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PubMed2002

Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes (MGSD).

OBJECTIVE: To compare the nutritional habits among six Mediterranean countries and also with the various official recommendations and the 'Mediterranean diet' as originally described. DESIGN: Cross-sectional study. SETTINGS: Three centres in Greece, two in Italy and one in Algeria, Bulgaria, Egypt and Yugoslavia. SUBJECTS: Randomly selected non-diabetic subjects from the general population, of age 35-60, not on diet for at least 3 months before the study. INTERVENTIONS: A dietary questionnaire validated against the 3-Day Diet Diary was used. Demographic data were collected and anthropometrical measurements done. RESULTS: All results were age adjusted. Energy intake varied in men, from 1825 kcal/day in Italy-Rome to 3322 kcal/day in Bulgaria and in women, from 1561 kcal/day in Italy-Rome to 2550 kcal/day in Algeria. Protein contribution (%) to the energy intake varied little, ranging from 13.4% in Greece to 18.5% in Italy-Rome, while fat ranged from 25.3% in Egypt to 40.2% in Bulgaria and carbohydrates from 41.5% in Bulgaria to 58.6% in Egypt. Fibre intake, g/1000 kcal, ranged from 6.8 in Bulgaria to 13.3 in Egypt and the ratio of plant to animal fat from 1.2 in Bulgaria to 2.8 in Greece. The proportion of subjects following the WHO and the Diabetes and Nutrition Study Group (DNSG) of the EASD recommendations for carbohydrates, fat and protein ranged from 4.2% in Bulgaria to 75.7% in Egypt. Comparison with the Mediterranean diet, as defined in the seven Country Study, showed significant differences especially for fruit, 123-377 vs 464 g/day of the Mediterranean diet, meat, 72-193 vs 35 g/day, cheese, 15-79 vs 13 g/day, bread, 126-367 vs 380 g/day. CONCLUSIONS: (a) Dietary habits of the 'normal' population vary greatly among the Mediterranean countries studied. (b) Egypt is closest to the DNSG recommendations. (c) Significant differences from the originally described Mediterranean diet are documented in most Mediterranean countries, showing a Westernization of the dietary habits.

Adult↗
PubMed2006

The Mediterranean diet in a world context.

OBJECTIVE: To put the debate on the Mediterranean diet in context by highlighting historical and prospective changes in the level and composition of food consumption in the world and key Mediterranean countries. DESIGN: Data from FAO's food balance sheets are used to illustrate historical evolution. Projections to 2030 are presented from FAO's recent and ongoing work on exploring world food and agriculture futures. SETTING: International. RESULTS AND CONCLUSIONS: Many developing countries are undergoing diet transitions bringing them closer to the diets prevalent in the richer countries, i.e. with more energy-dense foods. There follows an increase in the incidence of diet-related non-communicable diseases, which are superimposed on the health problems related to undernutrition that still afflict them. In parallel, many low-income countries are making little progress towards raising food consumption levels necessary for good nutrition and food security. Wider adoption of food consumption patterns akin to those of the Mediterranean diet hold promise of contributing to mitigate adverse effects of such diet transitions. However, the evolution of food consumption in the Mediterranean countries themselves is not encouraging, as these countries have also followed the trend towards higher shares of energy-dense foods. Possible policy responses to these problems include measures to raise awareness of the benefits of healthier diets and/or to change relative food prices in favour of such diets (by taxing fattening foods) or, at the extreme, making individuals who follow 'bad' diets, and thus are prone to associated diseases, bear a higher part of the consequent costs borne by the public health systems (tax fat people).

Developing Countries↗
PubMed1996

[The Mediterranean diet in the prevention of arteriosclerosis].

