovascular benefits. However, its specific impact on stroke risk requires further elucidation. We conducted a comprehensive meta-analysis of 30 studies, including both cohort and case-control designs, to evaluate the relationship between adherence to the Mediterranean diet and the risk of stroke. A systematic search was performed across multiple databases, and a random-effects model was used to estimate pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic, and publication bias was examined through funnel plots and Egger's regression test. Additionally, trial sequential analysis was conducted to determine the adequacy of the sample size. The meta-analysis revealed a significant reduction in stroke risk among individuals adhering to the Mediterranean diet, with a pooled HR of 0.88 (95% CI: 0.84-0.91). Notably, a significant heterogeneity was detected (I2 = 34%). The Z-score plot from trial sequential analysis confirmed that the sample sizes were sufficient to draw definitive conclusions. However, a potential publication bias was identified. The case-control studies confirmed a highly significant effect (HR = 0.54, 95% CI: 0.4-0.73). The funnel plots in both settings hinted at the presence of a potential publication bias, supported by a significant Egger's test. Our findings provide robust evidence supporting the protective effect of the Mediterranean diet against stroke. Despite the presence of some heterogeneity and potential publication bias, the cumulative evidence suggests that promoting the Mediterranean diet could serve as an effective public health strategy for stroke prevention. Further research is recommended to explore the underlying mechanisms and to assess the diet's impact across diverse populations.

Naturally occurring dietary patterns, a major contributor to health, are not well described among those with cardiovascular disease (CVD) - particularly in light of socioeconomic vulnerability. We sought to identify major dietary patterns in the US and their distribution by CVD, social risk factors, and Supplemental Nutrition Assistance Program (SNAP) participation.

This was a cross-sectional study among 32,498 noninstitutionalized adults from the National Health and Nutrition Examination Survey (2009-2020). We used principal component analysis to identify common dietary patterns. Individuals were assigned to the pattern for which they had the highest component score. Using multinomial logit regression, we estimated the percentage whose diets aligned with each pattern in population subgroups stratified by CVD, social risk factors, and SNAP. Analyses were adjusted for age, gender, race and ethnicity, total energy intake, and year, with sampling weights to provide nationally representative estimates.

Four dietary patterns were identified among US adults: American (33.7%; high in solid fats, added sugars, and refined grains), Prudent (22.6%; high in vegetables, nuts/seeds, oils, seafood, and poultry), Legume (15.8%), and Fruit/Whole Grain/Dairy (27.9%), that together explained 29.2% of dietary variance. More adults with prevalent CVD (37.1%) than without (33.3%, p=0.005) aligned with the American Pattern, with no differences among other patterns. Each additional social risk factor associated with more adults aligned with American (2.5% absolute increase) and Legume (1.3%), and fewer aligned with Prudent (-1.9%) and Fruit/Whole Grain/Dairy (-1.9%) patterns (p<0.001 each). Analysis of dietary patterns across SNAP participation showed higher proportion of SNAP participants and income-eligible SNAP non-participants compared to non-eligible adults for the American (40.2% [38.1, 42.3%], 35.1% [32.7, 37.5%], 31.9% [31.0, 32.8%], respectively) and Legume patterns (17.2% [15.6, 18.8%], 17.8% [16.1, 19.5%]), 15.4% [14.6,16.1%], respectively) and less for Prudent (17.0% [15.5, 18.6%], 20.2% [18.2, 22.3%], 24.2% [23.3, 25.1%], respectively) and Fruit/Whole Grain/Dairy Patterns (25.6% [23.8%, 27.3%], 26.9%[27.6%,29.5%], 28.6% [27.6%, 29.5%], respectively).

Empirical dietary patterns vary by CVD and socioeconomic vulnerability. Initiatives to improve nutrition in at-risk individuals should consider these naturally occurring dietary patterns and their variation in key subgroups.

Patients with heart failure with preserved ejection fraction (HFpEF) are burdened by multiple diet-sensitive comorbidities, including obesity and malnutrition. Despite this, a low percentage of patients with HFpEF have been enrolled in dietary intervention trials in heart failure and few dietary interventions have been conducted in HFpEF exclusively. This scoping review will examine available evidence regarding dietary interventions in patients with HFpEF, highlight existing gaps in knowledge, and discuss emerging dietary therapies in this population.

