Search Results (1,376)

Alzheimer’s disease (AD) is a multifactorial neurodegenerative disorder characterized by impaired glucose metabolism, mitochondrial dysfunction, inflammation, oxidative stress, and progressive cognitive decline. Because currently available pharmacological therapies provide only modest symptomatic benefit, nutrition-based interventions are increasingly being explored as complementary strategies for supporting brain metabolism and cognitive resilience. The KetoFLEX 12/3 dietary pattern, developed within the ReCODE (Reversal of Cognitive Decline) program, is a plant-rich, mildly ketogenic nutrition and lifestyle framework that integrates low-glycemic nutrition, time-restricted eating, and personalized metabolic optimization. The diet emphasizes deeply pigmented non-starchy vegetables, extra-virgin olive oil, nuts and seeds, omega-3-rich seafood, and minimally processed foods while limiting refined carbohydrates, sugars, processed foods, and selected grains and dairy products. Emerging mechanistic and clinical evidence suggests that KetoFLEX 12/3 may influence several pathways relevant to AD pathophysiology, including insulin signaling, mitochondrial bioenergetics, neuroinflammation, oxidative stress, autophagy, detoxification pathways, and gut–brain axis function. Observational findings from ReCODE-related studies have reported improvements in metabolic parameters, mood-related outcomes, cognitive measures, and brain volumetrics in participants adhering to multimodal precision-medicine interventions incorporating the KetoFLEX principles. Compared with traditional dietary models such as the Mediterranean or MIND diets, KetoFLEX 12/3 places greater emphasis on mild nutritional ketosis, meal timing, and metabolic personalization based on factors such as ApoE genotype and insulin sensitivity. The objective of this Perspective is to examine the mechanistic rationale, emerging evidence, limitations, and future research priorities for KetoFLEX 12/3 as a precision-nutrition framework for cognitive health in AD. Although much of the current evidence remains mechanistic, observational, or derived from multimodal intervention studies, the framework offers a biologically plausible precision-nutrition model that may inform future research and clinical investigation in cognitive decline. Full article

Background/Objectives: Diet-disease-related knowledge (DDRK) is theorized to foster healthier lifestyles; however, the structural interconnectedness between nutritional knowledge and personal biomarker awareness is not well understood. This study aimed to identify independent predictors of DDRK and cardiovascular health (CVH) literacy among Lebanese adults using a psychometric framework. Methods: A cross-sectional convenience-sampled online survey was conducted among 406 Lebanese adults. Standard validated questionnaires were used, including the GNKQ-Section 4, GPAQ, and MEDAS. CVH literacy was computed as the total awareness of five main CV biomarkers: total cholesterol, LDL, HDL, triglycerides, and HbA1c. Data were analyzed through multivariable logistic regression and EBICglasso network analyses. Results: Overall, the prevalence of cardiovascular (CV) biomarker unawareness was 65.5% across participants. Fully adjusted regression models showed that a continuous DDRK score was a significant factor independently associated with lower odds of CV biomarker unawareness (aOR = 0.878, 95% CI [0.824–0.936], p < 0.001), followed by a higher MEDAS score (aOR = 0.842, p = 0.003) and aging (aOR = 0.961, p < 0.001). The network model was dense (sparsity = 0.133) and showed DDRK–CVH literacy as the strongest conditional edge (r_partial = 0.202). The conditional associations of BMI (r = 0.000) and physical activity (r = 0.036) with CVH literacy collapsed after conditioning on DDRK and MEDAS. Centrality indicators showed that DDRK had the highest closeness and strength (both = 1.000). Conclusions: DDRK shows strong conditional network associations with Mediterranean diet adherence and CVH literacy. These exploratory findings generate hypotheses for future longitudinal or interventional research. Full article

