Mediterranean Diet and Health Promotion: evidence and current concerns

Main Article Content

Maria Giuliana Tozzi Ciancarelli Caterina Di Massimo Daniela De Amicis Irene Ciancarelli

Abstract

The Mediterranean diet (MD) is a dietary pattern described by Ancel B. Keys in the 1950s  as a typical dietary habit of some populations bordering the Mediterranean sea in the south of Europe characterized by frugal living style. Findings of the Seven Country Study showed that people faced in the Mediterranean area had a reduced incidence of cardiovascular and metabolic disease, cancer and age-related diseases. The mechanisms through which the MD exerts its health benefit and prevents the onset of several diseases are not completely clarified because of various and complex aspects. Several studies suggest that the claimed benefits of the MD dietary pattern is mainly linked to decreased inflammation and oxidative stress, strongly related to each other and involved in many chronic diseases. The high content of compounds with antioxidant and anti-inflammatory activity present in most foods of the MD pattern has been considered effective for the improvement of many functions and parameters, therefore useful for the maintenance of the health status and the prevention of many chronic diseases. However, the extensive metabolism to which antioxidant compounds are subjected, once ingested with foods,  reduces their antioxidant activity within the systemic circulation and tissues and their concentrations are very low in comparison with endogenous antioxidants. Foods produced for human nutrition have significant consequences for both the environment and the health of a specific population, and, in turn, the environment may address food choices and affect eating habit. The MD is a sustainable diet model that presents a very low environmental footprint, promotes the bio-diversity and protects human health and well-being. However, we must not ignore the planet changes and global environmental aspects that might convert the MD into a theoretical eating model far away from that described by Keys.

Article Details

How to Cite
TOZZI CIANCARELLI, Maria Giuliana et al. Mediterranean Diet and Health Promotion: evidence and current concerns. Medical Research Archives, [S.l.], v. 5, n. 7, july 2017. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/1385>. Date accessed: 24 dec. 2024.
Keywords
Mediterranean diet, health promotion, inflammation, oxidative stress, environmental pollutants
Section
Review Articles

References

Alsaffar AA. Sustainable diets: The interaction between food industry, nutrition, health and
the environment. Food Sci Technol Int. 2016;22(2):102-111.

Andersen LF, Jacobs DR Jr, Carlsen MH, Blomhoff R. Consumption of coffee is associated with
reduced risk of death attributed to inflammatory and cardiovascular diseases in the Iowa Women’s Health Study. Am J Clin Nutr. 2006;83(5):1039-1046.

Anter E, Thomas SR, Schulz E, Shapira OM, Vita JA, Keaney JF Jr. Activation of endothelial nitric-oxide synthase by the p38 MAPK in response to black tea polyphenols. J Biol Chem. 2004;279(45):46637-46643.

Aparicio-Soto M, Sánchez-Hidalgo M, Rosillo MÁ, Castejón ML, Alarcón-de-la-Lastra C. Extra virgin olive oil: a key functional food for prevention of immune-inflammatory diseases. Food Funct. 2016;7(11): 4492-4505.

Asif M, Rooney LW, Ali R, Riaz MN. Application and opportunities of pulses in food system: a review. Crit Rev Food Sci Nutr. 2013;53(11):1168-1179.

Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, Medina FX, Battino M, Belahsen R, Miranda G, Serra-Majem L; Mediterranean Diet Foundation Expert Group. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274-2284.

Baroni L, Cenci L, Tettamanti M, Berati M. Evaluating the environmental impact of various dietary patterns combined with different food production systems. Eur J Clin Nutr. 2007;61(2):279-286.

Belahsen R. Nutrition transition and food sustainability. Proc Nutr Soc. 2014;73(3):385-388.

Bower A, Marquez S, de Mejia EG. The Health Benefits of Selected Culinary Herbs and Spices Found in the Traditional Mediterranean Diet. Crit Rev Food Sci Nutr. 2016;56(16):2728-2746.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea–a review. J Am Coll Nutr. 2006;25(2):79-99.

Calcabrini C, De Bellis R, Mancini U, Cucchiarini L, Stocchi V, Potenza L. Protective Effect of Juglans regia L. Walnut Extract Against Oxidative DNA Damage. Plant Foods Hum Nutr. 2017; doi: 10.1007/s11130-017-0609-2.
Caretto A, Lagattolla V. Non-communicable diseases and adherence to Mediterranean diet. Endocr Metab Immune Disord Drug Targets. 2015;15(1):10-7.