Introduction: Ñuble is the region of Chile with the highest stroke incidence rates in the country. The aim was to estimate the association between adherence to the MED diet and the first ischemic stroke in adult patients living in the Ñuble region. Methods: a case-control hospital-based study. The cases (n = 89) were patients with first ischemic stroke, and controls (n = 178) were admitted to the same hospital during the same month the cases were recruited. We selected two controls for one case and paired them for sex and age (± 5 years). We used the food frequency questionnaire and the adherence Mediterranean diet questionnaire. A descriptive analysis of the variables and a conditional logistic regression to determine the association between variables. Results: 71 % of the sample was ≥ 65 years old and 64 % were male. Cases smoked (11.2 %), consumed at least one drink per month (41.6 %), and had a diagnosis of hypertension (76.4 %) more frequently than controls. In the model adjusted for all variables, it is observed that those who are in quartile 2 of adherence (6-7 points) are 42 % less likely to have a cerebral infarction compared to those who have a lower score (p < 0.005). Conclusions: our findings suggest that moderate adherence to a Mediterranean diet, defined by the PREDIMED score and adjustment for other variables, reduces the probability to first ischemic stroke.

Numerous studies linking environmental pollutants to oxidative stress, inflammation, and neurotoxicity have assigned pollutants to several neurodegenerative disorders, including Alzheimer's disease (AD). Heavy metals, pesticides, air pollutants, and endocrine disruptor chemicals have been shown to play important roles in AD development, with some traditional functions in amyloid-β formation, tau kinase action, and neuronal degeneration. However, pharmacological management and supplementation have resulted in limited improvement. This raises the interesting possibility that activities usually considered preventive, including diet, exercise, or mental activity, might be more similar to treatment or therapy for AD. This review focuses on the effects of diet on the effects of environmental pollutants on AD. One of the primary issues addressed in this review is a group of specific diets, including the Mediterranean diet (MeDi), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH intervention for Neurodegenerative Delay (MIND), which prevent exposure to these toxins. Such diets have been proven to decrease oxidative stress and inflammation, which are unfavorable for neuronal growth. Furthermore, they contribute to positive changes in the composition of the human gut microbiota and thus encourage interactions in the Gut-Brain Axis, reducing inflammation caused by pollutants. This review emphasizes a multi-professional approach with reference to nutritional activities that would lower the neurotoxic load in populations with a high level of exposure to pollutants. Future studies focusing on diet and environment association plans may help identify preventive measures aimed at enhancing current disease deceleration.

This study aims to investigate the dietary patterns of Chinese individuals aged 35 years and older who are at high risk of cardiovascular disease (CVD) and to explore the correlation between these dietary patterns and the risk of CVD. A total of 28,747 high-risk participants in China PEACE in Zhejiang Province from 2014 to 2019 were included in the analysis Dietary data were obtained using the Food Frequency Questionnaire, and dietary patterns were extracted through factor analysis. Cox regression was used to examine the relationship between the dietary patterns and CVD risk in the high-risk groups. Four dietary patterns were identified. The "Bean, egg, milk and pickle" dietary pattern was associated with an increased risk of CVD (HR = 1.29; 95% confidence interval (CI):1.09, 1.54; p＜0.05), after adjusting for confounders. In contrast, the "Seafood and animal meat", "Wheat and coarse cereals", and "Rice and vegetable" dietary patterns did not show a significant impact on CVD risk. These findings provide valuable insights for dietary guidance in high-risk groups and have significant implications for the prevention and management of CVD.

Cancer stem cells (CSCs) are a subpopulation of cancer cells that are believed to be responsible for tumor initiation, progression, metastasis, and resistance to conventional therapies. Oleuropein as a natural compound found in olive leaves and olive oil, has potential therapeutic effects in cancer treatment, particularly in targeting CSCs. It induces apoptosis in CSCs while sparing normal cells, inhibit proliferation, migration, and invasion, and suppress the self-renewal ability of CSCs. Additionally, oleuropein has shown synergistic effects with conventional chemotherapy drugs, enhancing their efficacy against CSCs.

This study aims to selectively target therapeutically resistant cancer stem cells (CSCs) within a heterogeneous tumor population by utilizing oleuropein (OLE) encapsulated in methacrylated alginate (OLE-mALG) within an in vivo-like microenvironment.

This study aims to target therapeutically resistant cancer stem cells (CSCs) with oleuropein (OLE) encapsulated in the methacrylated alginate (OLE-mALG) in a heterogeneous tumor population with an in vivo-like microenvironment.

Co-culture of CSCs with non-tumorogenic MCF-12 A cells was performed, the 3D breast cancer model was supported with methocel/matrigel/collagen-I, and vascularization was ensured with human umbilical vein endothelial cells (HUVEC). Then, OLE-loaded methacrylated alginate microparticles (mALG) were formed by dual crosslinking in the presence of both ionic and visible light obtained with a droplet based microfluidic system. The characterization and effectiveness of the produced OLE-mALG were evaluated by the FTIR, swelling/degradation/release analysis. Before producing OLE loaded mALG microparticles, a preliminary study was carried out to determine the effective dose of OLE for cells and the duration of OLE action on MCF-7, CSCs and MCF-12 A. Subsequently, CSC viability (WST-1), apoptosis (Bcl-2, Bax, caspase-3, caspase-9), stemness (OCT3/4, NANOG, SOX2), EMT profile (E-cadherin, Vimentin, Slug) and proliferation (SURVIVIN, p21, CYCLIN D1) after OLE-mALG treatment were all evaluated in the 3D model.