Background: Eating behaviors and psychological processes related to food consumption are increasingly recognized as key factors of successful adherence to a healthy dietary pattern. In this context, mindful eating and adherence to the Mediterranean Diet have emerged as models promoting beneficial health outcomes, whereas orthorexia nervosa, characterized by an obsessive focus on eating healthy foods, often leads to dietary inadequacies. Here, we investigated the association among mindful eating, adherence to the Mediterranean Diet, orthorexia nervosa and BMI in a cohort of university students. Methods: A sample of 518 Italian university students completed an online survey assessing general and sociodemographic characteristics, the adherence to the Mediterranean Diet pattern by MEDAS and MEDLIFE, the orthorexia tendency by ORTO-15 test and the degree of mindful eating by the Mind-Eat Scale. Students’ t-test, chi-square test, Pearson’s correlation, and K-means cluster analysis were used for analyses. Results: The participants had a mean BMI of 23.08 ± 3.51, with 69% normal-weight and 25% overweight/obese individuals, showing statistically significant sex differences. Mean Mind-Eat, MEDAS, MEDLIFE and ORTO-15 scores were 3.22 ± 0.46, 8.81 ± 2.35, 3.06 ± 1.14 and 38.31 ± 5.94, respectively. Men scored significantly higher than women in all categories, except for the MEDAS score, where no sex-related differences were observed. Interestingly, the Mind-Eat score was positively associated with ORTO-15 (r = 0.24, p < 0.0001), MEDAS (r = 0.23, p < 0.0001), and MEDLIFE (r = 0.11, p = 0.01) scores. Three clusters were derived, distinguishing optimal (cluster 2), intermediate (cluster 1) and poor (cluster 3) eating profiles, showing sex differences. BMI was significantly lower in cluster 2 than in cluster 3. Conclusions: Our results suggest that integrating psychological and dietary indicators of eating behavior may help identify young adults with less favorable weight-related profiles. Full article

Background/Objectives: Celiac disease (CD) is a complex multifactorial disorder driven by genetic susceptibility and environmental triggers, with ultra-processed foods (UPFs) acting as potential disruptors of immune homeostasis. This study aimed to characterize the patterns and temporality of UPF consumption in a pediatric population with CD to provide evidence-based insights that can optimize the nutritional quality of a gluten-free diet (GFD) beyond mere gluten avoidance. Methods: A total of 128 children aged 5–14 years were enrolled, comprising a baseline cohort of 48 children newly diagnosed with CD (pre-GFD), 88 patients who had followed a GFD for at least 6 months (post-GFD), including 44 participants from the pre-GFD cohort prospectively re-evaluated after 12 months and 44 additional patients with established GFD adherence and a control group of 36 healthy children (CTRL). Dietary intake was assessed using three-day 24 h recalls. Food processing levels were determined using the NOVA classification system, and adherence to the Mediterranean Diet was evaluated via the KIDMED index. Results: At baseline, UPFs (NOVA 4) were the primary daily energy source for both celiac patients and controls, accounting for over 57% of total caloric intake, peaking during breakfast (~74%) and afternoon snacks (~81%). Longitudinal analysis showed that the nutritional profile and global UPF consumption remained remarkably stable after 12 months on a GFD, though a significant increase in vitamin B6 intake was observed (0.9 ± 0.4 vs. 1.1 ± 0.5 mg; p = 0.034). However, meal-pattern shifts occurred over the 12 months: celiac children significantly reduced their daily intake of culinary ingredients (NOVA 2; p = 0.029) and processed foods (NOVA 3; p = 0.025). Compared to healthy controls, post-GFD patients exhibited significantly lower Vitamin D intakes (4.6 ± 9.4 vs. 6.2 ± 12.3 µg/day; p = 0.008), meeting only 30.8% of the reference intake. Both groups presented inadequate intakes of iron, calcium, folate, magnesium, and zinc. Conclusions: Pediatric celiac patients exhibit a high, deeply ingrained consumption of UPFs that mirrors healthy controls and persists 12 months after starting a GFD. While the GFD alters meal processing dynamics, it fails to resolve baseline micronutrient insufficiencies and is associated with lower dietary vitamin D intake, highlighting the urgent need for targeted nutritional interventions that focus on whole food quality rather than just gluten elimination. Full article