Carlsen MH, Halvorsen BL, Holte K, Bøhn SK, Dragland S, Sampson L, Willey C, Senoo H, Umezono Y, Sanada C, Barikmo I, Berhe N, Willett WC, Phillips KM, Jacobs DR Jr, Blomhoff R. The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide. Nutr J. 2010;9:3.

Castellani GC, Menichetti G, Garagnani P, Giulia Bacalini M, Pirazzini C, Franceschi C, Collino S, et al. Systems medicine of inflammaging. Brief Bioinform. 2016;17(3):527-540.

Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, Stampfer MJ, Willett WC Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012;142(6):1009-1018.

Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol. 2004;44(1):152-158.

Ciancarelli I, Di Massimo C, De Amicis D, Pistarini C, Tozzi Ciancarelli MG. Uric Acid and Cu/Zn superoxide dismutase: potential strategies and biomarkers in functional recovery of post-acute ischemic stroke patients after intensive neurorehabilitation. Curr Neurovasc Res. 2015;12(2):120-127.
Ciancarelli I, De Amicis D, Di Massimo C, Pistarini C, Tozzi Ciancarelli MG. Mean Platelet Volume During Ischemic Stroke is a Potential Pro-inflammatory Biomarker in the Acute Phase and During Neurorehabilitation Not Directly Linked to Clinical Outcome. Curr Neurovasc Res. 2016;13(3):177-183.

Colomer R, Menéndez JA. Mediterranean diet, olive oil and cancer. Clin Transl Oncol. 2006;8(1):15-21.
Cordova AC, Jackson LS, Berke-Schlessel DW, Sumpio BE. The cardiovascular protective effect of red wine. J Am Coll Surg. 2005;200(3):428-439.

Dai J, Jones DP, Goldberg J, Ziegler TR, Bostick RM, Wilson PW, Manatunga AK, Shallenberger L, Jones L, Vaccarino V. Association between adherence to the Mediterranean diet and oxidative stress. Am J Clin Nutr. 2008;88(5):1364-1370.

D’Archivio M, Filesi C, Di Benedetto R, Gargiulo R, Giovannini C, Masella R. Polyphenols, dietary sources and bioavailability. Ann Ist Super Sanità. 2007;43(4):348-361.

Davinelli S, Scapagnini G. Polyphenols: a promising nutritional approach to prevent or reduce the progression of prehypertension. High Blood Press Cardiovasc Prev. 2016;23(3):197-202.
Davis CR, Hodgson JM, Woodman R, Bryan J, Wilson C, Murphy KJ. A Mediterranean diet lowers blood pressure and improves endothelial function: results from the MedLey randomized intervention trial. Am J Clin Nutr. 2017;doi:10.3945/ajcn.116.146803.

De Boer J, Hoogland CT, Boersema JJ. Towards more sustainable food choices: value priorities and motivational orientations. Food Qual Prefer. 2007;18:985-996.

De Lange DW, van Golde PH, Scholman WLG, Kraaijenhagen RJ, Akkerman JWN, van de Wiel A. Red wine and red wine polyphenolic compounds but not alcohol inhibit ADP-induced platelet aggregation. Eur J Intern Med. 2003;14(6):361-366.

De Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779-785.

Del Rio D, Costa LG, Lean ME, Crozier A. Polyphenols and health: what compounds are involved? Nutr Metab Cardiovasc Dis. 2010;20(1):1-6.

Dernini S, Berry EM. Mediterranean diet: from a healthy diet to a sustainable dietary pattern. Front Nutr. 2015;2:15.

Di Massimo C, Scarpelli P, Di Lorenzo N, Caimi G, di Orio F, Tozzi Ciancarelli MG. Impaired plasma nitric oxide availability and extracellular superoxide dismutase activity in healthy humans with advancing age. Life Sci. 2006;78(11):1163-1167.

Donini LM, Dernini S, Lairon D, Serra-Majem L, Amiot MJ, Del Balzo V, Giusti AM, Burlingame B, Belahsen R, Maiani G, Polito A, Turrini A, Intorre F, Trichopoulou A, Berry EM. A Consensus Proposal for Nutritional Indicators to Assess the Sustainability of a Healthy Diet: The Mediterranean Diet as a Case Study. Front Nutr. 2016;3:37.

Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440-1446.

