Search Results (223)

Background/Objectives: Type 2 diabetes (T2D) is a chronic metabolic disorder closely linked to cardiovascular disease and obesity and notably influenced by lifestyle and dietary patterns. The Mediterranean diet has well-established benefits across multiple cardiometabolic risk factors, including those relevant to diabetes. This study aimed to investigate the degree to which adults with T2D adhere to a Mediterranean dietary pattern and to examine how such adherence relates to glycemic and lipidemic regulation. Methods: This cross-sectional study included 100 adults with T2D (54 men and 46 women). Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Score (MDS). Demographic, anthropometric, lifestyle, and clinical data were collected, and glycemic and lipid parameters were analyzed. Associations between Mediterranean diet adherence and metabolic outcomes were examined using correlation analyses and multivariable regression models adjusted for relevant confounders. Results: Most participants showed low adherence to the Mediterranean diet. A significant inverse association was observed between Mediterranean diet adherence and hemoglobin A1c (HbA1c) levels, with individuals scoring ≤35 on the MDS demonstrating higher HbA1c levels. Similar trends were observed in the lowest tertile of adherence. Notably, each one-point increase in MDS predicted a 0.13% reduction in HbA1c. In multivariable regression analyses, Mediterranean diet adherence remained the strongest predictor of glycemic control, independent of age, body mass index (BMI), sex, smoking status, physical activity and the number of antidiabetic treatments. Higher adherence was also significantly associated with lower low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels, as well as higher high-density lipoprotein cholesterol (HDL) concentrations. Conclusions: Greater adherence to the Mediterranean diet is independently associated with improved glycemic regulation and a more favorable lipid profile in adults with T2D. These findings support the Mediterranean diet as a valuable non-pharmacologic strategy for optimizing metabolic outcomes in people with T2D. Full article

Background/Objectives: Healthy ageing, focused on maintaining daily autonomy and cognitive function despite chronic comorbidities, poses a challenge for public health systems, especially for those aged ≥80, given the expected increase in this population. Promoting a healthy lifestyle in this group is essential to achieving this goal, with primary care services playing a key role in this effort. Therefore, our objective was to profile the participants based on these characteristics. Methods: The study included 222 non-institutionalized, dementia-free individuals (mean age 84.58 ± 3.72 years, 56.3% women) recruited from a primary healthcare service. Data were collected from medical records and interviews, including the cognitive Pfeiffer test, the functional Barthel index (BI), and ad hoc questionnaires (for lifestyle variables). Latent profiling analysis (LPA) was used to classify the participants. Results: The participants reported social support (97.7%), low-risk alcohol consumption (94.6%), adherence to the Mediterranean diet (85.1%), physical activity (74.8%), and never smoking (72.5%). Hypertension (86.5%), cataracts (74.3%), and osteoarticular diseases (68.5%) were the most frequent chronic conditions. Women showed a significantly different distribution of certain variables and a higher number of comorbidities (6.34 ± 2.38) than men (5.58 ± 2.44) (p = 0.019). After LPA, we found that 38.29% of individuals met characteristics compatible with healthy ageing, predominantly male (60%); the association of a high probability of cognitive impairment with a high degree (severe or total), exhibited by the profiles likely >85% women (18.5% of individuals); physical activity, smoking, osteoporosis, anxiety, COPD, chronic kidney disease (CKD), and creatinine blood levels exhibited statistical differences between profiles; and the probability of dependence severity was associated with an increase in age, although cognitive status conservation was associated being male. Conclusions: The studied +80 group seems to follow a healthy lifestyle, as self-reported. Women fare worse than men in resilient ageing. While common factors related to dysfunctionality did not differentiate between profiles, CKD, an increasingly common age-related condition, did. Full article

