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Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: 15 December 2024 | Viewed by 28033

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Special Issue Editors

Prof. Dr. Yeganeh Manon Khazrai

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Guest Editor

Research Unit of Food Science and Human Nutrition, Department of Science and Technology for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, Rome, Italy
Interests: nutrition; obesity; metabolism; person-centred counselling; motivational interviewing

Dr. Claudia Di Rosa

E-Mail Website
Co-Guest Editor

Special Issue Information

Dear Colleagues,

The Mediterranean diet is considered one of the healthiest dietary patterns worldwide to such an extent that in 2010, UNESCO recognized it as an “intangible cultural heritage of humanity”. Studies have shown that its ingredients based on plant foods, such as fruits, vegetables, unrefined cereals, legumes, olive oil, seeds, and small amounts of fish, cheese and poultry are beneficial in lowering the risk of cardiovascular disease and in preventing many other chronic pathological and non-communicable conditions such as obesity, type 2 diabetes mellitus, hypertension, metabolic syndrome, and certain types of cancer.

Plant-based diets have recently become very popular too, both for ethical and health reasons. These types of diets can include the consumption of high glycaemic index foods (e.g. rice, potatoes, bread, pasta), which increase glycemia and induce a vicious cycle leading to overeating.

The “planetary health diet” has been supported by the EAT-Lancet Commission as sustainable and able to feed the planet and reduce malnutrition. In this nutritional pattern, the main food should comprise fruits, vegetables, nuts, and legumes, with a reduced weekly amount of animal products (e.g., no more than 98 g of red meat, 203 g of poultry and 196 g of fish per person per week).

These diets all tend to decrease the intake of red and processed meats and animal fats. However, how low in fat should a healthy diet be? Are all fats equally bad for cardiovascular health and all other chronic conditions?

For this Special Issue, we welcome the submission of studies that evaluate the outcomes of diets in children and adults of all ages, as well as literature reviews.

Prof. Dr. Yeganeh Manon Khazrai
Dr. Claudia Di Rosa
Guest Editors

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Keywords

Mediterranean diet
nutrition education
plant-based diets
low fat diet
planetary diet

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Published Papers (9 papers)

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Research

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14 pages, 292 KiB

Open AccessArticle

Mediterranean Diet in Older Irish Adults: Prevalence, Patterns, Predictors and Pertinence

by Catherine Norton, Elaine Clarke, Pablo J. Marcos-Pardo and Audrey Tierney

Nutrients 2024, 16(16), 2615; https://doi.org/10.3390/nu16162615 - 8 Aug 2024

Viewed by 1089

Abstract

The Mediterranean diet (MD) shows the strongest evidence in support of healthy aging and prevention of age-related diseases. It is associated with a decreased risk of chronic disease, such as cardiovascular disease, obesity, hypertension, diabetes mellitus and cognitive disease. Given the health-promoting aspects of this diet, we conducted a secondary analysis of data from the LifeAge study (“Promoting the shift: sedentary Lifestyle towards active Ageing-LifeAge” Project No 603121-EPP-1-2018-1-ES-SPO-SCP) with the primary aim to determine the proportion of older Irish adults adhering to the MD and to examine the association between adherence to the MD (assessed using the Mediterranean Diet Adherence Screener (MEDAS) scoring tool) and anthropometric risk factors of non-communicable diseases. Of the 131 eligible participants (71.8% female, n = 94) (medically well, aged > 50 years and physically independent) (mean age = 66.2 ± 6.5 years), the mean cumulative MD score across the cohort was 5.8 ± 2.2, with 41% classified as moderate-to-high MD adherers (scoring > 7 MEDAS). Females had a significantly higher score compared to males (female 6.24 ± 1.98; male 4.86 ± 2.53; p = 0.002). Age (y), waist circumference (cm) and waist–hip ratio (WHR) each had a significant (p < 0.05) weak and negative correlation with MD score (r = −0.193, −0.240, −0.284, respectively). Visceral fat level had a significant (p < 0.05) moderate and negative correlation with MD score (r = −0.327). This analysis is the first to assess adherence to the MD in older Irish adults. MD adherence was lower in the Irish older cohort than that reported in older adults in Mediterranean regions and was adhered to more by females and those with a more favourable anthropometric profile. The health-promoting aspects of the diet are evident in non-Mediterranean regions as is demonstrated by the lesser incidence of some non-communicable diseases in moderate-to-high adherers. With the evidence of the protective effects of the MD, external to Mediterranean regions, it would be helpful to establish limitations to adherence, especially in aging populations living in non-Mediterranean regions. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

