Background-The Mediterranean diet is protective against cardiovascular disease; a proposed mechanism is through a reduction in systemic inflammation. It is unknown to what extent the association between the Mediterranean diet and inflammation is due to genetic or other familial factors. Methods and Results-We administered the Willett food frequency questionnaire to 345 middle-aged male twins and assessed adherence to the Mediterranean diet using a published adherence score. Fasting plasma levels of interleukin-6, C-reactive protein, and known cardiovascular risk factors were measured. Mixed-effect regression analyses were used to examine the relationship between diet score and inflammatory biomarkers after accounting for known cardiovascular risk factors. Adherence to the Mediterranean diet was associated with reduced levels of interleukin-6 (PϽ0.001) but not C-reactive protein (Pϭ0.10) after adjustment for total energy intake, other nutritional factors, known cardiovascular risk factors, and use of supplements and medications. When the overall association of adherence to the diet with interleukin-6 levels was partitioned into between-and within-pair effects, the between-pair effect was not significant (Pϭ0.9) and the within-pair effect was highly significant (PϽ0.0001). A 1-unit within-pair absolute difference in the diet score was associated with a 9% (95% CI, 4.5 to 13.6) lower interleukin-6 level. Conclusions-Shared environmental and genetic factors are unlikely to play a major role in the association between adherence to the Mediterranean diet and systemic inflammation. These results support the hypothesis that reduced inflammation is an important mechanism linking Mediterranean diet to reduced cardiovascular risk. (Circulation. 2008; 117:169-175.)

Background-Major depressive disorder (MDD) has been linked to inflammation, but this association may be due to common precursors to both depression and inflammation. Myeloperoxidase (MPO) is an inflammatory enzyme produced by activated leukocytes which predicts risk of coronary heart disease. We sought to examine whether MPO and other markers of inflammation are associated with MDD, and whether the association is confounded by genetic or other shared familial factors.

The associations between specific intra- and inter-personal psychosocial factors and dietary patterns were explored in a healthy, working adult population. Participants (N= 640) were enrolled in a prospective predictive health study and characterized by a mean age of 48(SD = 11) years, 67% women, and 30% minority. Baseline psychosocial measures of perceived stress, depressive symptoms, social support, and family functioning were examined for their relationships with three diet quality indices - AHEI, DASH, and the Mediterranean. Dietary intake was of moderate quality in this high income, well-educated, psychosocially healthy population. Social support was positively associated with better diet quality for all three indices (p< .01). Further research should focus on socio-environmental factors associated with diet quality.

Diet and activity pattern changes consequent to urbanization are contributing to the global epidemic of cardiovascular disease; less research has focused on activity within rural populations. We studied 527 women and 360 men (25-42 y), all rural-born and currently residing in rural or urban areas of Guatemala. We further classified rural male occupations as agricultural or nonagricultural. Overweight status (BMI > or = 25 kg/m(2)) differed by residence/occupation among men (agricultural-rural, 27%; nonagricultural-rural, 44%; and urban, 55%; P< 0.01) and women (rural, 58%; and urban, 68%; P= 0.04). A moderate-to-vigorous lifestyle was reported by 76, 37, and 20% of men (agricultural-rural, nonagricultural-rural, and urban, respectively; P< 0.01); most women were sedentary, with no difference by residence. Prevalence of the metabolic syndrome was 17, 24, and 28% in agricultural-rural, nonagricultural-rural, and urban men, respectively (P= 0.2), and 44 and 45% in rural and urban women (P= 0.4). Dietary variables were largely unassociated with adiposity or cardio-metabolic risk factors; physical activity was inversely associated with the percentage of body fat in men. Percent body fat was inversely associated with HDL-cholesterol, and positively associated with triglycerides, blood pressure, and the metabolic syndrome in both men and women, and with LDL-cholesterol and fasting glucose in women. Differences in physical activity level, mainly attributable to occupation, appear more important than residence, per se, in influencing the risk for cardiovascular disease among men; differences among these sedentary women are likely related to other factors associated with an urban environment.