Rotating shift work has been associated with impaired quality of life and changes in health behaviors among nurses. Although maintaining a healthy diet and engaging in physical activity may be associated with better quality of life, evidence in shift-working nurses remains limited. This pilot cross-sectional study explored associations between adherence to the Mediterranean diet, physical activity, and quality of life among nurses in Northern Greece from October 2025 to February 2026. A total of 100 nurses working rotating shifts participated in the study. Quality of life, adherence to the Mediterranean diet, and physical activity were assessed using the WHOQOL-BREF, MedDietScore, and IPAQ questionnaires, respectively. The mean MedDietScore was 22.56 ± 4.83, and the mean physical activity was 711.16 ± 576.05 MET-min/week. Adherence to the Mediterranean diet was positively associated with the Physical Health, Psychological Health, and Environment domains. In the multivariable model, physical activity remained positively and independently associated with Physical Health (β = 0.31, p = 0.002), whereas both physical activity and adherence to the Mediterranean diet were positively associated with the Environment domain. These findings suggest that lifestyle behaviors are associated with specific dimensions of quality of life among shift-working nurses and emphasize the need for larger studies. Full article

Background/Objectives: Nutrition during childhood and adolescence is a key determinant of long-term health, influencing metabolic homeostasis, neurocognitive development, and immune system maturation. Globalization and technological advances have reshaped food production and consumption, increasing the availability of ultra-processed foods (UPF) of low nutritional quality. This study aimed to investigate the relationship between parental factors, namely food literacy, perceived barriers and enablers, dietary attitudes, and healthy eating behaviors, and the consumption of discretionary UPF among children and adolescents living in 5 Mediterranean countries. Methods: This cross-sectional study was based on a survey completed by 2011 parents of children and adolescents aged 6–17 years from 5 Mediterranean countries, who reported on their children’s dietary and lifestyle habits. Adherence to the Mediterranean diet was assessed through the KIDMED index. Parental food literacy was measured using the Short Food Literacy Questionnaire (SFLQ). Perceived barriers and enablers were assessed based on the Theory of Planned Behavior, and parents’ attitudes toward their child’s diet were evaluated using the Healthy-Eating Attitudes Questionnaire (HEAQ). Finally, the Theory of Internet Use Related to Health (TIUH) questionnaire was used to assess parents’ tendencies related to health information use online. Results: Higher perceived barriers and enablers were significantly associated with lower discretionary UPF consumption across all models. Parental food literacy (SFLQ) showed a positive association with discretionary UPF consumption, remaining significant in the fully adjusted model, although with reduced magnitude. Healthy-eating attitudes (HEAQ) were initially positively associated with discretionary UPF intake but lost statistical significance after full adjustment. Regarding health-related internet use (TIUH), the Health Information dimension showed a strong positive association with discretionary UPF consumption, while other dimensions (Consciousness and Beliefs) showed inconsistent and non-significant associations in the fully adjusted model. Conclusions: Children’s consumption of discretionary UPF is shaped by several interrelated factors, such as family environment, eating patterns, and parents’ perceptions, rather than solely by knowledge or attitudes. Full article