OLE was encapsulated in mALG with an efficiency of 90.49% and released 73% within 7 h. OLE-mALG induced apoptosis through the decrease in anti-apoptotic Bcl-2 and an increase in pro-apoptotic Bax, caspase-3, and caspase-9 protein levels. While Vimentin and Slug protein levels decreased after 200 µg/mL OLE-mALG treatment to 3D breast cancer culture, E-cadherin levels increased. OLE-mALG treatment to CSC co-culture led to a decrease in proliferation by triggering p21/SURVIVIN expressions, and also resulted in an increase in stemness genes (OCT3/4/NANOG/SOX2).

200 µg/mL OLE-loaded mALG microparticles suppressed epithelial-to-mesenchymal transition by suppressing Vimentin and Slug protein levels, and increased E-cadherin levels in the 3D breast cancer model we created with CSCs, MCF-12 A and HUVECs. This complex system may allow the use of personalized cells for rapid drug screening in preclinical studies compared to animal experiments. OLE-mALG showed apoptotic and metastasis suppressive properties in cancer cells and it was concluded that it can be used in combination with or alternatively with chemotherapeutic agents to target breast cancer stem cells.

Thymol is a phenol monoterpene that is naturally derived from cymene and is an isomer of carvacrol. It constitutes a significant portion (10%-64%) of the essential oils found in thyme (Thymus vulgaris L., Lamiaceae), a medicinal plant renowned for its therapeutic properties. Wild thyme is native to the Mediterranean region and has been used in cooking and medicine for a long time. In contemporary contexts, both thymol and thyme offer diverse functional applications in the pharmaceutical, food, and cosmetic industries. Thymol has attracted scientific interest for its potential therapeutic applications in pharmaceuticals and nutraceuticals. Studies have explored its efficacy in treating respiratory, nervous, and cardiovascular disorders, highlighting its promising role in diverse therapeutic interventions. Additionally, this compound demonstrates antimicrobial, antioxidant, anticarcinogenic, anti-inflammatory, and antispasmodic properties. It also shows potential as a growth enhancer and has immunomodulatory properties as well. Other discussed aspects include thymol toxicity, bioavailability, metabolism, and distribution in animals and humans. This review summarizes the most significant data regarding the beneficial effects of thyme bioactive compounds and their applications as a food preservative while taking into account the thyme plant extract and its essential oil.

Eating patterns significantly impact the weight loss process. This study aimed to investigate the influence of primary eating patterns on weight loss measures in overweight and obese adults using network meta-analysis.

We systematically searched PubMed, Scopus, Web of Science (WOS), and Google Scholar until May 2, 2023. Our network meta-analysis followed the PRISMA extension guidelines for Comparing Mediterranean, low carbohydrate and low fat diet effects on weight loss among overweight/obese adults. We conducted a Frequentist random-effects network meta-analysis. Summary effects were presented as mean differences (MD) along with corresponding standard deviations (SD). P-scores were used for treatment ranking within the network.

Initial literature searches yielded 1574 citations. Ultimately, 1004 participants from 7 RCTs (or 9 trials) met inclusion criteria. All diets resulted in weight loss. Comparatively, the low-carbohydrate diet exhibited a significant decrease in weight loss compared to the Mediterranean diet (MD = -2.70 kg, 95% CI: -4.65, -0.75). Indirect evidence revealed that both the low-carbohydrate diet (MD = -6.31 kg, 95% CI: -11.23, -1.39) and the low-fat diet (MD = -5.61 kg, 95% CI: -10.61, -0.61) significantly reduced weight among overweight/obese adults compared to the standard hypolipemic diet. Rankings indicated the low-carbohydrate diet as the most effective dietary intervention for enhancing weight loss (P-score = 0.8994) and reducing body fat (P-score = 0.7060).

Overall, a low-carb diet appears to be among the most effective approaches for weight loss and body fat reduction. However, it's essential to consider that its efficacy may vary based on factors such as age, gender, genetics, and lifestyle habits.