Fazel-Tabar Malekshah A, Zaroudi M, Etemadi A, Islami F, Sepanlou S, Sharafkhah M, Keshtkar AA, Khademi H, Poustchi H, Hekmatdoost A, Pourshams A, Feiz-Sani A, Jafari E, Kamangar F, Dawsey SM, Abnet CC, Pharoah PD, Berennan PJ, Boffetta P, Esmaillzadeh A, Malekzadeh R. The combined effects of healthy lifestyle behaviors on all-cause mortality: The Golestan cohort study. Arch Iran Med. 2016;19(11):752-761.

Fitó M, Guxens M, Corella D, Sáez G, Estruch R, de la Torre R, Francés F,Cabezas C, López-Sabater Mdel C, Marrugat J, García-Arellano A, Arós F,Ruiz-Gutierrez V, Ros E, Salas-Salvadó J, Fiol M, Solá R, Covas MI; PREDIMED Study Investigators. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med. 2007;167(11):1195-1203.

Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC, Hu FB. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr. 2001;73(1):61-67.

Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093-1100.

Fuster V, Kelly BB. Promoting cardiovascular health in the developing world: a critical challenge to achieve global health. Washington, DC; National Academies Press(US); 2010.

Garnett T, Appleby MC, Balmford A, Bateman IJ, Benton TG, Bloomer P, et al. Agriculture. Sustainable intensification in agriculture: premises and policies. Science. 2013;341(6141):33-34.

Gayathri R, Ruchi V, Mohan V. Impact of nutrition transition and resulting morbidities on economic and human development. Curr Diabetes Rev. 2016;Aug 31.

Goldberg DM, Yan J, Soleas GJ. Absorption of three wine-related polyphenols in three different matrices by healthy subjects. Clin Biochem. 2003;36(1):79-87.

Gostin LO, Abou-Taleb H, Roache SA, Alwan A. Legal priorities for prevention of non-communicable diseases: innovations from WHO's Eastern Mediterranean region. Public Health. 2017;144:4-12.

Gresele P, Pignatelli P, Guglielmini G, Carnevale R, Mezzasoma AM, Ghiselli A, Momi S, Violi F. Resveratrol, at concentrations attainable with moderate wine consumption, stimulates human platelet nitric oxide production. J Nutr. 2008;138(9):1602-1608.

Halliwell B, Gutteridge JMC. Free Radicals in Biology and Medicine. Oxford University Press, London, UK, 3rd edition,1999.

Harmon BE, Boushey CJ, Shvetsov YB, Ettienne R, Reedy J, Wilkens LR, Le Marchand L, Henderson BE, Kolonel LN. Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project. Am J Clin Nutr. 2015;101(3):587-597.

Hawkes C. Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Globalization and Health. 2006;2:4-21.

Hernáez Á, Castañer O, Goday A, Ros E, Pintó X, Estruch R, Salas-Salvadó J, Corella D, Arós F, Serra-Majem L, Martínez-González MÁ, Fiol M, Lapetra J, de la Torre R, López-Sabater MC, Fitó
M. The Mediterranean Diet decreases LDL atherogenicity in high cardiovascular risk individuals: a randomized controlled trial. Mol Nutr Food Res. 2017;doi: 10.1002/mnfr.201601015.

Hollman PC, Cassidy A, Comte B, Heinonen M, Richelle M, Richling E, Serafini M, Scalbert A, Sies H, Vidry S. The biological relevance of direct antioxidant effects of polyphenols for cardiovascular health in humans is not established. J Nutr. 2011;141(5):989S–1009S.

Horgan GW, Perrin A, Whybrow S, Macdiarmid JI. Achieving dietary recommendations and reducing greenhouse gas emissions: modelling diets to minimise the change from current intakes.
Int J Behav Nutr Phys Act. 2016;13:46.

Huang WY, Davidge ST, Wu J. Bioactive natural constituents from food sources-potential use in hypertension prevention and treatment. Crit Rev Food Sci Nutr. 2013;53(6):615-630.

International Food Information Council. Functional foods.
http://www.foodinsight.org/Content/3842/Final%20Functional%20 Foods%20Backgrounder.pdf. Published July 2011. Accessed October 24, 2012.

Iqbal, R, Anand S, Ounpuu S, Islam S, Zhang X, Rangarajan S, Chifamba J, Al-Hinai A, Keltai M, Yusuf S. Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation. 2008;118(19):1929-1937.

Iriti M, Vitalini S. Health-promoting effects of traditional Mediterranean Diets – A review. Pol J Food Nutr Sci. 2012;62(2):71-76.