Background/Objectives: Major depressive disorder (MDD) is increasingly recognized as involving inflammation and the microbiota–gut–brain axis. Few studies have simultaneously assessed systemic inflammatory markers and gut microbiota composition within the same cohort while accounting for metabolic confounders. Moreover, data from Middle Eastern and North African (MENA) populations remain limited, restricting our understanding of how diet may influence neuroimmune–microbiome interactions in depression. This study aimed to investigate associations between MDD, systemic inflammatory markers, and gut microbiota composition in Lebanese adults. To our knowledge, this is the first study of its kind in Lebanon, as well as in the MENA region. Methods: In this cross-sectional case–control study, we examined circulating inflammatory markers and gut microbial profiles in 46 adults with DSM-5-confirmed MDD and 25 healthy controls. Plasma C-reactive protein (CRP) and interleukin-6 (IL-6) were measured, and the gut microbiota composition was characterized using 16S rRNA gene sequencing. Multivariable models were adjusted for age, sex, body mass index (BMI), Mediterranean diet adherence, and fluoxetine exposure. Results: Depression status was not independently associated with CRP or IL-6 after adjustment, whereas BMI emerged as a significant determinant of systemic inflammation. At the genus level, MDD was associated with the enrichment of Dorea, Lachnoclostridium, Collinsella, Bilophila, and Klebsiella and the depletion of Christensenella, Mitsuokella, and Victivallis, independent of inflammatory biomarkers. Alpha diversity did not differ between groups, while beta diversity showed modest metric-dependent differences, primarily driven by presence/absence-based measures. Conclusions: Specific microbial taxa may contribute to gut–brain signaling pathways implicated in MDD and systemic inflammation. Further longitudinal and mechanistic studies are required to clarify causal interactions within inflammation–microbiome networks in MDD. Full article

Background: Obesity is a major public health concern and shows a clear social gradient, with higher prevalence among individuals with lower socioeconomic position. Educational level is a key indicator of socioeconomic status, but the extent to which lifestyle factors explain its association with obesity remains unclear. Objective: To examine the association between educational level and obesity in a working-age population and to evaluate how adjustment for lifestyle factors influences the magnitude of the association between educational level and obesity. Methods: A cross-sectional study was conducted among 3108 working-age adults undergoing occupational health assessments in Spain. Educational level was categorised into three groups (higher, intermediate, and primary or none). Obesity was defined as a body mass index ≥30 kg/m². Lifestyle variables included smoking status, physical activity assessed using the International Physical Activity Questionnaire (IPAQ-SF), and adherence to the Mediterranean diet evaluated with the MEDAS-14 score. Sequential logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), with progressive adjustment for demographic, behavioural, and clinical factors. Results: The overall prevalence of obesity was 16.6%, with a clear gradient across educational levels (11.5% in higher education vs. 19.8% in primary or no education). In crude analyses, individuals with the lowest educational level had higher odds of obesity (OR 1.89; 95% CI 1.46–2.45). Adjustment for age and sex attenuated the association (OR 1.72; 95% CI 1.32–2.24), with further reduction after inclusion of lifestyle factors (OR 1.63; 95% CI 1.24–2.13). In the fully adjusted model, the association remained statistically significant (OR 1.61; 95% CI 1.18–2.21), indicating that adjustment for lifestyle factors attenuated the association between educational level and obesity, although the association remained statistically significant. Conclusions: Lower educational level is associated with a higher risk of obesity. Adjustment for lifestyle factors attenuated this association, although a statistically significant relationship remained. These findings support the role of education as a fundamental determinant of health and highlight the need for strategies addressing broader social and structural determinants of obesity. Full article

Background: MASLD is characterised by chronic inflammation and oxidative stress, which contribute to disease progression. Currently, no effective pharmacological treatment is available, and the first-line treatment remains lifestyle modification, including dietary changes and physical activity. This study aimed to assess the effect of dietary antioxidants, anthocyanins, on the risk of MASLD in a cohort from Southern Italy. Methods: The sample of this study comprised 1, 297 individuals aged between 54 and 64 years from a larger cohort, the NUTRIHEP study cohort. Data on anthocyanin intake were collected using a food-frequency questionnaire. MASLD is diagnosed when fatty liver disease is present in conjunction with at least one cardiometabolic risk factor. Results: Anthocyanin intake was inversely associated with MASLD risk. In Model b, adjusted for adjusted for age, sex, Fasting Glucose, Triglycerides, Diastolic Blood Pressure, Job, Alcohol consumption (g/day), daily energy intake, adherence to the Relative Mediterranean Diet (rMED), Available Carbohydrates, fibre intake, the third quartile (Q3) and the highest intake group (Q4) of anthocyanins showed a negative correlation with MASLD. Analysis of Anthocyanin intake as a continuous variable showed a modest negative association with MASLD risk (OR = 0.990, 95% CI 0.989–0.999), suggesting that higher anthocyanin intake may slightly lower the risk of MASLD. Conclusions: Our study highlights the protective effects of dietary anthocyanins against MASLD. These findings confirm the potential preventive role of dietary polyphenols in MASLD and identify anthocyanins as novel targets for intervention. Full article