It is well-known that mortality from coronary heart disease (CHD) is much lower in Italy and the Mediterranean countries than in Northern Europe and United States. Diet is one of the major environmental factors playing an important etiological role in different CHD incidence rates in these areas. The Seven Countries Study demonstrated that the average consumption of saturated fatty acids and cholesterol was directly related to CHD death rates, these being higher in Northern Europe and United States and lower in the Mediterranean countries and the Far East. Olive oil, particularly rich in oleic acid, could play a beneficial role in CHD prevention, as reported in the Italian Nine Communities Study carried out in the early 80s. Another multicenter study, the Intersalt Study, has clearly shown lower blood pressure in participants with lower intake of both sodium and alcohol and higher intake of potassium. Recent findings have also shown that two helping of fish per week and antioxidant vitamins, particularly vitamin E and beta carotene, are related to lower CHD incidence rate in the Mediterranean area compared to other countries. In conclusion, based on the reported findings, the Mediterranean diet represents an useful and effective mean for the prevention of CHD.

Alcohol Drinking↗
PubMed2005

Cyanidin attenuates PGE2 production and cyclooxygenase-2 expression in LNCaP human prostate cancer cells.

In the United States, the primary cancer in elderly men is prostate cancer (33% of newly diagnosed malignancies), but the prevalence is 75% lower in some Mediterranean countries. A possible explanation for the large difference in prostate cancer cases is that in Mediterranean countries the diet includes fish, olive oil and high amounts of nuts, fruits, vegetables, along with a regular intake of wine with meals several times per week. The LNCaP prostate cancer cells represent the nonaggressive androgen-dependent cell model that expresses moderate levels of cyclooxygenase-2 (COX-2). Epidemiological evidence indicates that polyphenolic compounds in diets are protective against cancer, and cyanidin and kaempferol are abundant in wine and plants. Therefore, the objective of the investigation was to determine the effects of cyanidin and kaempferol on prostaglandin E2 (PGE2) and COX-2 protein levels, and if peroxisome proliferator-activated receptor gamma (PPARgamma) and nuclear factor kappaB (NFkappaB) are involved in the expression of COX-2 in prostate cancer cells. Cyanidin and kaempferol at 1 microM reduced the level of PGE2 in LNCaP cell cultures and also attenuated the effect of arachidonic acid on increasing the amount of PGE2. Cyanidin reduced the levels of COX-2 protein in a dose- and time-dependent fashion. PPARgamma mRNA levels were lower in cells treated after 24 h with kaempferol (0.1 and 1 microM) and cyanidin (1 microM). The reduction of COX-2 mRNA by kaempferol and cyanidin may be mediated through the actions of NFkappaB and PPARgamma as nuclear factors that bind to the COX-2 gene promoter.

Anthocyanins↗
PubMed1979

[Estimation of coronary disease mortality and morbidity in France from epidemiological data].

The incidence of coronary heart diseases in France is estimated from three sources of information. Mortality statistics underestimate the number of deaths from coronary heart diseases. An evaluation of this number is proposed, but with a rather important lack of precision; for example, between 10 and 20% of male mortality between age 45 and 64. These French coronary death rates are inferior to those of numerous other European or Anglo-Saxon countries, but are comparable with those of some mediterranean countries. The incidence of coronary heart diseases measured in the Paris Prospective Study is inferior by half to that of the Framingham Study and is also inferior to those of several male populations from the 7 Countries Study, in the same age limits. Three French registers give similar results about the incidence of acute myocardial infarction. This incidence is equal to the lower limit of those measured in 21 foreign registers. These concording data suggest that the incidence of coronary heart diseases is relatively moderate in France. Etiological hypotheses are planned and the interest in a surveillance of French sanitary data is reminded.

Adult↗
PubMed1977

[Frequency of hepatitis A antibodies in populations of various European countries].