Cardiovascular diseases (CVDs) have a multifactorial origin. Among the risk factors, so-called behavioural risk factors play a major role in the onset of these diseases: smoking, unhealthy diet, lack of physical activity and sedentary lifestyle, alcohol, sleep disorders, depression and illicit drug use are among the main behavioural risk factors for CVD and are considered to be modifiable and accessible to prevention. The prevalence of these cardiovascular risk factors remains high among the French population. Nearly one in three adults are smokers, 71.7% do not meet the recommendation to eat five fruits and vegetables per day, and 4 out of 5 adults consume more than 6g of salt per day. Further, 38.7% of adults do not meet the recommendations for physical activity, 40.8% have a high level of sedentary, 49.4% report sleep problems in the last 8 days, and 12.5% have had a major depressive episode in the last 12 months. Despite some positive trends, such as an increase in the level of physical activity among men and the decline in smoking prevalence, the epidemiological situation regarding these risk factors remains a cause for concern in France. While the gap between risk factors in men and women is narrowing, this is often due to a worsening of the situation among women, who are increasingly adopting unfavourable behaviours and tending to reach the higher levels of risk factors traditionally observed among men. The epidemiological situation demonstrates the urgent need to strengthen policies to prevent these risk factors.

Cardiovascular disease (CVD) is the primary cause of death worldwide but there is a variation in its burden across some nations that seems to be related to dietary habits. Mediterranean populations have lower rates of morbidity and mortality from CVD. Thus, this systematic review and meta-analysis aimed to assess the impacts of the Mediterranean diet (MedDiet) enriched with olive oil on blood lipids, glycemic indices, blood pressure, and anthropometric indices.

A comprehensive search of the Web of Science, PubMed (MEDLINE), Scopus, Cochrane Library, Google Scholar, Embase, and CINAHL databases until March 2024 was conducted to identify clinical trials studying the effects of MedDiet enriched with olive oil on the aforementioned parameters.

In total, 3303 records were retrieved. A total of 18 clinical trials met the inclusion criteria after records were screened for eligibility. According to the pooled analysis from the random-effects model, the MedDiet enriched with olive oil significantly reduced triglycerides (TG) compared with the control group (WMD = -2.40 mg/dl; 95%CI, -4.533 to -0.262; P = 0.027). Strong heterogeneity was observed. Sensitivity analysis did not change our results and no significant effect of any trial on the overall effect sizes of all variables were found. There was a concern about the reporting bias for some studies which reported some main outcomes.

MedDiet enriched with olive oil showed no consistent effects on any of the reported markers of cardiovascular health except on TG.

CRD42023424641.

Dietary factors might contribute to the risk of lung cancer by increasing the concentration of inflammatory markers. The literature-derived Dietary Inflammatory Index (DII) has been established to evaluate the inflammatory potential of diet correlated with inflammatory markers. The association between DII scores and the risk of lung cancer has been conflicting. So, in the current study, we aimed to assess the effect of pro-inflammatory dietary patterns measured with DII and the risk of lung cancer.

A multi-center case-control study was carried out on 616 patients with lung cancer and 3412 healthy controls. Dietary intakes were collected using a 131-item food frequency questionnaire during a face-to-face interview. The DII scores including thirty-six nutrients were calculated after energy adjustments. Finally, the association between DII level and the risk of lung cancer was evaluated by performing a multi-variable regression method after adjusting for potential confounders.

The risk of overall lung cancer, small cell, and squamous cell carcinoma was elevated in the third tertile compared to the first tertile of the DII score, (odds ratio [OR] T3 vs. T1 of overall lung cancer = 1.38 (95% confidence interval [CI] 1.08-1.77), P trend = 0.01, OR T3 vs. T1 of squamous cell lung cancer = 1.82 (95% CI 1.02-3.24), P trend = 0.04, OR T3 vs. T1 of small cell lung cancer = 1.66 (95% CI 1.08-2.54), P trend = 0.019). However, no increase was observed in the risk of adenocarcinoma by adherence to a pro-inflammatory dietary pattern.

A positive link was found between DII and the risk of overall lung cancer, small-cell, and squamous-cell lung cancer. However, there was no association between DII and the risk of lung adenocarcinoma.

This review article investigates the intricate relationship between nutrigenomics and neurological disorders, highlighting how genetic variations affect an individual's response to nutrients. The study delves into the role of diet-related oxidative stress and the gut-brain axis in the progression and management of brain disorders such as Parkinson's disease, Alzheimer's disease, epilepsy, stroke, migraines, and depression. The review encompasses various clinical trials and introduces new trends and techniques, including omics and artificial intelligence, in identifying and managing neurological disorders. The main findings emphasize that personalized diet recommendations, tailored to an individual's genetic makeup, can significantly improve cognitive health and manage neurological conditions. The study concludes that further research in the field of nutrigenomics is essential to advancing personalized nutrition strategies for better neurological functioning, ultimately linking diet, genes, and brain health.