Chronic low-grade inflammation, or “inflammaging,” represents a central mechanism linking dietary patterns, gut microbiome composition, and biological aging. Evidence from Blue Zone populations and Mediterranean diet studies demonstrates that specific nutritional interventions are associated with up to 23% lower all-cause mortality, with analyses suggesting that part of this association may be mediated by measurable improvements in inflammatory biomarkers. This paper synthesizes published evidence from Mediterranean diet trials, centenarian microbiome studies, and digital health platforms to propose a comprehensive digital health framework that integrates quarterly inflammation and microbiome monitoring with continuous lifestyle tracking to deliver personalized longevity interventions. This paper introduces the Longevity-Inflammation Index (L-II), a composite score combining high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and microbiome-derived markers, with scoring algorithms derived from centenarian population studies. The proposed platform leverages artificial intelligence to generate evidence-based recommendations adapted from centenarian and Mediterranean dietary patterns. Published evidence from multiple randomized controlled trials demonstrates that Mediterranean dietary interventions reduce hs-CRP by 18–32%, increase microbiome diversity by 6–28%, and improve metabolic markers including HOMA-IR and TG/HDL ratios. Digital health platforms demonstrate sustained engagement rates of 58–84% at 12 months, with dietary logging frequencies of 4–6 days per week. Cost-effectiveness analyses of dietary interventions show incremental cost-effectiveness ratios of USD 2100–4800 per quality-adjusted life year gained. This inflammation-centered digital health framework offers a scalable approach for translating longevity research into practical interventions for healthy aging, with validation studies needed to confirm the integrated platform’s efficacy and real-world implementation feasibility. Full article

Background: Insulin resistance (IR) is a key metabolic abnormality underlying type 2 diabetes and cardiometabolic diseases. Although lifestyle and sociodemographic determinants are well described, the role of psychosocial constructs—such as purpose in life—remains insufficiently characterized. No prior study in large occupational samples has examined the associations between purpose in life and IR when evaluated through three complementary indices: the triglyceride–glucose index (TyG), the Single-Point Insulin Sensitivity Estimator for Insulin Resistance (SPISE-IR), and the metabolic score for insulin resistance (METS-IR). Objectives: To analyze the cross-sectional associations between purpose in life and IR indicators in a large working population and determine whether these associations persist after accounting for sociodemographic and lifestyle factors. Methods: A cross-sectional study was conducted among 93,077 Spanish workers aged 20–69 years undergoing routine occupational health examinations. IR was estimated using TyG, SPISE-IR, and METS-IR indices. Purpose in life was assessed using the 10-item Purpose in Life Test and categorized into three groups based on the empirical distribution of scores. Multinomial logistic regression models adjusted for age, sex, social class, smoking, Mediterranean diet adherence, physical activity, and BMI were used to examine associations. Results: Lower purpose in life was consistently associated with higher IR categories across all indices. Compared with individuals reporting high purpose, those with low purpose had higher odds of belonging to the high IR category (TyG ORa 1.59; 95% CI 1.45–1.74; SPISE-IR ORa 1.94; 95% CI 1.76–2.13; METS-IR ORa 2.21; 95% CI 1.98–2.47). Adding purpose in life to sociodemographic and lifestyle models modestly improved discrimination for identifying high IR categories. Conclusions: In this large occupational cohort, purpose in life was independently associated with insulin resistance as measured by three metabolic indices. These findings highlight the relevance of psychosocial factors in metabolic health. Longitudinal studies are needed to clarify temporal pathways and assess whether purpose-oriented approaches may contribute to improved metabolic profiles. Full article

Background/Objectives: The Mediterranean diet (MD) constitutes one of the most broadly studied dietary patterns, which has been linked to the prevention of non-communicable diseases and mental health disorders. University students, a population exposed to significant psychosocial stressors and lifestyle changes, may particularly benefit from healthy eating patterns such as the MD. This study was designed to examine the potential associations of MD adherence with symptoms of depression and anxiety among Greek university students. Methods: A cross-sectional study was initially conducted among 7160 active university students from ten diverse geographic regions in Greece. After the enrollment procedure and the application of relevant exclusion criteria, 5191 university students (52.0% female; mean age: 21.3 ± 2.4 years) constituted the study population. MD adherence was assessed using the KIDMED index, while depressive and anxiety symptoms were evaluated using the Beck Depression Inventory-II (BDI-II) and State–Trait Anxiety Inventory (STAI-6), respectively. Sociodemographic and anthropometric data were collected for all the enrolled university students. All the questionnaires were completed by face-to-face interviews with expert personnel. Results: Students with low adherence to the MD were significantly more likely to report symptoms of depression (OR = 2.12; p ˂ 0.001) and anxiety (OR = 2.27; p ˂ 0.001) and to be overweight or obese (OR = 2.45; p ˂ 0.001) after adjustment for multiple confounding factors. Low MD adherence was also associated with male gender (OR = 0.73; p ˂ 0.01), living alone (OR = 0.78; p ˂ 0.01), smoking (OR = 0.75; p ˂ 0.01), low physical activity (OR = 1.84; p = 0.001), and poorer academic performance (OR = 0.83; p ˂ 0.01). Conclusions: Low adherence to the MD is significantly associated with increased likelihood of depression, anxiety, and excess body weight among university students in Greece. These findings underscore the importance of promoting healthy dietary habits and related lifestyle behaviors in young adult populations as a potential strategy for mental health prevention and intervention. Due to the presence of several limitations in the present study, future longitudinal and interventional studies should be performed to confirm the present findings. Full article