Using a solid phase radioimmunoassay, prevalence of anti-HA was determined in sera of 661 German patients treated following accidents, 70 persons born in Mediterranean countries and 175 persons from Lillehammer, Norway. In Germany (55% positive) an increase in prevalence of anti-HA from 13% in the group below 20 years of age to 92% in persons over 49 was noted. This and further data suggest that after infection anti-HA is detectable for life. Persons from Norway (17% positive) aged below 40 years had a low prevalence of anti-HA (4-10%), whereas even young persons from Mediterranean countries (81% positive) hat antibody in about 80% of cases. Prevalence rates in different age groups suggest a remarkable decrease in incidence of hepatitis A infection over the last three decades in Germany. This results in a rise in the mean age at which hepatitis A infection is acquired and high morbidity during travel abroad. Only one of 10 hepatitis A infections appears to produce clinical disease. Young anti-HA positive individuals exhibit higher titers on average than older ones.

Adult↗
PubMed1994

Nutrition and health in relation to food production and processing.

Intensive animal rearing, manipulation of crop production and food processing have altered the qualitative and quantitative balance of nutrients of foods consumed by Western society. This change, to which the physiology and biochemistry of man may not be presently adapted to, is thought to be responsible for the chronic diseases that are rampant in the Industrialised Western Countries. Agriculture production and food processing practices, dietary habits and lifestyle of the West is being fostered without any appraisal of the health implications by most developing countries. Consequently, a rising trend in the incidences of obesity, diabetes, high blood pressure, cardiovascular diseases, dental decay and appendicitis is apparent. Mediterranean countries are adopting the agriculture and food practices of northern Europe as the result of the harmonisation of European food and agriculture policy. It is predicted that the low incidence of morbidity and mortality from coronary heart disease, stroke, diabetes and breast and colon cancer of the Mediterranean countries would rise to the high northern European level in the foreseeable future. Most of these chronic diseases are lifestyle related and are preventable. This can be realised by tackling the root problem which is food production and processing practices and not by dispensing designer drugs or opening more hospital beds.

Agriculture↗
PubMed1993

Descriptive epidemiology of gall-bladder cancer in Europe.

Trends in mortality from cancer of the gall-bladder and bile ducts over the period 1965-1989 were analysed for 25 European countries on the basis of official death certifications from the World Health Organization databank. A high-mortality area--i.e. with overall death certification rates, world standard, around or over 2/100,000 men and 4/100,000 women in 1985-1989--was identified in Germany and the surrounding central European countries (Austria, Czechoslovakia, Hungary and Poland). The highest rates were in Hungary (3.9/100,000 men and 7.4/100,000 women). During the two decades considered, rates increased in Czechoslovakia and Hungary, remained stable in Poland and declined in Austria and Germany. Intermediate-mortality areas included Scandinavian countries (except Norway) and Switzerland: their rates in the late 1980s were between 1.5 and 2.5/100,000 men and between 2.2 and 4.2/100,000 women. Mortality increased in Finland and Sweden, declined in the Netherlands and Switzerland, and did not change consistently in Denmark. Low-mortality countries (i.e. with rates in 1985-1989 below 2.0/100,000 men and 2.5/100,000 women) included Belgium, France, Britain, Ireland, Norway, Bulgaria and Mediterranean countries. Over the last two decades, certification rates declined in Bulgaria and Great Britain, but increased in all other countries. The ratio between the countries with the highest and lowest gall-bladder cancer mortality rates declined from 21 to 12 in women, although they remained stable around 10 for men. The pattern was similar when analysis was restricted to truncated rates from patients aged between 35 and 64 years. These trends, and particularly the exceedingly high rates in central Europe, the low rates in Mediterranean countries and the low and declining rates in Britain and Ireland are discussed in terms of known (cholelithiasis) or potential (dietary) factors in gall-bladder cancer aetiology, and of trends in cholecystectomy rates.

Adult↗
PubMed2003

Silvicultural management in maintaining biodiversity and resistance of forests in Europe-the Mediterranean region.