Islam Eu, Yang XE, He ZL, Mahmood Q. Assessing potential dietary toxicity of heavy metals in selected vegetables and food crops. J Zhejiang Univ Sci B. 2007;8(1):1-13.

Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr. 2001;73(1):1-2.

Kakkoura MG, Sokratous K, Demetriou CA, Loizidou MA, Loucaides G, Kakouri E, Hadjisavvas A, Kyriacou K. Mediterranean diet–gene interactions: A targeted metabolomics study in Greek-Cypriot women. Mol Nutr Food Res. 2017;61(4). doi: 10.1002/mnfr.201600558.

Katz DL , Meller S. Can we say what diet is best for health? Annu Rev Public Health. 2014;35:83-103.

Keys A, Menotti A, Karvonen MJ, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Keys MH, et al. The diet and 15-year death rate in the seven countries study. Am J Epidemiol. 1986;124(6):903-915.

Khaw KT, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined impact of health behaviours and mortality in men and women: the EPIC–Norfolk prospective population study. PLoS Med. 2008;5(3):e70.

Knight A, Bryan J, Murphy K. Is the Mediterranean diet a feasible approach to preserving cognitive function and reducing risk of dementia for older adults in Western countries? New insights and future directions. Ageing Res Rev. 2016;25:85-101.

Knoops KT, de Groot, LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, van Staveren WA. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292(12):1433-1439.

Koloverou E, Panagiotakos DB, Pitsavos C, Chrysohoou C, Georgousopoulou EN, Grekas A, Christou A, Chatzigeorgiou M, Skoumas I, Tousoulis D, Stefanadis C; ATTICA Study Group.
Adherence to Mediterranean diet and 10-year incidence (2002-2012) of diabetes: correlations with inflammatory and oxidative stress biomarkers in the ATTICA cohort study. Diabetes Metab Res Rev. 2016;32(1):73-81.

Kones R. Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention. Ther Adv Cardiovasc Dis. 2011;5(1):61-81.

Korre M, Tsoukas MA , Frantzeskou E, Yang J, Kales SN. Mediterranean Diet and Workplace Health Promotion. Curr Cardiovasc Risk Rep. 2014;8(12):416.

Lacoppidan SA, Kyrø C, Loft S, Helnæs A, Christensen J, Hansen CP, Dahm CC, Overvad K, Tjønneland A, Olsen A. Adherence to a Healthy Nordic Food Index Is Associated with a Lower Risk of Type-2 Diabetes--The Danish Diet, Cancer and Health Cohort Study. Nutrients. 2015;7(10):8633-8644.

Lairon D. Intervention studies on Mediterranean diet and cardiovascular risk. Mol Nutr Food Res. 2007;51(10):1209-1214.

Leclercq C, Arcella D, Piccinelli R, Sette S, Le Donne C, Turrini A; INRAN-SCAI 2005-06 Study Group. The Italian National Food Consumption Survey INRAN-SCAI 2005-06: main results in
terms of food consumption. Public Health Nutr. 2009;12(12):2504-2532.

Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):480-486.

Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586-613.

Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta–analysis. Prev Med. 2012;55(3):163-170.

Malik A, Mukhtar H. Prostate cancer prevention through pomegranate fruit. Cell Cycle. 2006;5(4):371-373.

Mangge H, Becker K, Fuchs D, Gostner JM. Antioxidants, inflammation and cardiovascular disease. World J Cardiol. 2014;6(6):462-477.

Martínez-González MÁ, Ruiz-Canela M, Hruby A, Liang L, Trichopoulou A, Hu FB. Intervention Trials with the Mediterranean Diet in Cardiovascular Prevention: Understanding Potential Mechanisms through Metabolomic Profiling. J Nutr. 2016;pii: jn219147.

McKay DL, Chen CY, Yeum KJ, Matthan NR, Lichtenstein AH, Blumberg JB. Chronic and acute effects of walnuts on antioxidant capacity and nutritional status in humans: a randomized, cross-over pilot study. Nutr J. 2010;9:21.

Medina-Remón A, Casas R, Tressserra-Rimbau A, Ros E, Martínez-González MA, Fitó M, Corella D, Salas-Salvadó J, Lamuela-Raventos RM, Estruch R; PREDIMED Study Investigators. Polyphenol intake from a Mediterranean diet decreases inflammatory biomarkers related to atherosclerosis: a substudy of the PREDIMED trial. Br J Clin Pharmacol. 2017;83(1):114-128.

Mehio Sibai A, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N. Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab. 2010;57(3-4):193-203.