Introduction: “The dog is a man’s best friend” and research has showed that this idea is extended beyond the degree of loyalty. Dog ownership has been linked to several positive health outcomes for the owner. The aim of the present cross-sectional case–control study was to assess differences in the physical activity level (PAL), body composition, quality of life (QoL), and diet quality and dietary knowledge between dog owners and non-owners. Methods: A total of 55 dog owners and an equal amount of non-dog owners (all aged between 18 and 60 years old) formed the case and control groups, respectively. Basic anthropometric measurements were performed, including body fat (BF) and diet, assessed with the Mediterranean Diet Score (MedDietScore) and the Eating Assessment Table (EAT). Physical activity was recorded for 3 consecutive days using activity monitors. QoL was evaluated using the brief version of the World Health Organization QoL (WHOQOL-BREF) tool. Results: The two groups demonstrated a similar PAL, but lower BF% (p = 0.009), hip circumference (p < 0.001), triceps (p = 0.012), and subscapular skinfolds (p = 0.003) were recorded among dog owners. The EAT score was greater among dog owners (p = 0.0023), indicating improved dietary intake and knowledge, even after adjustment for education attained and BMI (p = 0.026). On the other hand, greater adherence to the Mediterranean diet was exhibited among those not having dogs (p = 0.018). Regarding dog measurements and their owners’ anthropometry, dog neck circumference was negatively correlated to the owners’ biceps and triceps skinfolds (r = −0.327, p = 0.016; r = −0.320, p = 0.018, respectively). Additionally, dog breed size was negatively correlated to the owners’ triceps skinfold (r = −0.325, p = 0.015), sum of skinfolds (r = −0.311, p = 0.021), hip circumference (r = −0.341, p = 0.011), body fat (r = −0.357, p = 0.007), and fat mass index (r = −0.307, p = 0.023). Conclusions: Dog ownership is associated with improved body composition and smaller skinfold thickness at specific body sites, as well as with a more health-conscious lifestyle, including better diet quality and knowledge. Full article

Background/Objectives: Breast cancer is the most common malignancy among women globally, with survival rates improving due to earlier detection and better treatment. As a result, cancer survivors now constitute a growing segment of the population, and addressing their long-term health and well-being is a public health priority. Diet and nutrition represent modifiable factors that may influence recurrence, comorbidities, and quality of life (QoL), yet clear evidence-based guidance remains limited. This umbrella review thus synthesized evidence from published reviews on the effects of dietary and nutrition interventions among breast cancer survivors. Methods: Following a prospectively registered protocol in PROSPERO (CRD420251185022), six databases (PubMed, EMBASE, Scopus, Cochrane Library, PsycINFO and CINAHL) were systematically searched for systematic reviews/meta-analyses evaluating dietary or nutrition interventions in adult breast cancer survivors. Eligible reviews reported anthropometric, metabolic, psychosocial, or survival outcomes. Methodological quality was appraised using the AMSTAR-2 tool, and findings were narratively synthesized. Results: Nine systematic reviews encompassing more than 10,000 breast cancer survivors were included. Interventions ranged from general dietary counselling and structured weight-management programmes to Mediterranean-style dietary patterns, dietitian-led primary care, multiple health behaviour change interventions, mobile nutrition apps, and broader lifestyle programmes incorporating diet. Across reviews, interventions consistently improved diet quality and fruit–vegetable intake, produced modest but meaningful reductions in weight, body mass index, and body fat, and enhanced several QoL domains (e.g., fatigue, physical functioning, body image). Higher adherence to Mediterranean-style diets was associated with lower all-cause and non–breast cancer mortality, though certainty was limited by observational designs. However, evidence for long-term maintenance, survival endpoints, and ethnically diverse or low- and middle-income populations remains sparse. Conclusions: Dietary and nutrition interventions, particularly structured, dietitian-supported, and Mediterranean-style approaches, contribute to improved diet quality, sustainable weight control, and enhanced QoL among breast cancer survivors. Integrating nutrition care into survivorship pathways should be the focus of future research. Full article