Background: The role of diet on the risk of chronic pancreatitis (CP) is understudied. The health benefits of the Mediterranean diet (MedDiet) pattern have long been recognized, but its association with CP risk is unclear. We aimed to investigate the association between adherence to MedDiet and the incidence of CP in a large-scale cohort. Methods: 190 790 participants from the UK Biobank were involved, all free of CP and with typical diet recall data at recruitment. The diagnosis of CP was ascertained by the combination of hospital inpatient data, primary care data, and death registry data. Multivariable Cox regression models were used to evaluate the associations between MedDiet adherence, measured by the Mediterranean Diet Adherence Screener (MEDAS) continuous score, and the incidence of CP. The mediating role of inflammation (assessed by C-reactive protein) and metabolic status between MedDiet adherence and CP risk was also investigated. Results: During a mean of 10.8 years of follow-up, 214 participants developed CP. Individuals with the highest adherence to MedDiet, defined by continuous MEDAS scores, exhibited significantly lower risk of developing CP (hazard ratio [HR] = 0.57, 95% confidence interval [CI]: 0.40-0.82; p = 0.002) compared to those in the lowest tertiles. Metabolic status mediated 4.74% of the association between MedDiet adherence and CP risk, while the mediating role of C-reactive protein was not significant. Conclusion: Greater Mediterranean diet adherence is associated with reduced chronic pancreatitis risk.

Recent advances in machine learning technologies and omics methodologies are revolutionizing dietary assessment by integrating phenotypical, clinical, and metabolic biomarkers, which are crucial for personalized precision nutrition. This investigation aims to evaluate the feasibility and efficacy of artificial intelligence tools, particularly machine learning (ML) methods, in analyzing these biomarkers to characterize food and nutrient intake and to predict dietary patterns.

We analyzed data from 138 subjects from the European Dietary Deal project through comprehensive examinations, lifestyle questionnaires, and fasting blood samples. Clustering was based on 72 h dietary recall, considering sex, age, and BMI. Exploratory factor analysis (EFA) assigned nomenclature to clusters based on food consumption patterns and nutritional indices from food frequency questionnaires. Elastic net regression identified biomarkers linked to these patterns, helping construct algorithms.

Clustering and EFA identified two dietary patterns linked to biochemical markers, distinguishing pro-Mediterranean (pro-MP) and pro-Western (pro-WP) patterns. Analysis revealed differences between pro-MP and pro-WP clusters, such as vegetables, pulses, cereals, drinks, meats, dairy, fish, and sweets. Markers related to lipid metabolism, liver function, blood coagulation, and metabolic factors were pivotal in discriminating clusters. Three computational algorithms were created to predict the probabilities of being classified into the pro-WP pattern. The first is the main algorithm, followed by a supervised algorithm, which is a simplified version of the main model that focuses on clinically feasible biochemical parameters and practical scientific criteria, demonstrating good predictive capabilities (ROC curve = 0.91, precision-recall curve = 0.80). Lastly, a reduced biochemical-based algorithm is presented, derived from the supervised algorithm.

This study highlights the potential of biochemical markers in predicting nutritional patterns and the development of algorithms for classifying dietary clusters, advancing dietary intake assessment technologies.

The association between HDL cholesterol (HDL-C) levels and death from cardiovascular disease follows a U-shaped pattern, increasing at the extremes. The objective of the study was to characterize a sample of subjects with extreme hyperalphalipoproteinemia (HAE).

53 cases with HAE were recruited, 24 women (HDL-C>135mg/ dL) and 29 men (HDL-C>116mg/ dL). A detailed medical history was taken and questionnaires on adherence to the Mediterranean diet and physical activity were collected. Carotid ultrasounds were performed to detect the presence of suclinical atherosclerosis.

The most prevalent cardiovascular risk factor (CVRF) was dyslipidemia (64%) with no significant differences between men and women, unlike hypertension (21% in women, versus 55% in men, p=0.01) and others CVRF, for example, diabetes. 7% of the series had previous cardiovascular disease, women had higher LDL cholesterol (p=0.002) and HDL-C than men (without significant differences). Plaque was detected in 53% of cases, being more prevalent in men. Patients with plaque were older, drank more alcohol and smoked more (p<0.05).

Men had a higher prevalence of CVRF than women, except for dyslipidemia. Subclinical atherosclerosis occurred in more than half of the series. Age, alcohol consumption and smoking were independently associated with the presence of plaque, however, our data do not show a significant influence of HDL-C levels.

To evaluate the relationship between adherence to the Mediterranean diet (MD) and periphereal artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM).

An observational sectional study was conducted with 174 patients diagnosed with T2DM, of which 78 patients had PAD. A patient was considered to have PAD if they obtained an ankle-brachial index (ABI) < 0.9 and/or absence of both distal pulses in one of the two feet. Data on sociodemographic and anthropometric variables, physical activity, smoking habits, biochemical blood parameters, and comorbidities were recorded. Good adherence to the MD was considered with a score ≥ 9 in MEDAS-14. Vascular factors independently associated with adherence to the MD in patients with T2DM were identified through multivariate logistic regression analysis.

