Category Archives: Mediterranean Diet

Chemical composition of olive oil

Olive oil constituents

Olive Oil
Fig. 1 – EVOO

From a chemical point of view, we can identify in the olive oil two fractions, depending on the behavior in the presence of heating and strong alkaline solutions (concentrated solutions of KOH or NaOH):

  • the saponifiable fraction, which represents 98-99% of the total weight, is composed of substances that form soaps in the above conditions;
  • the unsaponifiable fraction, which represents the remaining 1-2% of the total weight, is composed of substances that fail to form soaps in the above conditions.

Saponifiable fraction of olive oil

It is composed of saturated and unsaturated fatty acids, esterified almost entirely to glycerol to form triglycerides (or triacylglycerols). To a much lesser extent, diglycerides (or diacylglycerols), monoglycerides (monoacylglycerols), and free fatty acids are also found.
Unsaturated fatty acids make up 75 to 85% of the total fatty acids. Oleic (O) and linoleic (L) acids are the most abundant ones; palmitoleic, eptadecenoic, gadoleic and alpha-linolenic (Ln) acids are present in lower/trace amounts.

Oleic Acid
Fig. 2 – IOOC and Fatty Acids

Oleic acid is the major fatty acid in olive oils. According to the rules laid down by the International Olive Oil Council (IOOC), its concentration must range from 55% to 83% of total fatty acids.
Linoleic acid is the most abundant polyunsaturated fatty acid in olive oil; its concentration must vary between 2.5% and 21% (IOOC). Because of its high degree of unsaturation, it is subject to oxidation; this means that an oil high in linoleic acid becomes rancid easily, and thus it may be stored for a shorter time.
In a Mediterranean-type diet, olive oil is the main source of fat: therefore, oleic acid, among monounsaturated fatty acids, and linoleic acid, among polyunsaturated fatty acids, are the most abundant fatty acids.
alpha-Linolenic acid must be present in very low amount, according to the IOOC standards ≤1%. It is an omega-3 polyunsaturated fatty acid, which may have health benefits. However, because of to its high degree of unsaturation (higher than that of linoleic acid), it is very susceptible to oxidation, and therefore it promotes rancidity of the olive oil that contains it.
Saturated fatty acids make up 15 to 25% of the total fatty acids.
Palmitic (P) (7.5-20%) and stearic (S) acids (0.5-5%) are the most abundant saturated fatty acids; myristic, heptadecanoic, arachidic, behenic and lignoceric acids may be present in trace amounts.

The presence of fatty acids that should be absent or present in amounts different than those found is a marker of adulteration with other vegetable oils. On this regard, particular attention is paid to myristic, arachidic, behenic, lignoceric, gadoleic and alpha-linolenic acids, whose limits are set by IOOC.

Fatty acid composition is influenced by several factors.

  • The climate.
  • The latitude.
  • The zone of production.
    Italian, Spanish and Greek olive oils are high in oleic acid and low in palmitic and linoleic acids, while Tunisian olive oils are high in palmitic and linoleic acids but lower in oleic acid. Therefore, oils can be divided into two groups:

one rich in oleic acid and low in palmitic and linoleic acids;
the other high in palmitic and linoleic acids and low in oleic acid.

  • The cultivar.
  • The degree of olive ripeness at the time of oil extraction.
    It should be noted that oleic acid is formed first in the fruit, and data seem to indicate a competitive relationship between oleic acid and palmitic, palmitoleic, and linoleic acids.

Triglycerides of olive oil

Olive Oil
Fig. 3 – The sn Positions of Triglycerides

As previously said, fatty acids in olive oil are almost entirely present as triglycerides.
In small percentage, they are also present as diglycerides, monoglycerides, and in free form.
During triglyceride biosynthesis, thanks to the presence of specific enzymes, only about 2% of glycerol binds palmitic acid in the sn-2 position (also the percentage of stearic acid in the sn-2 position is very low); for the most part, the sn-2 position is occupied by oleic acid.
On the contrary, if we consider oils that have undergone a nonenzymatic esterification, the percentage of palmitic acid in the sn-2 position increases significantly.
Note: sn = stereospecific numbering

Among triglycerides present in significant proportions in olive oil, there are:

  • OOO: 40-59%;
  • POO: 12-20%;
  • OOL: 12.5-20%;
  • POL:  5.5-7%;
  • SOO: 3- 7%.

POP, POS, OLnL, OLnO, PLL, PLnO are present in smaller amounts.
Trilinolein (LLL) is a triglyceride that contains three molecules of linoleic acid. Its low content is an indicator of an oil of good quality.
Triglycerides containing three saturated fatty acids or three molecules of alpha-linolenic acid have not been reported.

Diglycerides and monoglycerides of olive oil

Their presence is due to an incomplete synthesis and/or a partial hydrolysis of triglycerides.
The content of diglycerides in virgin olive oil ranges from 1% to 2.8%. 1,2-Diglycerides prevail in fresh olive oil, representing over 80% of the diglycerides. During oil storage, isomerization occurs with a progressive increase of the more stable 1-3 isomers, which after about 10 months become the major isomers.
Therefore, the ratio 1,2/1,3-diglycerides may be used as an indicator of the age of the oil.
Monoglycerides are present in amounts lower than diglycerides, <0.25%, with 1-monoglycerides far more abundant than 2-monoglycerides.