Introduction: The dietary glycemic index (GI) and glycemic load (GL) are dietary indicators of how carbohydrate-containing foods affect blood glucose. While the Mediterranean diet’s glycemic impact has been explored, data specific to the Greek population remain limited. This study aims to assess the dietary GI and GL in the HYDRIA survey of a representative sample of Greek adults. Methods: HYDRIA was conducted from June 2013 to December 2014 and collected nationally representative data, including detailed dietary information. GI and GL were analyzed by age, sex, BMI, education, employment, smoking status, and Mediterranean diet adherence. Multivariate analysis was used to identify independent predictors of GI and GL. Results: The analysis included 3951 adults (52% females; median age: 49 years). The average GI was 59.7 (95% CI: 59.4–60.0) and the mean GL 101.7 (95% CI: 99.4–104.0). Males had significantly (p ≤ 0.001) higher mean GI and GL (61.2, 95% CI: 57.4–64.7 and 112.9, 95% CI: 82.1–151.1, respectively) than females (59.2, 95% CI: 55.6–62.8 and 81.9, 95% CI: 62.2–107.8, respectively). Older age (≥55 years) and higher education were associated with lower GI and GL in both sexes. Current smoking was associated with higher GI and GL, particularly in males. Among males, medium and high adherence to the Mediterranean diet was associated with lower GI and GL. This relationship was not observed in females. Discussion: These findings emphasize the role of demographics and lifestyle factors in determining differences in dietary GI and GL of the Greek population. The Mediterranean diet appeared to mitigate the dietary GI and GL mainly in males, suggesting effects that merit further investigation. Full article

Background: Obesity and insomnia are prevalent public health issues with shared behavioral and physiological pathways. However, their interplay remains understudied in occupational cohorts. Obesity and insomnia are prevalent public health issues with shared behavioral and physiological pathways. However, their interplay remains understudied in occupational cohorts. This study aimed to evaluate the associations of sociodemographic factors, lifestyle habits, and insomnia severity with multiple obesity indices in a large population of Spanish workers. Methods: We conducted a cross-sectional analysis of 84,898 workers (2021–2024). Data were obtained from annual occupational health assessments conducted across multiple Spanish regions between 2020 and 2024. Insomnia severity was assessed using the Insomnia Severity Index (ISI), dietary quality using the 14-item Mediterranean Diet Adherence Screener (MEDAS-14), and physical activity using the International Physical Activity Questionnaire—Short Form (IPAQ-SF). Adiposity was measured using Body Mass Index (BMI), waist-to-height ratio (WtHR), the Clínica Universidad de Navarra–Body Adiposity Estimator (CUN-BAE), and the Metabolic Score for Visceral Fat (METS-VF). Multivariable logistic regression models were used to examine associations adjusted for age, sex, education, and occupational social class. Results: Higher ISI scores were significantly and independently associated with elevated adiposity across all indices, with the strongest association observed for METS-VF (odds ratio = 1.19, 95% CI 1.14–1.25, p < 0.001). Women showed higher mean CUN-BAE and METS-VF values than men (CUN-BAE: 37.4 ± 6.2 vs. 25.6 ± 6.4; p < 0.001; METS-VF: 5.7 ± 0.7 vs. 6.4 ± 0.6; p < 0.001), despite lower BMI (25.3 ± 4.8 vs. 26.8 ± 4.3; p < 0.001). Lower physical activity (OR = 5.70; 95% CI 4.91–6.50), poor adherence to the Mediterranean diet (OR = 3.29; 95% CI 2.88–3.70), smoking (OR = 1.29; 95% CI 1.22–1.36), and lower occupational class (Class III: OR = 1.77; 95% CI 1.56–1.97) were also significantly associated with higher obesity markers. Associations were more pronounced among women and participants with severe insomnia symptoms. Conclusions: Insomnia severity, sociodemographic disadvantage, and unhealthy behaviors (low physical activity, poor diet, smoking) were all independent correlates of general and visceral adiposity. The findings underscore the need for comprehensive workplace health programs that integrate sleep quality assessment, dietary improvement, and physical activity promotion to prevent obesity and its metabolic consequences. Full article