ABI, DFU, intermittent claudication and pedal pulse absence correlated with MD adherence. DFU, intermittent claudication and posterior tibial pulse absence were associated with the final score obtained in the MEDAS-14. Nut consumption, white meat preference and sautéed dish intake were associated with PAD presence. Multivariate analysis linked MD adherence to sex (OR = 0.044, 95 % CI 0.003-0619), age (OR = 0.139, 95 % CI 0.029-0.666), duration of T2DM (OR = 7.383, 95 % CI 1.523-35.779) and age at diagnosis of T2DM (OR = 6082, 95 % IC 1.415-26.136), as well as the presence of DFU (OR = 0.000, 95 % IC 0.000-0.370) and intermittent claudication (OR = 0.004, 95 % IC 0.000-0.534).

Adherence to the MD is associated with a reduction in vascular complications in T2DM, highlighting its potential as a dietary intervention strategy.

We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

Retractions serve a crucial role in maintaining the integrity and accuracy of scientific literature. There has been growing interest in understanding the patterns behind retractions. This bibliometric study analyzed retracted articles published between 2003 and 2022, indexed by the Science Citation Index Expanded of the Web of Science Core Collection database. A total of 8466 retracted articles were identified, revealing an overall increase up to 2019, followed by a decline. A total of 109 countries contributed to the retracted articles, with China and the United States having the highest absolute numbers. In addition, the articles were published in 2347 different journals, with Tumor Biology recording the largest number of retracted articles. The top 10 most cited retracted articles indicated that data and image integrity issues were the main reasons for retraction. The primary reasons for retractions, identified by linking the retracted articles to the Retraction Watch Database, were data and results issues followed by plagiarism and duplication. In conclusion, the present bibliometric study offered an overview of the status of retracted articles indexed by the Web of Science Core Collection over the past two decades. These findings provide insight into areas where scientific integrity may be compromised and serve as a guide to foster a responsible research environment.

Atherosclerotic cardiovascular disease remains a major health issue, often developing silently as subclinical atherosclerotic disease (SAD). The Mediterranean diet (MDiet) is known for its cardiovascular benefits, but the combined influence of both MDiet adherence and physical activity (PA) on SAD progression has not been previously documented. Objective: We aimed to investigate how adherence to a healthy lifestyle, defined as MDiet adherence and PA level, influences SAD progression in subjects from the ILERVAS cohort follow-up. Methods: A study on 3097 participants from the ILERVAS prospective cohort was conducted. MDiet adherence was assessed using the MEDAS score, and PA categories were established using the IPAQ, both categorized into low, moderate, and high levels. Two different lifestyle scores integrating the MDiet and PA categories were built. The presence of atherosclerotic plaques was assessed by carotid and femoral ultrasound examination. Demographic, clinical, and biochemical data were also obtained. Multivariable linear, logistic, and Poisson regression models adjusted for potential confounders were used to analyze the association between the lifestyle scores and SAD progression, as well as the MDiet and PA as separate variables and number of territories with plaque. Results: A healthier lifestyle score did not show an effect on SAD progression. However, a higher MEDAS score was associated with a 3% decrease in the number of territories with plaque (IRR 0.97, 95% CI 0.96-0.99, p < 0.001), suggesting a protective effect of the adherence to the MDiet. PA did not show a significant association (IRR 1.00, 95% CI 1.00-1.00, p = 0.269). Older age, hypertension, dyslipidemia, smoking, and lower eGFR were associated with SAD progression, while the female sex was protective (IRR 0.67, 95% CI 0.63-0.72, p < 0.001). Conclusions: The findings of this study show that higher adherence to the MDiet is associated with reduced incidence of SAD, indicating its potential role in cardiovascular prevention strategies. Although a higher lifestyle score or physical activity levels did not show any significant effect, promoting the MDiet, alongside managing traditional cardiovascular risk factors, could be an effective public health intervention to prevent atherosclerosis and reduce the burden of cardiovascular disease.

To relate adherence to healthy dietary patterns, evaluated by different dietary indices, to the intake of nutrients and food groups among pregnant women in the United Arab Emirates.

The analyses included 1122 pregnant women from the Mutaba'ah Study. Dietary intake was assessed using a semi-quantitative Food Frequency Questionnaire. Adherence to three dietary pattern indices was assessed; Alternate Healthy Eating Index for Pregnancy (AHEI-P), Alternate Mediterranean Diet (aMED) and Dietary Approaches to Stop Hypertension (DASH). Associations between adherence (score >median) to the three dietary indices and intake of nutrients and food groups were analyzed using logistic regression analysis.