Outstanding features of Mediterranean forest area are highlighted with a special reference to biodiversity and connections with forest management. The naturally originated and anthropogenic progress of the mosaic-like evolution, as well as the man-induced factors and natural constraints are described. The past and present close linkages between management and biodiversity are then analysed by means of a few, outstanding cases typical of the geographical region. The management shift on increasing economically marginal forest area (abandonment) appears to be the major force currently driving connections with inherent and associated biodiversity. The goals following the new-established environmental roles of forests have shifted towards adaptive management, namely the implementation of locally tailored rules in accordance with prominent forest functions. Key priorities to face up to the new scenarios are then discussed. Economic and policy implications are addressed with reference to multipurpose forestry and the related annual flow of outputs. It is shown the role of water-related services, as well the provision of various non-wood forest products and public goods in addition to wood and other traditional forest outputs. Reference is also made to the dualism between the Northern and the South-Eastern Mediterranean countries due to different level of economic development (and pressure of forest resources) together with very different institutional structures, i.e. public ownership in Southern and South-Eastern Mediterranean countries. Nevertheless, the situation is going to become more harmonious in the medium run by growing economic development, the affirmation of local rights on forest resources, globalisation and, above all, rural out migration and exchanges of peoples confirming the traditional role of the Mediterranean Region at cross road of South-North and Eastern-Western cultures.

Climate↗
PubMed2004

Nutritional habits of subjects with Type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD).

AIMS/HYPOTHESIS: The aim of this study was to compare the nutritional habits of Type 2 diabetic patients among Mediterranean countries and also with those of their background population and with the nutritional recommendations of the Diabetes and Nutrition Study Group. METHODS: We did a cross-sectional study of 1833 non-diabetic subjects and 1895 patients with Type 2 diabetes, in nine centres in six Mediterranean countries. A dietary questionnaire validated against the 3-Day Diet Diary was used. RESULTS: In diabetic patients the contribution of proteins, carbohydrates and fat to the energy intake varied greatly among centres, ranging from 17.6% to 21.0% for protein, from 37.7% to 53.0% for carbohydrates and from 27.2% to 40.8% for fat, following in every centre the trends of the non-diabetic population. Furthermore, diabetic patients compared to the corresponding background population had: (i). lower energy intake, (ii). lower carbohydrate and higher protein contribution to the energy intake, (iii). higher prevalence of obesity, ranging from 9 to 50%. The adherence to the nutritional recommendations for proteins, carbohydrate and fat was very low ranging from 1.4 to 23.6%, and still decreased when fibre was also considered. CONCLUSION/INTERPRETATION: In diabetic patients of the Mediterranean area: (i). dietary habits vary greatly among countries, according to the same trends of the background population; (ii). the prevalence of obesity is much lower than the 80% reported for patients with diabetes in Western countries; (iii). Carbohydrate intake is decreased with a complementary increase of protein and fat consumption, resulting to a poor compliance with the nutritional recommendations.

Cross-Sectional Studies↗
PubMedDate not supplied

Multiple symmetrical lipomatosis: no longer just a Mediterranean disease?

Multiple symmetrical lipomatosis is a rare condition, of which the etiology remains unclear. Most reported cases have been from the Mediterranean countries, and it is generally thought of as a disorder characteristic of that region. However, there have been 11 cases reported in Japan since 1978, suggesting that this condition is no longer confined to Mediterranean countries.

Adult↗
PubMed2004

Development of coastal recreational water quality standards in the Mediterranean.

Concern about adverse health effects arising out of human exposure to polluted seawater through bathing and other forms of aquatic recreation has led to the development of various quality criteria and standards worldwide. Attempts at quantifying health hazards from polluted recreational waters have been made in several Mediterranean countries through the conduction of epidemiological studies aimed at establishing direct correlation between the microbiological quality of the water and health effects on exposed population groups. This article provides an overview on the development of the criteria and standards for coastal recreational waters in the Mediterranean by examining the evolution of the WHO guidelines, the WHO/UNEP interim criteria for bathing waters and the EU Directives. It also provides a brief account of the various quality criteria and standards for coastal recreational waters in current use in all the Mediterranean countries.