Menotti A, Alberti-Fidanza A, Fidanza F, Lanti M, Fruttini D. Factor analysis in the identification of dietary patterns and their predictive role in morbid and fatal events. Public Health Nutr. 2012;15(7):1232-1239.

Mertens E, Markey O, Geleijnse JM, Lovegrove JA, Givens DI. Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study. Eur J Nutr. 2017;doi:10.1007/s00394-017-1408-0.

Miranda AM, Steluti J, Fisberg RM, Marchioni DM. Dietary intake and food contributors of polyphenols in adults and elderly adults of Sao Paulo: a population-based study. Br J Nutr. 2016;115(6):1061-1070.
Niebylski ML, Redburn KA, Duhaney T, Campbell NR. Healthy food subsidies and unhealthy food taxation: A systematic review of the evidence. Nutrition. 2015;31(6):787-795.

Noah A, Truswell AS. There are many Mediterranean diets. Asia Pac J Clin Nutr. 2001;10(1):2-9.

Oliviero F, Spinella P, Fiocco U, Ramonda R, Sfriso P, Punzi L. How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis. Swiss Med Wkly. 2015;145:w14190.

Ortega RM. Importance of functional foods in the Mediterranean diet. Public Health Nutrition. 2006;9(8A):1136-1140.

Owolabi M, Miranda JJ, Yaria J, Ovbiagele B. Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism. BMJ Glob Health. 2016;1(3). pii: e000105.

Panagiotakos DB, Pitsavos C, Polychronopoulos E, Chrysohoou C, Zampelas A,Trichopoulou A. Can a Mediterranean diet moderate the development and clinical progression of coronary heart disease? A systematic review. Med Sci Monit. 2004;10:RA193-198.

Panagiotakos DB, Chrysohoou C, Siasos G, Zisimos K, Skoumas J, Pitsavos C, Stefanadis C. Sociodemographic and lifestyle statistics of oldest old people (>80 years) living in ikaria island: the ikaria study. Cardiol Res Pract. 2011;doi:10.4061/2011/679187.

Pellegrini N, Serafini M, Colombi B, Del Rio D, Salvatore S, Bianchi M, Brighenti F. Total antioxidant capacity of plant foods, beverages and oils consumed in Italy assessed by three different in vitro assays. J Nutr. 2003;133(9):2812-2819.

Pellegrini N, Serafini M, Salvatore S, Del Rio D, Bianchi M, Brighenti F. Total antioxidant capacity of spices, dried fruits, nuts, pulses, cereals and sweets consumed in Italy assessed by three different in vitro assays. Mol Nutr Food Res. 2006;50(11):1030-1038.

Preedy VR, Watson RR, eds. The Mediterranean Diet: An Evidence-Based Approach. Academic Press; 2015.

Psaltopoulou T, Kyrozis A, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A. Diet, physical activity and cognitive impairment among elders: the EPIC-Greece cohort (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr. 2008;11 (10):1054-1062.

Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: a meta-analysis. Ann Neurol. 2013;74(4):580-591.
Reedy J, Krebs-Smith SM, Miller PE, Liese AD, Kahle LL, Park Y, Subar AF. Higher diet quality is associated with decreased risk of all cause, cardiovascular disease, and cancer mortality among older adults. J Nutr. 2014;144(6):881-889.

Renaud S, de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet. 1992;339(8808):1523-1526.

Ros E, Nunez I, Perez-Heras A, Serra M, Gilabert R, Casals E, Deulofeu R. A walnut diet improves endothelial function in hypercholesterolemic subjects: a randomized crossover trial. Circulation. 2004;109(13):1609-1614.

Sacks FM, Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N. A dietary approach to prevent hypertension: a review of the Dietary Approaches to Stop Hypertension (DASH) Study. Clin Cardiol. 1999;22(7Suppl):III6-10.

Sáez-Almendros S, Obrador B, Bach-Faig A, Serra-Majem L. Environmental footprints of Mediterranean versus Western dietary patterns: beyond the health benefits of the Mediterranean diet. Environ Health. 2013;12:118.

Schulze MB, Hu FB. Dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease. Curr Atheroscler Rep 2002;4(6):462-467.

Schwingshackl L, Hoffmann G. Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension Score, and health outcomes: a systematic review and meta-analysis of cohort studies. J Acad Nutri Diet. 2015;115(5):780-800.

