Objective: To present the Mediterranean diet (MD) pyramid: a lifestyle for today. Design: A new graphic representation has been conceived as a simplified main frame to be adapted to the different nutritional and socio-economic contexts of the Mediterranean region. This review gathers updated recommendations considering the lifestyle, dietary, sociocultural, environmental and health challenges that the current Mediterranean populations are facing. Setting and Subjects: Mediterranean region and its populations. Results: Many innovations have arisen since previous graphical representations of the MD. First, the concept of composition of the 'main meals' is introduced to reinforce the plant-based core of the dietary pattern. Second, frugality and moderation is emphasised because of the major public health challenge of obesity. Third, qualitative cultural and lifestyle elements are taken into account, such as conviviality, culinary activities, physical activity and adequate rest, along with proportion and frequency recommendations of food consumption. These innovations are made without omitting other items associated with the production, selection, processing and consumption of foods, such as seasonality, biodiversity, and traditional, local and eco-friendly products. Conclusions: Adopting a healthy lifestyle and preserving cultural elements should be considered in order to acquire all the benefits from the MD and preserve this cultural heritage. Considering the acknowledgment of the MD as an Intangible Cultural Heritage of Humanity by UNESCO (2010), and taking into account its contribution to health and general well-being, we hope to contribute to a much better adherence to this healthy dietary pattern and its way of life with this new graphic representation.

HER2 is a tyrosine kinase receptor causally involved in cancer. A subgroup of breast cancer patients with particularly poor clinical outcomes expresses a heterogeneous collection of HER2 carboxy-terminal fragments (CTFs). However, since the CTFs lack the extracellular domain that drives dimerization and subsequent activation of full-length HER2, they are in principle expected to be inactive. Here we show that at low expression levels one of these fragments, 611-CTF, activated multiple signaling pathways because of its unanticipated ability to constitutively homodimerize. A transcriptomic analysis revealed that 611-CTF specifically controlled the expression of genes that we found to be correlated with poor prognosis in breast cancer. Among the 611-CTF-regulated genes were several that have previously been linked to metastasis, including those for MET, EPHA2, matrix metalloproteinase 1, interleukin 11, angiopoietin-like 4, and different integrins. It is thought that transgenic mice overexpressing HER2 in the mammary glands develop tumors only after acquisition of activating mutations in the transgene. In contrast, we show that expression of 611-CTF led to development of aggressive and invasive mammary tumors without the need for mutations. These results demonstrate that 611-CTF is a potent oncogene capable of promoting mammary tumor progression and metastasis.HER2 (ErbB2) is a type I transmembrane protein that belongs to the epidermal growth factor receptor (EGFR, ErbB1, HER1) family. Two additional members, HER3 and -4 (ErbB3 and -4), complete this family. When an EGF-like ligand binds to HER1, -3, or -4, its extracellular domain adopts the socalled open conformation, which allows the formation of homo-or heterodimers (5). Despite not binding any ligand, HER2 readily interacts with other ligand-bound HER receptors because its extracellular domain is constitutively in an open conformation (10).At the cell surface, dimerization of the extracellular domains leads to interaction between the intracellular kinases of the HER receptors and subsequent transphosphorylation of tyrosine residues in the C-terminal tails. The phosphotyrosines act as docking sites for proteins that initiate signals which are transduced to the nucleus through different pathways, including the mitogen-activated protein kinases (MAPKs), phosphoinositide-3-kinase-activated Akt, Src, and phospholipase C gamma (PLCgamma) pathways. These signaling circuitries control the expression of target genes that act coordinately to modify key aspects of cellular biology, including proliferation, migration, survival, and differentiation (7).In addition to the canonical mode, HER receptors or fragments of them are capable of direct signaling. For example, a nuclear carboxy-terminal fragment (CTF) encompassing the entire cytoplasmic domain of HER4 has been shown to regulate gene transcription (22,39). The CTF of HER4 is generated at the plasma membrane by the sequential action of two types of proteolytic enzymes known as the alpha-and gammasecretases. Alpha-secre...