Background: This randomized controlled trial aimed to evaluate the effects of a school physician-led counseling intervention on total cholesterol (TC) levels, adherence to the Mediterranean diet, physical activity, and sedentary behavior in children aged 6–7 years with elevated cholesterol levels in a Mediterranean setting. Methods: A one-year randomized controlled study was conducted among children aged 6–7 years with elevated TC levels, excluding those with familial hypercholesterolemia (FH). Participants were randomly assigned to either a control group (n = 38) or an intervention group (n = 39). All participants received standard care consisting of educational materials and baseline counseling, while the intervention group additionally participated in three structured follow-up counseling sessions conducted by school physicians during the one-year study period. Counseling focused on Mediterranean dietary habits, implementation of basic dietary principles in cases of elevated TC levels, promotion of physical activity, and reduction in sedentary behavior. TC levels were measured at baseline and at the end of the study. Dietary habits, physical activity, and sedentary behavior were assessed using validated questionnaires. For the primary outcome, a descriptive change-from-baseline analysis, unadjusted mean difference, the approximate 95% confidence interval, and Cohen’s d effect size were calculated. Results: At baseline, no significant differences in TC levels were observed between groups (p = 0.852). After the intervention, mean TC levels were lower in the intervention group than in the control group (4.977 ± 0.414 mmol/L vs. 5.137 ± 0.410 mmol/L); however, the between-group difference did not reach statistical significance (p = 0.089). The unadjusted mean difference at follow-up was −0.160 mmol/L, with an approximate 95% confidence interval from −0.35 to 0.03 and a small-to-moderate effect size in favor of the intervention group (Cohen’s d = −0.39). Descriptive change-from-baseline analysis showed a greater mean reduction in TC in the intervention group than in the control group (−0.364 mmol/L vs. −0.195 mmol/L). A statistically significant improvement in adherence to the Mediterranean diet was observed in the intervention group compared with the control group (p < 0.001). Favorable changes were also observed in several physical activity and sedentary behavior variables, including participation in organized physical activity, walking and running activities, and reduced television viewing and video gaming time. Given the exploratory nature of behavioral analyses and the number of physical activity and sedentary behavior outcomes examined, these findings should be interpreted cautiously. Conclusions: The school physician-led counseling intervention did not result in a statistically significant between-group difference in TC levels after one year, although the direction and magnitude of change favored the intervention group. The intervention was associated with improved adherence to the Mediterranean diet and favorable exploratory lifestyle-related behavioral changes. Nevertheless, the findings should be interpreted cautiously in light of the relatively small sample size, non-significant primary outcome, and exploratory nature of behavioral analyses. Full article