Background: Insulin resistance (IR) is a key pathophysiological mechanism linking obesity, type 2 diabetes, and cardiovascular disease. Office workers, due to prolonged sedentary behavior and suboptimal lifestyle patterns, may be particularly susceptible to IR. However, large-scale studies in this occupational group remain scarce. Objective: To evaluate the prevalence of elevated IR risk using non–insulin-based indices—TyG, METS-IR, and SPISE—and their associations with sociodemographic and lifestyle factors in a large sample of Spanish office workers. Methods: This cross-sectional study included 82,020 office workers from Spain (2021–2022). IR risk was assessed using the TyG index, METS-IR, and SPISE, all derived from fasting biochemical and anthropometric data. Sociodemographic and lifestyle variables were self-reported using validated questionnaires. Sex-stratified analyses and multivariate logistic regression models were performed. Results: Men showed significantly higher odds of elevated IR risk compared to women across all indices: TyG (OR = 2.48, 95% CI: 2.37–2.60), METS-IR (OR = 1.47, 95% CI: 1.38–1.57), and SPISE (OR = 1.88, 95% CI: 1.78–1.99). Smoking, physical inactivity, and low adherence to the Mediterranean diet were independently associated with elevated IR scores, regardless of sex or age. Conclusions: A substantial proportion of office workers exhibit elevated insulin resistance risk, particularly among men and those with unhealthy lifestyles. TyG, METS-IR, and SPISE are valuable, low-cost tools for early IR detection in occupational health settings. These findings support the implementation of preventive strategies targeting modifiable behaviors in sedentary working populations. Full article

Background: Oxidative stress represents a key pathogenic factor in spondyloarthritis (SpA), yet its comprehensive assessment remains underutilized in routine clinical practice. Objectives: We evaluated oxidative stress biomarker profiles in SpA patients to determine associations with disease activity, systemic inflammation, structural damage, lifestyle factors, and therapeutic responses for practical clinical implementation. Methods: This cross-sectional study included 101 patients meeting the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria. Oxidative stress assessment utilized a validated biomarker panel: copper, zinc, glutathione peroxidase (GPx), ceruloplasmin (Cp), transferrin (TF), haptoglobin (Hp), bilirubin (BR), and uric acid (UA). Clinical, radiological, lifestyle, and therapeutic data underwent systematic analysis. Results: Glutathione peroxidase activity was elevated in 82.1% of patients, establishing it as the most sensitive oxidative stress marker. Copper levels increased in 30.7% and zinc deficiency occurred in 36.4% of cases. Oxidative stress markers correlated significantly with inflammatory parameters (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], neutrophil-to-monocyte ratio [NMR], systemic immune-inflammation index [SII]) and disease activity scores (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score based on CRP [ASDAS-CRP], Disease Activity Score 44 [DAS44-CRP]). Higher oxidative stress was associated with a poorer quality of life, as indicated by elevated Ankylosing Spondylitis Quality of Life (ASQoL) scores. Physical activity and adherence to a Mediterranean diet were independently associated with better antioxidant capacity. Smoking and nonsteroidal anti-inflammatory drug (NSAID) use correlated with increased oxidative burden. Anti-tumor necrosis factor alpha (anti-TNFα) therapy was associated with reduced levels of oxidative stress. Structural damage, particularly cervical spine involvement, correlated with heightened oxidative stress. Conclusions: This comprehensive evaluation reveals significant clinical correlations between oxidative stress and multiple disease domains in SpA. Modifiable lifestyle factors and therapeutic interventions have a significant impact on the redox balance. These findings establish practical targets for personalized management. The integration of oxidative stress assessment into routine practice could enhance disease monitoring and inform the development of antioxidant-based therapeutic strategies. Full article

