Background: Epidemiological studies suggest that the Mediterranean diet (MedDiet) may reduce the risk of developing the metabolic syndrome (MetS). We compared the 1-year effect of 2 behavioral interventions to implement the MedDiet vs advice on a low-fat diet on MetS status.Methods: A total of 1224 participants were recruited from the PREDIMED (Prevenció n con Dieta Mediterránea) Study, a multicenter, 3-arm, randomized clinical trial to determine the efficacy of the MedDiet on the primary prevention of cardiovascular disease. Participants were older subjects at high risk for cardiovascular disease. Interventions were quarterly education about the MedDiet plus provision of either 1 L/wk of virgin olive oil (MedDiet ϩ VOO) or 30 g/d of mixed nuts (MedDietϩ nuts), and advice on a low-fat diet (control diet). All diets were ad libitum, and there was no increase in physical activity for any of the interventions. Lifestyle variables and MetS features as defined by the National Cholesterol Education Program Adult Treatment Panel III criteria were assessed.Results: At baseline, 61.4% of participants met criteria for the MetS. One-year prevalence was reduced by 6.7%, 13.7%, and 2.0% in the MedDiet ϩ VOO, MedDietϩ nuts, and control diet groups, respectively (MedDiet ϩ nuts vs control groups, P = .01; MedDiet ϩ VOO vs control group, P =.18). Incident rates of the MetS were not significantly different among groups (22.9%, 17.9%, and 23.4%, respectively). After adjustment for sex, age, baseline obesity status, and weight changes, the odds ratios for reversion of MetS were 1.3 (95% confidence interval, 0.8-2.1) for the MedDietϩVOO group and 1.7 (1.1-2.6) for the MedDietϩnuts group compared with the control diet group. Conclusion:A traditional MedDiet enriched with nuts could be a useful tool in the management of the MetS.

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The total dietary fiber, sugar, protein, lipid profile, sodium, and energy contents of 11 raw cashew kernel (Anacardium occidentale L.) samples from India, Brazil, Ivory Coast, Kenya, Mozambique, and Vietnam were determined. Total fat was the major component accounting for 48.3% of the total weight, of which 79.7% were unsaturated FA (fatty acids), 20.1% saturated FA, and 0.2% trans FA. Proteins, with 21.3 g/100 g, were ranked second followed by carbohydrates (20.5 g/100 g). The average sodium content was 144 mg/kg. Fourteen FA were identified among which oleic acid was the most abundant with a contribution of 60.7% to the total fat, followed by linoleic (17.77%), palmitic (10.2%), and stearic (8.93%) acids. The mean energy content was 2525 kJ/100g. Furthermore, the sterol profile and content, amino acids, vitamins, and minerals of four raw cashew kernel samples from Brazil, India, Ivory Coast, and Vietnam were determined. β‐Sitosterol with 2380 ± 4 mg/kg fat was the most occurring sterol. Glutamic acid, with 4.60 g/100 g, was the amino acid with highest presence, whereas tryptophan with 0.32 g/100 g was the one with lower presence. Vitamin E with an average contribution of 5.80 mg/100 g was the most abundant vitamin. Potassium with a mean value of 6225 mg/kg was the mineral with highest amount in cashew samples.

BackgroundThe relationship between plasma concentrations of betaine and choline metabolism and major cardiovascular disease (CVD) end points remains unclear. We have evaluated the association between metabolites from the choline pathway and risk of incident CVD and the potential modifying effect of Mediterranean diet interventions.Methods and ResultsWe designed a case‐cohort study nested within the PREDIMED (Prevention With Mediterranean Diet) trial, including 229 incident CVD cases and 751 randomly selected participants at baseline, followed up for 4.8 years. We used liquid chromatography–tandem mass spectrometry to measure, at baseline and at 1 year of follow‐up, plasma concentrations of 5 metabolites in the choline pathway: trimethylamine N‐oxide, betaine, choline, phosphocholine, and α‐glycerophosphocholine. We have calculated a choline metabolite score using a weighted sum of these 5 metabolites. We used weighted Cox regression models to estimate CVD risk. The multivariable hazard ratios (95% confidence intervals) per 1‐SD increase in choline and α‐glycerophosphocholine metabolites were 1.24 (1.05–1.46) and 1.24 (1.03–1.50), respectively. The baseline betaine/choline ratio was inversely associated with CVD. The baseline choline metabolite score was associated with a 2.21‐fold higher risk of CVD across extreme quartiles (95% confidence interval, 1.36–3.59; P<0.001 for trend) and a 2.27‐fold higher risk of stroke (95% confidence interval, 1.24–4.16; P<0.001 for trend). Participants in the higher quartiles of the score who were randomly assigned to the control group had a higher risk of CVD compared with participants in the lower quartile and assigned to the Mediterranean diet groups (P=0.05 for interaction). No significant associations were observed for 1‐year changes in individual plasma metabolites and CVD.ConclusionsA metabolite score combining plasma metabolites from the choline pathway was associated with an increased risk of CVD in a Mediterranean population at high cardiovascular risk.Clinical Trial Registration URL: http://www.controlled-trials.com. Unique identifier: ISRCTN35739639.