Background/Objectives: Diabetic retinopathy (DR) is a major microvascular complication of type 2 diabetes (T2D) and a leading cause of visual impairment. The relationships among Mediterranean diet adherence, dietary components, DR, and vision-related quality of life remain incompletely defined. This cross-sectional study evaluated Mediterranean Diet Score (MDS) as the primary dietary endpoint, individual MDS components as secondary endpoints, and micronutrient intakes as exploratory endpoints. Methods: In this single-centre study, 129 subjects with long-standing T2D were classified as no DR (NDR; n = 85), non-proliferative DR (NPDR; n = 36), or proliferative DR (PDR; n = 8). Dietary intake was assessed using a food frequency questionnaire and vision-related quality of life using the NEI-VFQ-25. Results: Subjects with DR had longer diabetes duration than those without DR (18 vs. 16 years, p < 0.01). Overall MDS did not differ by DR status, indicating a null finding for the primary dietary endpoint. In secondary analyses, lower legume consumption was observed among participants with DR and was associated with higher odds of DR in multivariable models. Participants with PDR showed poorer vision-related quality of life, although this finding was limited by the small PDR subgroup and high NEI-VFQ-25 scores in other groups. Exploratory analyses suggested associations between selected micronutrient intakes and NEI-VFQ-25 domains. Conclusions: Overall Mediterranean diet adherence was not associated with DR status. Secondary and exploratory findings should be considered hypothesis-generating and require confirmation in prospective studies. Full article

Background: Adolescent mental health is a global concern, with lifestyle factors such as diet and physical activity (PA) playing a crucial role. While the Mediterranean Diet adherence (MDA) is known for its neuroprotective benefits on mental health, the mechanisms by which they are related remain unclear. Therefore, the aim of this study was twofold: (1) to examine the associations between MDA, PA, and screen time (ST) with anxiety symptoms, depression, stress, and total psychological distress in Chilean adolescents; and (2) to determine whether PA mediates the relationship between MDA and anxiety symptoms. Methods: A cross-sectional study was conducted with 322 Chilean school-aged adolescents 158 males and 164 females (14.98 ± 1.96 years). Mental health outcomes (depression, anxiety, and stress) and lifestyle behaviors, including MDA, PA, and ST, were comprehensively assessed using validated self-reported questionnaires. Results: After adjusting for age and sex, multiple linear regression models showed that higher MDA was significantly and inversely associated with anxiety (b = −0.23, p = 0.044), stress (b = −0.25, p = 0.022), and total psychological distress (b = −0.72, p = 0.022). Conversely, ST was identified as a consistent risk factor, positively predicting higher levels of anxiety (b = 0.45, p = 0.008), stress (b = 0.42, p = 0.008), and total distress (b = 1.11, p = 0.014). Furthermore, PA was inversely linked to anxiety (b = −0.35, p = 0.013) and successfully mediated the relationship between MDA and anxiety symptoms (Indirect Effect = −0.047, 95% CI: −0.10 to −0.01). No significant mediation effects were observed for depression or stress. Conclusions: The present study identifies robust inverse associations between MDA and symptoms of anxiety, depression, and stress in Chilean adolescents. A key finding is the specific pattern of relationships observed: while higher MDA is directly linked to lower levels of depression and stress, its association with anxiety is shared with levels of PA. Despite these findings, the cross-sectional nature of the study limits the establishment of causal relationships, and further longitudinal research is needed to confirm these directional pathways. Full article

The Mediterranean diet (MedDiet) has emerged as a promising dietary strategy for the prevention and management of type 2 diabetes mellitus (T2DM). This narrative review provides a comprehensive synthesis linking the biological pathways of the MedDiet with established clinical evidence. Adherence to this traditional dietary pattern—characterized by a high intake of fiber, complex carbohydrates, antioxidants, and healthy fats—has demonstrated significant benefits in terms of glycemic control, enhanced insulin sensitivity, and overall metabolic health. Mechanistically, the review explains how the MedDiet improves health by modulating key physiological processes, including anti-inflammatory and antioxidant pathways, the regulation of branched-chain amino acid metabolism, the enhancement of short-chain fatty acid production via gut microbiota modulation, and upregulated incretin effects. Importantly, this review explains how the MedDiet complements modern medications, including glucagon-like peptide-1 (GLP-1) receptor agonists and sodium–glucose cotransporter-2 (SGLT-2) inhibitors. By integrating molecular mechanisms with human clinical outcomes, this narrative review addresses multiple aspects of the MedDiet in both the prevention and management of T2DM including glycemic control, weight management, and cardiovascular risk reduction, rendering it a valuable dietary strategy for both the prevention and treatment of this chronic condition. Full article