Women with higher intake of polyunsaturated fatty acids, fiber, vegetables, fruits, legumes, and nuts and lower intake of saturated fatty acids, red meat, and sweetened beverages had significantly higher odds of adherence to all three dietary patterns (p<0.05). Associations between intakes of nutrients and food groups with odds of adherence to the dietary patterns differed for total fat (only with AHEI-P, [odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98]) and monounsaturated fatty acids (only with aMED, [OR: 1.06; 95% CI: 1.02-1.10]), dairy (with AHEI-P [OR: 0.89; 95% CI: 0.84-0.95] and aMED [OR: 0.86; 95% CI: 0.81-0.91], and with DASH [OR: 1.10; 95% CI: 1.04-1.17]), whole grain (only with aMED [OR: 2.19; 95% CI: 1.61-2.99] and DASH [OR: 4.27; 95% CI: 3.04-5.99]) and fish (with AHEI-P [OR: 1.36; 95% CI: 1.02-1.80] and aMED [OR: 1.79; 95% CI: 1.35-2.38], and with DASH [OR: 0.67; 95% CI: 0.52-0.86]).

Adherence to the three dietary pattern indices was generally associated with a favorable intake of nutrients and food groups. However, the indices captured slightly different aspects of dietary intake. These results show that dietary indices that assess adherence to healthy dietary patterns cannot be used interchangeably.

The metabolic syndrome (MetS) is a multiplex modifiable risk factor for cardiovascular disease, type 2 diabetes mellitus and other health outcomes, and is a major challenge to clinical practice and public health. The rising global prevalence of MetS, driven by urbanization, sedentary lifestyles and dietary changes, underlines the urgency of addressing this syndrome. We explore the complex underlying mechanisms, including genetic predisposition, insulin resistance, accumulation of dysfunctional adipose tissue and ectopic lipids in abdominal obesity, systemic inflammation and dyslipidaemia, and how they contribute to the clinical manifestations of MetS. Diagnostic approaches vary but commonly focus on abdominal obesity (assessed using waist circumference), hyperglycaemia, dyslipidaemia and hypertension, highlighting the need for population-specific and phenotype-specific diagnostic strategies. Management of MetS prioritizes lifestyle modifications, such as healthy dietary patterns, physical activity and management of excess visceral and ectopic adiposity, as foundational interventions. We also discuss emerging therapies, including new pharmacological treatments and surgical options, providing a forward-looking perspective on MetS research and care. This Primer aims to inform clinicians, researchers and policymakers about MetS complexities, advocating for a cohesive, patient-centred management and prevention strategy. Emphasizing the multifactorial nature of MetS, this Primer calls for integrated public health efforts, personalized care and innovative research to address this escalating health issue.

We Investigated how promoting diverse, healthy food options affects long-term dietary choices. We hypothesized that encouraging exploration of nutritious plant-based foods would lead to lasting improvements in diet. Participants (N = 211) were randomly assigned into two groups for a 6-week intervention: The fixed menu group was given the same large menu every week, while the changing menu group received a new small menu each week. At the end of the intervention both groups were exposed to the same menu suggestions. Food diversity evaluation was based on weekly reports collected during the intervention. Self-reported adherence to Mediterranean diet components was assessed using the I-MEDAS screener. The proportion of plant-based foods in participants' diets was estimated using a 0-100% scale based on self-report. Both items were evaluated using online questionnaires given to participants at baseline, at the end of the intervention, as well as three and six months after the intervention concluded. Results mean(SD) demonstrated that participants in fixed menu group explored a significantly wider array of items 26.33(11.64) than those in the changing menus group [19.79(10.29), t(202) = 4.25, p < 0.001, Cohen's d = 0.60]. A repeated measures analysis of covariance rmANCOVA revealed that short-term increase in I-MEDAS and PBD score were noted in both groups; however, only participants with the fixed menu sustained this increase at months follow-up [diff = 1.50, t(132) = 4.50, p < 0.001 Our findings suggest that manipulating the rate of exposure to food suggestions may affect overall dietary variety. It seems that early presentation with options may increase overall dietary variety and may even support longer-term habits. This study contributes to developing effective interventions and highlights the challenge of promoting exploratory behavior in nutrition.

The main study goal is to assess the relationship between adherence to the mediterranean diet (MD) and the presence of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).

Observational pilot study of 174 patients diagnosed with T2DM. Sociodemographic and anthropometric variables, physical activity, smoking habits, blood biochemical parameters and comorbidities were recorded. The presence of alterations in sensitivity to pressure, pain, thermal and vibration was explored. Good MD adherence was a score  ≥  9 the 14-point MD adherence questionnaire (MEDAS-14).