Objectives: The present study aimed to examine the relationships between screen time (ST), sleep time (SLT), physical activity engagement (PA), Mediterranean diet (MD) adherence, body mass index (BMI), self-esteem (SE) and academic performance (AP) in high-socioeconomic-status (SES) school-aged youth in southern Spain. Methods: A descriptive, comparative, non-experimental and cross-sectional research study was conducted with a total sample of 217 Spanish students (13.88 ± 1.32). Structural equation modelling (SEM) was employed to analyse relationships between study variables as a function of sex. Results: SLT was positively associated with MD adherence and negatively related with BMI. Both PA and MD adherence were positively linked to SE, whilst MD adherence and SE were also positively related to AP. Regarding sex differences, ST was a stronger determinant among girls, showing negative associations with PA (β = −0.378; p < 0.001) and MD adherence (β = −0.315; p < 0.001), with this pattern not being observed in boys. PA was positively associated with SE in both sexes, but more strongly in boys (β = 0.332; p < 0.001) than in girls (β = 0.190; p = 0.034). In girls, both MD adherence (β = 0.295; p < 0.001) and SE (β = 0.224; p = 0.008) were positively associated with AP, with these associations not being found in boys. Conclusions: The findings underscore the complex interplay between lifestyle behaviours, psychosocial factors, and AP in school-aged youth. Regardless of SES, interventions should focus on reducing ST, promoting PA and MD adherence, and enhancing SE whilst considering sex-specific patterns. Full article

Background/Objectives: Adherence to the Mediterranean Diet (MedDiet) has declined even within Mediterranean regions, while its adoption has become more common in non-Mediterranean contexts. This study compares Germany and Türkiye, two culturally contrasting contexts traditionally classified as non-Mediterranean and Mediterranean, respectively, to examine cross-cultural differences and patterns in MedDiet adherence and related lifestyle behaviors. Specifically, it aims to compare adherence to the Mediterranean lifestyle (MedLife), physical activity, and social participation, and to analyze their associations within each country. Methods: Using data from the MEDIET4ALL survey, 1184 valid responses (609 from Germany and 575 from Türkiye) were analyzed for dietary behaviors, perceived barriers to MedDiet adherence, physical activity, and social engagement, with adherence assessed via the MEDLIFE index. Results: The majority of respondents were healthy (79%), employed (67%), young adults (56%), of normal weight (51%), living in urban environments (72%), and showed a gender balance (52.5% female). Most were classified as medium MedDiet adherent in both Germany (45%) and Türkiye (56%), with no significant difference in total MedLife scores. However, block- and item-level analyses revealed that Turkish participants showed higher adherence to Mediterranean food consumption (p < 0.001), particularly in limiting processed meat and consuming legumes, dairy, nuts/olives, and olive oil. In contrast, German participants adhered more closely to recommendations for red meat and cereal intake. German participants also scored higher on lifestyle-related behaviors (e.g., regular napping and recommended sleep duration), while no significant differences were found in the dietary habits block. Awareness of the MedDiet was significantly higher among German participants (p < 0.001), with country-specific differences in perceived barriers (i.e., higher total score among Germans with p = 0.03). Germans reported more barriers related to social norms and health conditions, while Turkish respondents more often cited attitudes, cost, and individual beliefs. Physical activity levels were significantly higher in Germany, whereas Turkish respondents reported greater social participation (p < 0.001). Weak to moderate correlations (r = 0.09 to 0.035) were found between MedLife adherence and both physical activity and social participation, with stronger associations observed among German participants. Conclusions: These findings highlight the culturally embedded nature of lifestyle behaviors related to MedDiet adherence. Despite similar overall adherence levels, Germans and Turks differ in specific dietary patterns, lifestyle practices, and perceived barriers, underscoring the need for culturally tailored interventions to improve adherence. Full article