Environment↗
PubMed1989

Latitudinal variation of Adh gene frequencies in Drosophila melanogaster: a Mediterranean instability.

The relationship between allelic frequencies at the Adh locus and latitude of origin was studied using selected published data from various parts of the world and original observations. An overall increase of Adh-F with increasing latitude was observed but the relationship is not linear. Tropical populations are generally similar, having a low frequency of the F allele (average 15 per cent) and a smooth increase with latitude (one per cent for one degree). Between 30 and 42 degrees latitude, populations living in a Mediterranean climate in various parts of the world (Mediterranean countries, Australia's east coast and North America's west coast) are also similar, with a much higher average frequency of F (70 per cent), a steeper slope (two per cent) and a broader range of variability for a given latitude. In a restricted area (near Cordoba in southern Spain) numerous wild collected samples also showed a large variability, sometimes over a very short distance. Allelic frequencies in Mediterranean countries are thus quite unstable and it is proposed that this phenomenon be called a "Mediterranean instability". Further north, numerous samples from France were characterized by an even higher frequency of F (95 per cent) and a greater homogeneity over a broad geographic area. These observations are discussed and the need for more field studies is emphasized.

Africa↗
PubMed2003

The identification and variability of the parasites causing leishmaniasis in HIV-positive patients in Italy.

Between 1988 and 1998, 258 Leishmania strains from patients infected with HIV were characterized by iso-enzyme electrophoresis at the Istituto Superiore di Sanità (ISS) in Rome. Most (227) of the isolates came from 80 Italian patients with visceral leishmaniasis (VL), the rest from cases of Leishmania/HIV co-infection in other Mediterranean countries. Every strain was found to be Leishmania infantum. In Italy, 19 zymodemes of L. infantum were identified, broadly divided into three groups. Over 50% of the Italian patients were infected by the commonest agent of Mediterranean VL in HIV-negative individuals (zymodeme MON-1) whereas the remaining patients were infected by two distinct groups of zymodemes: one usually causing simple, self-resolving cutaneous leishmaniasis in HIV-negative patients, the other consisting of agents detected, so far, only in HIV-positive subjects. This last group, consisting of seven zymodemes, showed re-assortment patterns within electromorphs frequently observed in dermotropic L. infantum zymodemes. A similar grouping was also observed in the isolates from other Mediterranean countries. Basing on general data recorded at the ISS over the last 20 years, accurate identification of the geographical origin of the zymodemes was attempted by careful analysis of the patients' histories, using the iso-enzyme electromorphs as geographical markers. Furthermore, a polymorphism index (no. of zymodemes/no. of patients) was defined for each Leishmania species and geographical region, and used to assess the level of L. infantum zymodeme heterogeneity in Italy, before and after stratification by HIV status. The greatest zymodeme heterogeneity was found in Sicily (southern Italy), with nine zymodemes identified among only 30 HIV-positive patients.

AIDS-Related Opportunistic Infections↗
PubMed2006

Monounsaturated fatty acids, olive oil and blood pressure: epidemiological, clinical and experimental evidence.

Diet has an important role in the prevention and treatment of hypertension. In early epidemiological studies, conducted mainly in the USA, monounsaturated fatty acids showed a deleterious association with blood pressure or no relationship at all. However, more recent studies, conducted in Mediterranean countries, have shed new light on this issue. In the present review we summarise the main results of epidemiological studies and feeding trials, and explain the possible mechanisms through which monounsaturated fatty acids, and specifically olive oil as the major dietary source of this type of fat in Mediterranean countries, could exert a favourable effect on blood pressure.

Adult↗
PubMed2004

Psychosocial morbidity and its correlates in cancer patients of the Mediterranean area: findings from the Southern European Psycho-Oncology Study.