Background: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact—and thus the sustainability—of diets. Objective: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. Methods: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. Conclusions: The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

BackgroundDietary patterns can substantially vary the resource consumption and environmental impact of a given population. Dietary changes such as the increased consumption of vegetables and reduced consumption of animal products reduce the environmental footprint and thus the use of natural resources. The adherence of a given population to the Mediterranean Dietary Pattern (MDP) through the consumption of the food proportions and composition defined in the new Mediterranean Diet pyramid can thus not only influence human health but also the environment. The aim of the study was to analyze the sustainability of the MDP in the context of the Spanish population in terms of greenhouse gas emissions, agricultural land use, energy consumption and water consumption. Furthermore, we aimed to compare the current Spanish diet with the Mediterranean Diet and in comparison with the western dietary pattern, exemplified by the U.S.A. food pattern, in terms of their corresponding environmental footprints.MethodsThe environmental footprints of the dietary patterns studied were calculated from the dietary make-up of each dietary pattern, and specific environmental footprints of each food group. The dietary compositions were obtained from different sources, including food balance sheets and household consumption surveys. The specific environmental footprints of food groups were obtained from different available life-cycle assessments.ResultsThe adherence of the Spanish population to the MDP has a marked impact on all the environmental footprints studied. Increasing adherence to the MDP pattern in Spain will reduce greenhouse gas emissions (72%), land use (58%) and energy consumption (52%), and to a lower extent water consumption (33%). On the other hand, the adherence to a western dietary pattern implies an increase in all these descriptors of between 12% and 72%.ConclusionsThe MDP is presented as not only a cultural model but also as a healthy and environmentally-friendly model, adherence to which, in Spain would have, a significant contribution to increasing the sustainability of food production and consumption systems in addition to the well-known benefits on public health.

Objective: The present study aimed to analyse the worldwide trends of adherence to the Mediterranean diet (MD), in 1961-1965 and 2000-2003. Design: Data were obtained from the FAO food balance sheets in two periods: 1961-1965 and 2000-2003. In order to have a sample from across the world, forty-one countries were selected. The average of available energy for different food groups was calculated for all selected countries. These values were used to evaluate the adherence to the MD through a variation of Mediterranean Adequacy Index (MAI).

Word count: 6944. Number of figures: 2. Number of tables: 3. Number and names of supplementary online material if applicable: no. 2 Background: From the 1960s to the early 21st-century adherence to the Mediterranean diet (MD) declined around the world. This was partly due to the westernization of eating habits. However, in the last decade a new variable came into play, the economic crisis, which may have affected dietary patterns.

Factor analysis using the correlations between indexes was applied. The correlation with factors and the reliability coefficient were calculated. Setting: A total of 324 healthy undergraduates at the University of Barcelona, Spain, were surveyed. Results: The highest correlations were observed between MDP adherence index and MAI (0?82); MAI and MSDPS (0?80); and MDS and rMED (0?77). Factor analysis showed a hidden common factor that explained over 70 % of the variability (71?03 %). This factor is understood as 'adherence to the Mediterranean diet'. The indexes that showed the highest correlation with this factor were Med-DQI (0?85), MDS (0?84), rMED (0?80) and MAI (0?80). These indexes showed acceptable performance in measuring the adherence to the Mediterranean diet. The components that correlated strongly with this factor were monounsaturated-to-saturated fatty acid ratio (MS ratio), fruit and vegetables. Furthermore, a second common factor was found explaining 18 % of the variability. This second factor is highly positive related to dairy products and lean meat, and negative related to MS ratio. Conclusions: The indexes showed satisfactory performance in assessing adherence to the Mediterranean diet. However, in order to improve the reliability and concordance between the indexes, further studies are required to select the components, the number of components, and the scoring criteria of the indexes to improve their internal consistency.

Cardiodiabesity has been used to define and describe the well-known relationship between type 2 Diabetes Mellitus (T2DM), obesity, the metabolic syndrome (MetS) and cardiovascular disease (CVD). The objective of this study was to perform a scientific literature review with a systematic search to examine all the cardiovascular risk factors combined and their relationship with adherence to the Mediterranean Diet (MedDiet) pattern as primary prevention against cardiodiabesity in a holistic approach. Research was conducted using the PubMed database including clinical trials, cross-sectional and prospective cohort studies. Thirty-seven studies were reviewed: fourteen related to obesity, ten to CVD, nine to MetS, and four to T2DM. Indeed 33 provided strong evidence on the association between adherence to a MedDiet and a reduced incidence of collective cardiodiabesity risk in epidemiological studies. This scientific evidence makes the MedDiet pattern very useful for preventive strategies directed at the general population and also highlights the need to consider all these diet-related risk factors and health outcomes together in daily primary care.