Background: Atherogenic dyslipidemia is defined by the coexistence of high triglyceride concentrations, low levels of high-density lipoprotein cholesterol (HDL-C), and an excess of small, dense particles of low-density lipoprotein cholesterol (LDL-C). This lipid profile is strongly associated with an increased burden of cardiovascular disease and represents a leading cause of global morbidity and mortality. To better capture this risk, composite lipid ratios—including total cholesterol to HDL-C (TC/HDL-C), LDL-C to HDL-C (LDL-C/HDL-C), triglycerides to HDL-C (TG/HDL-C), and the atherogenic dyslipidemia index (AD)—have emerged as robust markers of cardiometabolic health, frequently demonstrating superior predictive capacity compared with isolated lipid measures. Despite extensive evidence linking these ratios to cardiovascular disease, few large-scale studies have examined their association with sociodemographic characteristics, lifestyle behaviors, and social isolation in working populations. Methods: We conducted a cross-sectional analysis of a large occupational cohort of Spanish workers evaluated between January 2021 and December 2024. Anthropometric, biochemical, and sociodemographic data were collected through standardized clinical protocols. Indices of atherogenic risk—namely the ratios TC/HDL-C, LDL-C/HDL-C, TG/HDL-C, and the atherogenic dyslipidemia index (AD)—were derived from fasting lipid measurements. The assessment of lifestyle factors included tobacco use, physical activity evaluated through the International Physical Activity Questionnaire (IPAQ), adherence to the Mediterranean dietary pattern using the MEDAS questionnaire, and perceived social isolation measured by the Lubben Social Network Scale. Socioeconomic classification was established following the criteria proposed by the Spanish Society of Epidemiology. Logistic regression models were fitted to identify factors independently associated with moderate-to-high risk for each lipid indicator, adjusting for potential confounders. Results: A total of 117,298 workers (71,384 men and 45,914 women) were included. Men showed significantly higher odds of elevated TG/HDL-C (OR 4.22, 95% CI 3.70–4.75) and AD (OR 2.95, 95% CI 2.70–3.21) compared with women, whereas LDL-C/HDL-C ratios were lower (OR 0.86, 95% CI 0.83–0.89). Advancing age was positively associated with all lipid ratios, with the highest risk observed in participants aged 60–69 years. Lower social class, smoking, physical inactivity, poor adherence to the Mediterranean diet, and low social isolation scores were consistently linked to higher atherogenic risk. Physical inactivity showed the strongest associations across all indicators, with ORs ranging from 3.54 for TC/HDL-C to 7.12 for AD. Conclusions: Atherogenic dyslipidemia and elevated lipid ratios are strongly associated with male sex, older age, lower socioeconomic status, unhealthy lifestyle behaviors, and reduced social integration among Spanish workers. These findings highlight the importance of workplace-based cardiovascular risk screening and targeted prevention strategies, particularly in high-risk subgroups. Interventions to promote physical activity, healthy dietary patterns, and social connectedness may contribute to lowering atherogenic risk in occupational settings. Full article

Metabolic syndrome (MetS) is a global public health challenge, characterized by the coexistence of cardiometabolic risk factors such as abdominal obesity, dyslipidaemia, hypertension, and insulin resistance. Non-pharmacological strategies, including the Mediterranean diet (MD) and physical activity (PA), have been widely studied for their potential to prevent and manage MetS. This systematic review aimed to synthesize the evidence on the combined effect of MD and PA on MetS components in adults, based on randomized controlled trials (RCTs). Twenty-two RCTs published between 2018 and 2024 were included, involving 11,478 participants. The interventions ranged from 8 weeks to 3 years and combined adapted or hypocaloric MDs with moderate-to-high-intensity PA, typically including walking, aerobic exercise, or high-intensity interval training (HIIT), performed 3 to 7 times per week. The combined interventions resulted in reductions in body weight (−2.5 to −7.2 kg), body mass index (−0.7 to −2.2 kg/m²), waist circumference (−5.1 to −7.8 cm), and blood pressure (up to −9.0 mmHg systolic and −6.7 mmHg diastolic). Improvements in HDL cholesterol, triglyceride levels, and insulin sensitivity were also observed. These findings suggest that integrated interventions based on the Mediterranean lifestyle are effective in reducing MetS components and may support future public health strategies. Full article