BACKGROUND: A few and partial data are available on psychosocial morbidity among cancer patients in Mediterranean countries. As a part of a more general investigation (Southern European Psycho-Oncology Study-SEPOS), the rate of psychosocial morbidity and its correlation with clinical and cultural variables were examined in cancer patients in Italy, Portugal and Spain. METHODS: A convenience sample of cancer outpatients with good performance status and no cognitive impairment were approached. The Hospital Anxiety-Depression scale (HAD-S), the Mini-Mental Adjustment to Cancer scale (Mini-MAC), and the Cancer Worries Inventory (CWI) were used to measure psychological morbidity, coping strategies and concerns about illness. RESULTS: Of 277 patients, 34% had pathological scores ("borderline cases" plus "true cases") on HAD-S Anxiety and 24.9% on HAD-S Depression. Total psychiatric "caseness" was 28.5% and 16.6%, according to different HAD cut-offs (14 and 19, respectively). Significant relationships of HAD-S Anxiety, HAD-S Depression, HAD-S Total score, with Mini-MAC Hopeless and Anxious Preoccupation, and CWI score were found. No differences emerged between countries on psychosocial morbidity, while some differences emerged between the countries on coping mechanisms. Furthermore, Fatalism, Avoidance and marginally Hopeless were higher compared to studies carried out in English-speaking countries. LIMITATIONS: The relatively small sample size and the good performance status prevent us to generalize data on patients with different cancer sites and advanced phase of illness. CONCLUSIONS: One-third of the patients presented anxiety and depressive morbidity, with significant differences in characteristics of coping in Mediterranean countries in comparison with English-speaking countries.

Adaptation, Psychological↗
PubMed2006

Tobacco smoking, alcohol drinking and non-Hodgkin's lymphoma: A European multicenter case-control study (Epilymph).

To study the role of tobacco smoking and alcohol drinking in the etiology of non-Hodgkin's lymphoma (NHL), we conducted a multicenter case-control study in Spain, France, Germany, Italy, Ireland and Czech Republic between 1998 and 2004, which included 1,742 cases of NHL and 2,465 controls matched on age, sex and recruitment area. Tobacco smoking was not associated with the risk of NHL overall or with risk of specific histological subtypes. Similarly, there was no association between alcohol drinking and the risk of NHL overall or across histological subtypes. However, a protective effect of alcohol drinking was observed among men (OR = 0.76, 95% CI = 0.62-0.93) and in non-Mediterranean countries (OR = 0.73, 95% CI = 0.61-0.86). There was no evidence of interaction between alcohol drinking and tobacco smoking in NHL etiology. The results of this large-scale European study did not support an association between tobacco and NHL and suggested a protective effect of alcohol on development of NHL for men and in non-Mediterranean countries.

Adult↗
PubMed2006

Distribution of hepatitis C virus genotypes in the Middle East.

It is well established that hepatitis C develops into cirrhosis of the liver and hepatocellular carcinoma (HCC) both of which are fatal diseases. The World Health Organization estimates that there are at least 21.3 million hepatitis C virus (HCV) carriers in the Eastern Mediterranean countries, which is close to the number of carriers estimated in the Americas and Europe combined. With such a high disease burden of HCV infection in this part of the world, and in light of the new evidence that genotypes may influence the outcome of antiviral therapy, the focus of this review is on the epidemiology and distribution of HCV genotypes in the Eastern Mediterranean countries. Accumulated data show that there are two main patterns for the distribution of HCV genotypes in the Middle East: in the first pattern, genotype 4 is prevalent in most of the Arab countries, and in the second pattern, genotype 1a or 1b predominates in the non-Arab countries. Results from the limited number of clinical trials on the treatment of chronic HCV genotype 4 using peginterferon alfa-2b in combination with ribavirin are encouraging. However, efforts to develop more effective antiviral therapies and the establishment of an effective HCV vaccine remain the largest challenges for the near future.

Genotype↗