25 pages, 1378 KiB

Open AccessArticle

Drivers and Barriers Influencing Adherence to the Mediterranean Diet: A Comparative Study across Five Countries

by Chiara Biggi, Beatrice Biasini, Nives Ogrinc, Lidija Strojnik, Isabella Endrizzi, Leonardo Menghi, Ikram Khémiri, Amani Mankai, Fethi Ben Slama, Henda Jamoussi, Katerina Riviou, Kaoutar Elfazazi, Nayyer Rehman, Francesca Scazzina and Davide Menozzi

Nutrients 2024, 16(15), 2405; https://doi.org/10.3390/nu16152405 - 25 Jul 2024

Viewed by 1229

Abstract

Given the global decline in adherence to the Mediterranean Diet (MD), even within its native region, it is key to identify the factors influencing this trend to mitigate the negative health outcomes associated with westernized diets. To this end, 4025 individuals (49.6% women, 42.6 ± 14.2 y/o) from Greece, Italy, Morocco, Slovenia, and Tunisia remotely completed a series of measures assessing motives, attitudes, and psychosocial factors related to MD adherence, which was evaluated using the MEDAS questionnaire. The results suggested medium-to-low adherence across all countries, with the highest adherence in Italy and Morocco and the lowest in Slovenia. Structural equation modeling revealed that positive attitudes toward the healthiness of food were the strongest predictors of adherence, whereas picky eating was a significant negative predictor in all countries except Greece. Adherence to the MD was positively influenced by health motivations in Morocco and weight control in Slovenia and Greece, while sensory appeal negatively influenced adherence in Italy. Additionally, price and convenience were significant barriers in Tunisia and Greece, whereas a preference for local and seasonal foods promoted adherence in Morocco and Greece. Overall, our findings underscore the need for country-specific interventions and policies that address distinct local factors and motivations to ease favorable shifts in dietary patterns toward MD principles. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

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15 pages, 1076 KiB

Open AccessArticle

Low-Protein Diets Could Be Effective and Safe in Elderly Patients with Advanced Diabetic Kidney Disease

by Liliana Garneata, Carmen-Antonia Mocanu and Gabriel Mircescu

Nutrients 2024, 16(14), 2230; https://doi.org/10.3390/nu16142230 - 11 Jul 2024

Viewed by 1106

Abstract

Low-protein diets (LPDs) seem to improve metabolic complications of advanced CKD, thus postponing kidney replacement therapy (KRT) initiation. However, the nutritional safety of LPDs remains debatable in patients with diabetic kidney disease (DKD), especially in the elderly. This is a sub-analysis of a prospective unicentric interventional study which assessed the effects of LPD in patients with advanced DKD, focusing on the feasibility and safety of LPD in elderly patients. Ninety-two patients with DKD and stable CKD stage 4+, proteinuria >3 g/g creatininuria, good nutritional status, with confirmed compliance to protein restriction, were enrolled and received LPD (0.6 g mixed proteins/kg-day) supplemented with ketoanalogues of essential amino acids for 12 months. Of the total group, 42% were elderly with a median eGFR 12.6 mL/min and a median proteinuria 5.14 g/g creatininuria. In elderly patients, proteinuria decreased by 70% compared to baseline. The rate of kidney function decline was 0.1 versus 0.5 mL/min-month before enrolment. Vascular events occurred in 15% of cases, not related to nutritional intervention, but to the severity of CKD and higher MAP. LPDs seem to be safe and effective in postponing KRT in elderly patients with advanced DKD while preserving the nutritional status. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