Sette S, Le Donne C, Piccinelli R, Arcella D, Turrini A, Leclercq C; INRAN-SCAI 2005-06 Study Group. The third Italian National Food Consumption Survey, INRAN-SCAI 2005-06--part 1:
nutrient intakes in Italy. Nutr Metab Cardiovasc Dis. 2011;21(12):922-932.

Sies H. Polyphenols and health: update and perspectives. Arch Biochem Biophys 2010;501(1):2-5.

Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344.

Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr. 2014;17(12):2769-2782.

Starr ME, Evers BM, Saito H. Age-associated increase in cytokine production during systemic inflammation: adipose tissue as a major source of IL-6. J Gerontol A Biol Sci Med Sci. 2009;64(7):723-730.

Tapiero H, Tew KD, Ba GN, Mathé G. Polyphenols: do they play a role in the prevention of human pathologies? Biomed Pharmacother. 2002;56(4):200-207.

Tarascou I , Souquet JM , Mazauric JP , Carrillo S, Coq S, Canon F, Fulcrand H, Cheynier V. The hidden face of food phenolic composition. Archi Biochem Biophys 2010;501(1):16-22.

Tozzi Ciancarelli MG, Di Massimo C, De Amicis D, Ciancarelli I, Carolei A. Moderate consumption of red wine and human platelet responsiveness. Thromb Res 2011;128(2):124-129.

Traill WB, Mazzocchi M, Shankar B, Hallam D. Importance of government policies and other influences in transforming global diets. Nutr Rev. 2014;72(9):591-604.

Tsang C, Higgins S, Duthie GG, Duthie SJ, Howie M, Mullen W, Lean EJ, Crozier A. The influence of moderate red wine consumption on antioxidant status and indices of oxidative stress associated with CHD in healthy volunteers. Br J Nutr. 2005;93(2):233-240.

Vallverdú-Queralt A, Regueiro J, Martínez-Huélamo M, Rinaldi AlvarengaJF, Leal LN, Lamuela-Raventos RM. A comprehensive study on the phenolic profile of widely used culinary herbs and spices: rosemary, thyme, oregano, cinnamon, cumin and bay. Food Chem. 2014;154:299-307.

van Dam RM, Li T, Spiegelman D, Franco OH, Hu FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ. 2008;337:a1440.

Vareiro D, Bach-Faig A, Raido´ Quintana B, Bertomeu I, Buckland G, Vaz de Almeida MD, Serra-Majem L. Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas. Public Health Nutr. 2009;12(9A):1667-1675.

Vázquez-Fresno R, Llorach R, Urpi-Sarda M, Lupianez-Barbero A, Estruch M, Corella D, Fitó M, Arós F, Ruiz-Canela M, Salas-Salvadó J, Andres-Lacueva C. Metabolomic pattern analysis after mediterranean diet intervention in a nondiabetic population: a 1- and 3‑year follow-up in the PREDIMED study. J Proteome Res. 2015;14(1):531-540.

Vogel RA, Corretti MC, Plotnick GD. The postprandial effect of components of the Mediterranean diet on endothelial function. J Am Coll Cardiol. 2000;36(5):1455-1460.
Watson D, Lorenz U, St. Hansen M, Szlezak J, Zoboli R, Kuhndt M, et al. European Environment Agency (EEA); towards a Set of Indicators on Sustainable Consumption and Production (scp) for EEA Reporting. European Topic Centre on Sustainable Consumption and Production (ETC/SCP) Working Paper 1/2010. Copenhagen 2010.

World Cancer Research Fund/American Institute for Cancer Research: Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective American Institute of Cancer Research, Washington DC 2007.

World Heart Organization Study Group. Diet, Nutrition and the Prevention of Chronic Diseases. Geneva, Switzerland: World heart Organization, Technical Report Series, 797, 1990.

World Health Organization. Diet, nutrition and the prevention of chronic diseases. WHO Tech Rep Ser. 2003;1-60.

World Health Organization. Global status report on non-communicable diseases 2010. Geneva: World Health Organization;2011.

World Health Organization. Global Action Plan for the Prevention and Control of non-communicable diseases 2013-2020. Geneva,2014.

Wirt A, Collins CE. Diet quality-what is it and does it matter? Public Health Nutr. 2009;12(12):2473-2492.

Yousaf B, Amina, Liu G, Wang R, Imtiaz M, Rizwan MS, Zia-Ur-Rehman M, Qadir A, Si Y. The importance of evaluating metal exposure and predicting human health risks in urban-periurban environments influenced by emerging industry. Chemosphere. 2016;150:79-89.