Background/Objectives: The increasing burden of non-communicable diseases, together with accelerating environmental degradation, highlights the urgent need for sustainable dietary patterns that promote both human and planetary health. The Mediterranean diet (MedDiet), traditionally followed in countries bordering the Mediterranean basin, has gained recognition as a model of sustainable nutrition due to its well-documented health benefits and relatively low environmental impact. However, its broader role within sustainable food systems requires comprehensive and interdisciplinary evaluation. The aim of this review is to provide a state-of-the-art synthesis of the evidence on the MedDiet as a sustainable dietary pattern, integrating its health, environmental, economic, and socio-cultural dimensions. Methods: This state-of-the-art narrative review synthesizes evidence from peer-reviewed literature on the MedDiet and sustainability. Relevant studies were identified through major scientific databases, focusing on publications addressing nutritional, environmental, economic, and socio-cultural dimensions. Both observational and interventional studies, as well as modeling and life cycle assessment analyses, were included. Additional sources from international organizations and policy reports were incorporated to contextualize global trends and challenges. Results: High adherence to the MedDiet is consistently associated with a reduced risk of cardiovascular disease, type 2 diabetes, cancer, and all-cause mortality. From an environmental perspective, the MedDiet is associated with lower greenhouse gas emissions, reduced land and water use, and enhanced biodiversity conservation compared with Western dietary patterns. Economically, it may represent a cost-effective dietary model and support local food systems when grounded in traditional practices, although affordability varies across contexts. Socio-culturally, the MedDiet promotes food heritage, culinary skills, and social cohesion. Nevertheless, globalization, urbanization, and the increasing consumption of ultra-processed foods have contributed to declining adherence, posing significant challenges to its sustainability and scalability. Moreover, the sustainability benefits of the MedDiet seem to be context-dependent rather than intrinsic, raising several challenges and limitations for its adoption. Conclusions: The MedDiet should be viewed not as a definitive solution to global food-system challenges but as a valuable reference model that illustrates how dietary practices can contribute simultaneously to human health, environmental sustainability, and cultural continuity. Modern sustainable dietary strategies should build upon the strengths of the MedDiet while recognizing its limitations, embracing contextual adaptation, and addressing the structural determinants that shape food choices. Full article

Background/Objectives: Advanced glycation end-products (AGEs) are implicated in the vascular complications of type 2 diabetes mellitus (T2DM). Although the Mediterranean diet (MD) confers well-recognized benefits, adherence among people with T2DM is moderate. Evidence regarding the relationship between adherence to the MD and AGEs remains limited. This study aimed to investigate the association between adherence to the MD and AGE levels in individuals with T2DM in Greece. Methods: Adults with T2DM were enrolled in this cross-sectional study. Ocular and skin AGEs were assessed using autofluorescence techniques, while serum AGEs were quantified using an enzyme-linked immunosorbent assay (ELISA). MD adherence was scored with the Mediterranean Diet Score (MedDietScore) (range 0–55). Results: Sixty-one individuals were studied (mean age: 65 ± 9 years; 35 men). Median glycated hemoglobin (HbA1c) and MedDietScore were 6.95 (6.2–7.5)% and 29.0 (27.5–31.5), respectively. Higher adherence to the MD was more frequent among women (p = 0.019) and was associated with lower HbA1c levels (p = 0.002). MedDietScore was inversely correlated with HbA1c (ρ = −0.437, p < 0.001), ocular AGEs (ρ = −0.435, p = 0.013), and skin AGEs (ρ = −0.309, p = 0.033). In multivariable regression analyses, higher adherence to the MD was independently associated with lower ocular (p = 0.043) and skin AGEs (p = 0.005). Conclusions: Higher adherence to the MD was associated with female sex and lower HbA1c. MedDietScore was inversely related to skin, and ocular AGE levels in individuals with T2DM. Full article