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10 pages, 281 KiB

Open AccessArticle

Health Literacy and Its Association with the Adoption of the Mediterranean Diet: A Cross-Sectional Study

by Ana Duarte, Juliana Martins, Cristiana Lopes, Maria José Silva, Cláudia Augusto, Silvana Peixoto Martins and Rafaela Rosário

Nutrients 2024, 16(14), 2176; https://doi.org/10.3390/nu16142176 - 9 Jul 2024

Viewed by 883

Abstract

Health literacy (HL) is a crucial factor influencing health-related decisions, including dietary patterns. The Mediterranean diet is widely recognized as one of the healthiest eating patterns. This study aims to explore the association between HL levels among adults in socially vulnerable contexts and their adoption of the Mediterranean diet. Conducted as part of a cluster-randomized trial in primary schools, the research involved 557 parents of children aged 6 to 10 who consented to participate. HL was assessed using the HLS questionnaire, while adoption of the Mediterranean diet was evaluated using the MEDAS questionnaire. Participants also provided anthropometric and sociodemographic data via a questionnaire, from which BMI was calculated (weight/height²). Education level was categorized as higher education or lower and professional status was classified based on occupational categories. Generalized linear models and logistic regression were employed for analysis. The findings indicate a direct association between HL level and adoption of the Mediterranean diet (B = 0.022, 95% CI 0.010–0.035, p < 0.001), underscoring the influence of HL on dietary choices. Specifically, the healthcare dimension of HL emerges as pivotal in shaping dietary behaviors, particularly towards the Mediterranean diet. These results underscore the importance of policies and programs aimed at enhancing HL, especially among socially vulnerable populations. Prioritizing public health interventions to improve HL is critical for promoting better dietary decision-making. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

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17 pages, 337 KiB

Open AccessArticle

Predictors of Eating Less Meat and More Plant-Based Food in the Polish Sample

by Marzena Jeżewska-Zychowicz, Marta Sajdakowska, Jerzy Gębski, Małgorzata Kosicka-Gębska and Krystyna Gutkowska

Nutrients 2024, 16(11), 1646; https://doi.org/10.3390/nu16111646 - 27 May 2024

Viewed by 815

Abstract

The study aimed to identify predictors of the intention to eat less meat and more plant-based foods, including attitudes towards eating meat, habitual meat eating, subjective norms, and self-identity. A cross-sectional study using CAWI (Computer-Assisted Web Interview) was conducted in a group of 1003 Polish adults in 2023. To measure the predictor variables, the following tools were used: Beliefs and Eating Habits Questionnaire (KomPAN), Meat Attachment Questionnaire (MAQ), and scales to measure subjective norms and self-identity. Logistic regression analysis was used to verify associations between independent variables, and the intentions to eat more plant-based food and less meat next year were treated as dependent variables. More respondents were willing to increase their consumption of plant-based foods rather than reduce their meat consumption. The intention to consume less meat and more plant foods was more prevalent among women, older people (only intention to reduce meat consumption), and better-educated people (only intention to increase plant food consumption). Habitual frequency of eating plant foods, negative feelings about meat, and environmentally oriented identities had a stimulating effect on the intention to eat more plant foods and less meat, while experiencing pleasure in eating meat had a limiting effect on the intention to eat more plant foods and less meat. In addition, the habitual frequency of meat consumption and subjective norms reduced the likelihood of eating less meat, while no predictive effect was observed for the intention to eat more plant foods. In conclusion, educational and promotional activities to raise awareness of the link between food consumption and the environment can have a strong impact on eating less meat and more plant-based food, even among those strongly accustomed to meat consumption. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

13 pages, 506 KiB

Open AccessArticle

A Plant-Based Cholesterol-Lowering Diet Score Correlates with Serum LDL-Cholesterol Levels

by Jerry Polesel, Matteo Di Maso, Giovanna Esposito, Sara Vitale, Elvira Palumbo, Giuseppe Porciello, Ilaria Calabrese, Anita Minopoli, Bruna Grilli, Ernesta Cavalcanti, Diego Serraino, Egidio Celentano, David J. A. Jenkins and Livia S. A. Augustin