The study population consisted of 174 patients (61.5% men and 38.5% women), with a mean age of 69.56 ± 8.86 years; 19% of these patients adhered to the MD. The score obtained in the MEDAS-14 was higher in patients who did not present alterations in sensitivity to pressure (p = 0.047) or vibration (p = 0.021). The patients without diabetic peripheral neuropathy were more likely to comply with the MD and had a higher score on the MEDAS-14 (p = 0.047). However, multivariate analysis showed that only altered sensitivity to pressure was associated with adherence to the MD (altered sensitivity OR = 2.9; 95%CI 1.02-8.22; p = 0.045).

Although the patients with DPN had lower scores on the MEDAS questionnaire and therefore poorer adherence to the mediterranean diet, the only parameter significantly associated with the MD was that of sensitivity to pressure (monofilament test).

In high-income countries, the oral health of the population is influenced by public health interventions, widespread use of oral care products, dental practice measures, and the cost of dental treatment. We compiled information on changes of the prevalence of proximal and upstream determinants of periodontitis, caries, and tooth loss over the last three decades to outline their potential effects on changes of oral health during this period. Information was retrieved from repeated cross-sectional studies and from published literature. While both the prevalence of edentulism and the number of missing teeth (from the DMF-T index) decreased, the number of sound teeth as well as the total number of teeth increased. The prevalence of severe periodontitis was unchanged, whereas the prevalence of periodontal health and moderate periodontitis may have increased to a minor extent. Concerning oral health risk factors, the proportion of individuals with tertiary education increased, while smoking prevalence declined. More and more people used oral care products. Whether one reimbursement system worked better than another one in terms of tooth retention could not be elucidated. In tooth retention, population-wide use of fluoridated toothpastes had the greatest impact. To some extent, the higher number of teeth present may be related to the more frequent use of interdental cleaning aids and powered toothbrushes. Since there was no decrease in severe periodontitis in most cohorts, periodontal interventions probably contributed little to improved tooth retention.

Objective: This study aimed to analyze the relationship between the consumption of selected food products and the risk of prevalence of selected metabolic and cardiovascular disorders among nurses. Methodology: This cross-sectional study was conducted among 405 nurses. To achieve the study objective, body composition analysis (Tanita MC-980), blood pressure measurement (Welch Allyn 4200B), anthropometric measurements, lipid profile, fasting blood glucose (CardioChek PA), and surveys regarding the consumption of specific food groups were conducted. Results: More than half of the respondents were overweight or/and obese, and almost 40% had elevated blood pressure levels. The results obtained from logistic regression models indicated that the consumption of specific food product groups may predispose to/increase the risk of hypertension, abdominal obesity, overweight, obesity, body fat accumulation, and the risk of cardiovascular events. Conclusions: These findings highlight the importance of targeted nutritional strategies to enhance the health and professional efficacy of nursing staff, paving the way for improved healthcare practices.

(1) The main aim of this study was to analyze the relationship of the Mediterranean diet (MD) with vascular function in participants with and without increased insulin resistance (IR) in the Spanish population. A secondary aim was to study differences by gender. (2) Methods: Data were analyzed from 3401 subjects in the EVA, MARK, and EVIDENT studies (mean age = 60 years and 57% men). IR was evaluated with the triglyceride and glucose index (TyG index). TyG index = Ln [(fasting triglyceride mg/dL × fasting glucose mg/dL)/2]. The MD was measured against the MEDAS questionnaire, with the 14 items used in the PREDIMED study. Vascular stiffness was estimated with the brachial-ankle pulse wave velocity (baPWV) and the cardio ankle vascular index (CAVI) using the Vasera VS-1500®. (3) Results: The mean MEDAS value was 5.82 ± 2.03; (men: 5.66 ± 2.06; women: 6.04 ± 1.99; p < 0.001). MD adherence was 36.8% (men: 34.2%; women: 40.3%; p < 0.001). The mean baPWV value was 14.39 ± 2.78; (men: 14.50 ± 2.65; women: 14.25 ± 2.93; p = 0.005). A baPWV value ≥ 14.5 m/s was found in 43.4% (men: 43.6%; women: 40.0%; p = 0.727). The mean CAVI value was 8.59 ± 1.28; (men: 8.75 ± 1.28; women: 8.37 ± 1.26; p < 0.001). CAVI values ≥ 9 were present in 39.0% (men: 44.4%; women: 31.7%; p < 0.001). The mean value of the TGC/G index was 10.93 ± 1.39; (men: 11.08 ± 1.33; women: 10.73 ± 1.43; p < 0.001). IR was found in 49.9%. The average value of the MD score value was negatively associated with baPWV and CAVI in all groups analyzed (<0.05), except in the group of women with insulin resistance. (4) Conclusions: The results suggest that MD adherence is negatively associated with the vascular stiffness parameters analyzed in all the groups studied except the group of women with insulin resistance.