Bread is widely considered to be the foodstuff that provides the most dietary salt to the diet. As such, it is one of the key public health targets for a salt reduction policy. In this respect, it has been shown that a reduction in the salt content of bread is possible, and an alternative approach involves partial replacement with other, mainly potassium-based salts, which also counteract the effects of sodium. This replacement should be undertaken on the basis of criteria that maintain the product's sensory profile, and it tends to be more successful in breads with more naturally flavorful taste. The present review was conducted to examine salt intake in Europe and the health problems associated with its excessive consumption; particular focus is placed on the salt content of bread and the effects of its possible reduction and/or correction. The beneficial effects of such changes are highlighted by way of a theoretical calculation in baguette-type wheat bread. European legislation in the field of nutrition and health claims allows the positive aspects of such salt reduction and replacement methods to be stated.

A total of 930 subjects at high cardiovascular risk (420 men and 510 women) were recruited in the framework of a multicentre, randomized, controlled, parallel-group clinical trial directed at testing the efficacy of the TMD on the primary prevention of cardiovascular disease (The PREDIMED Study). Participants were assigned to a lowfat diet (control, n = 310) or one of two TMDs [TMD + virgin olive oil (VOO) or TMD + nuts]. Depending on group assignment, participants received free provision of extra-virgin olive oil, mixed nuts, or small non-food gifts. After 1 year of intervention, both TMDs decreased plasma N-terminal pro-brain natriuretic peptide, with changes reaching significance vs. control group (P < 0.05). Oxidized low-density lipoprotein decreased in both TMD groups (P < 0.05), the decrease in TMD + VOO group reaching significance vs. changes in control group (P = 0.003). Changes in lipoprotein(a) after TMD + VOO were less than those in the control group (P = 0.046) in which an increase (P = 0.035) was observed. No changes were observed in urinary albumin or albumin/creatinine ratio.

Oxidative stress has been involved in the aetiology of hypertension, insulin resistance, the metabolic syndrome, cardiovascular disease and other chronic conditions. Several epidemiological studies suggest that a diet rich in natural antioxidants is associated with protective effects against major diseases, especially cardiovascular disease. The Mediterranean diet is rich in fat and foods with important antioxidant properties, such as fruits and vegetables, olive oil, and nuts. In this review we focus on epidemiological evidence and clinical trials that relate the Mediterranean diet with oxidative stress markers. We focus our review on two important Mediterranean vegetable sources of potentially oxidized fat-olive oil and nuts.

BackgroundThe traditional Mediterranean dietary pattern (MedDiet) is associated with longevity and low rates of cardiovascular disease (CVD). However, there is little information on who is more likely to follow this food pattern.AimTo evaluate how different factors are associated with lower MedDiet adherence in older Spanish subjects.MethodsWe included 7305 participants (men aged 55–80 y, women 60–80 y) at high-risk of CVD recruited into the PREDIMED trial (ISRCTN35739639). Socioeconomic, anthropometric, lifestyle characteristics and CVD risk factors were recorded. A validated 14-item questionnaire was used to evaluate MedDiet adherence at baseline. Multivariate models were used to estimate odds ratios (OR) and 95% confidence intervals for lower adherence to the MedDiet (<9 points out of 14) and ascertain factors independently associated with it.ResultsFormer smoking (OR = 0.87; 95% CI, 0.78–0.98), physical activity (OR for the 3rd vs. the 1sttertile: 0.69; 0.62–0.78), and higher educational level (OR for university vs. less than primary school: 0.54; 0.38–0.77) were associated with higher MedDiet adherence. Conversely, having a larger waist-to-height ratio (OR for 0.1 units, 1.35; 1.22–1.49), being diabetic (OR = 1.13; 1.03–1.24), being single (OR = 1.27; 1.01–1.61) or divorced or separated (OR = 1.44; 1.09–1.89), and current smoking (OR = 1.28; 1.11–1.47) were associated with lower adherence.ConclusionsParticipants with little education, a larger waist-to-height ratio, or diabetes and those who were less physically active, single, divorced or separated, or smokers were less likely to adhere to the MedDiet, an ideal model for food choices. Stronger efforts of health promotion are needed in these groups to foster adoption of the MedDiet.