Nutrients 2024, 16(4), 495; https://doi.org/10.3390/nu16040495 - 8 Feb 2024

Cited by 1 | Viewed by 2587

Abstract

Background: A cholesterol-lowering diet score was previously developed for epidemiological studies; its association with serum lipid profile was not confirmed yet. Methods: The score was developed as an adaptation of the dietary portfolio for cholesterol reduction, assigning one point for adherence to seven dietary indicators and ranging from 0 (null adherence) to 7 (highest adherence). The score was calculated for breast cancer patients enrolled in the DEDiCa study using a 7-day food record; serum lipid profile, including total and low-density lipoprotein cholesterol (LDL-C), was evaluated in serum at baseline. Results: Patients with the highest adherence to the cholesterol-lowering diet (i.e., score ≥ 4) reported lower LDL-C level than women with score 0–1 (median: 107 mg/dL and 122 mg/dL, respectively; p < 0.01). The proportion of women with LDL-C above the recommended limit of 116 mg/dL was 60.0% with score 0–1 and 42.6% with score ≥4. Although the score directly correlates with consumption of foods from vegetal sources, it was mildly associated with the healthful plant-based diet index (r-Spearman = 0.51) and the Mediterranean Diet Adherence Screener (r-Spearman = 0.30) Conclusions: These results provide experimental evidence that the cholesterol-lowering diet score is capable of detecting a specific plant-based dietary pattern that affects circulating cholesterol levels. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

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Review

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22 pages, 698 KiB

Open AccessReview

Cardiovascular Disease and the Mediterranean Diet: Insights into Sex-Specific Responses

by Anushriya Pant, Derek P. Chew, Mamas A. Mamas and Sarah Zaman

Nutrients 2024, 16(4), 570; https://doi.org/10.3390/nu16040570 - 19 Feb 2024

Cited by 4 | Viewed by 2810

Abstract

Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

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15 pages, 366 KiB

Open AccessReview

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability

by Giulia Viroli, Aliki Kalmpourtzidou and Hellas Cena

Nutrients 2023, 15(22), 4723; https://doi.org/10.3390/nu15224723 - 8 Nov 2023

Cited by 10 | Viewed by 11025

Abstract

Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

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21 pages, 756 KiB

Open AccessReview

Effects of Animal and Vegetable Proteins on Gut Microbiota in Subjects with Overweight or Obesity

by Claudia Di Rosa, Ludovica Di Francesco, Chiara Spiezia and Yeganeh Manon Khazrai

Nutrients 2023, 15(12), 2675; https://doi.org/10.3390/nu15122675 - 8 Jun 2023

Cited by 5 | Viewed by 5500

Abstract

The gut microbiota plays a pivotal role in the balance between host health and obesity. The composition of the gut microbiota can be influenced by external factors, among which diet plays a key role. As the source of dietary protein is important to achieve weight loss and gut microbiota modulation, in the literature there is increasing evidence to suggest consuming more plant proteins than animal proteins. In this review, a literature search of clinical trials published until February 2023 was conducted to examine the effect of different macronutrients and dietary patterns on the gut microbiota in subjects with overweight and obesity. Several studies have shown that a higher intake of animal protein, as well as the Western diet, can lead to a decrease in beneficial gut bacteria and an increase in harmful ones typical of obesity. On the other hand, diets rich in plant proteins, such as the Mediterranean diet, lead to a significant increase in anti-inflammatory butyrate-producing bacteria, bacterial diversity and a reduction in pro-inflammatory bacteria. Therefore, since diets rich in fiber, plant protein, and an adequate amount of unsaturated fat may help to beneficially modulate the gut microbiota involved in weight loss, further studies are needed. Full article

(This article belongs to the Special Issue Mediterranean Diet, Plant-Based Diet, Low-Fat Diet and Human Health)

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