Unsaponifiable fractions of olive oil

It is composed of a large number of different molecules, very important from a nutritional point of view, as they contribute significantly to the health effects of olive oil.
Furthermore, they are responsible for the stability and the taste of olive oil, and are also used to detect adulteration with other vegetable oils.
This fraction includes tocopherols, sterols, polyphenols, pigments, hydrocarbons, aromatic and aliphatic alcohol, triterpene acids, waxes, and minor constituents.
Their content is influenced by factors similar to those seen for fatty acid composition, such as:

  • the cultivar;
  • the degree of ripeness of the olive;
  • the zone of production;
  • the crop year and olive harvesting practices;
  • the storage time of olives;
  • the oil extraction process;
  • the storage conditions of the oil.

It should be noted that many of these compounds are not present in refined olive oils, as they are removed during the refining processes.

Polyphenols

They make up 18 to 37% of the unsaponifiable fraction.
They are a very heterogeneous group of molecules with nutritional and organoleptic properties  (for example, oleuropein and hydroxytyrosol give oil its bitter and pungent taste).
For a more extensive discussion, see: ” Polyphenols in olive oil: variability and composition.”

Hydrocarbons

Olive Oil
Fig. 4 – Squalene

They make up 30 to 50% of the unsaponifiable fraction.
Squalene and beta-carotene are the main molecules.
Squalene, isolated for the first time from shark liver, is the major constituent of the unsaponifiable fraction, and constitutes more than 90% of the hydrocarbons. Its concentration ranges from 200 to 7500 mg/kg of olive oil.
It is an intermediate in the biosynthesis of the four-ring structure of steroids, and it seems to be responsible of several health effects of olive oil.
In the hydrocarbon fraction of virgin olive oil, n-paraffins, diterpene and triterpene hydrocarbons, isoprenoidal polyolefins are also found.
Beta-carotene acts both as antioxidant, protecting oil during storage, and as dye (see below).

Sterols

They are important lipids of olive oil, and are:

  • linked to many health benefits for consumers;
  • important to the quality of the oil;
  • widely used for checking its genuineness.
    On this regard, it is to underline that sterols are species-specific molecules; for example, the presence of high concentrations of brassicasterol, a sterol typically found in Brassicaceae (Cruciferae) family, such as rapeseed, indicates adulteration of olive oil with canola oil.

Four classes of sterols are present in olive oil: common sterols, 4-methylsterols, triterpene alcohols, and triterpene dialcohols. Their content ranges from 1000 mg/kg, the minimum value required by the IOOC standard, to 2000 mg/kg. The lowest values are found in refined oils because of the refining processes may cause losses up to 25%.

Common sterols or 4α-desmethylsterols
Olive Oil
Fig. 5 – beta-Sitosterol

Common sterols are present mainly in the free and esterified form; however they have been also found as lipoproteins and sterylglucosides.
The main molecules are beta-sitosterol, which makes up 75 to 90% of the total sterol, Δ5-avenasterol, 5 to  20%, and campesterol, 4%. Other components found in lower amounts or traces are, for example, stigmasterol, 2%, cholesterol, brassicasterol, and ergosterol.

4-methylsterols

They are intermediates in the biosynthesis of sterols, and are present both in the free and esterified form. They are present in small amounts, much lower than those of common sterols and triterpene alcohols, varying between 50 and 360 mg/kg. The main molecules are obtusifoliol, cycloeucalenol, citrostadienol, and gramisterol.

Triterpene alcohols or 4,4-dimethylsterols

They are a complex class of sterols, present both in the free and esterified form. They are found in amounts ranging from 350 to 1500 mg/kg.
The main components are beta-amyrin, 24-methylenecycloartanol, cycloartenol, and butyrospermol; other molecules present in lower/trace amounts are, for example, cyclosadol, cyclobranol, germanicol, and dammaradienol.

Triterpene dialcohols

The main triterpene dialcohols found in olive oil are erythrodiol and uvaol.
Erythrodiol is present both in the free and esterified form; in virgin olive oil, its level varies between 19 and 69 mg/kg, and the free form is generally lower than 50 mg/kg.

Tocopherols

They make up 2 to 3% of the unsaponifiable fraction, and include vitamin E.
Of the eight E-vitamers, alpha-tocopherol represents about 90% of tocopherols in virgin olive oil. It is present in the free form and in very variable amount, but on average higher than 100 mg/kg of olive oil. Thanks to its in vivo antioxidant properties, its presence is a protective factor for health. Alpha-tocopherol concentration seems to be related to the high levels of chlorophylls and to the concomitant requirement for deactivation of singlet oxygen.
Beta-tocopherol, delta-tocopherol, and gamma-tocopherol are usually present in low amounts.

Pigments

In this group we find chlorophylls and carotenoids.
In olive oil, chlorophylls are present as phaeophytins, mainly  phaeophytin a (i.e. a chlorophyll from which magnesium has been removed and substituted with two hydrogen ions), and confer the characteristic green color to olive oil. They are photosensitizer molecules that contribute to the photooxidation of olive oil itself.
Beta-carotene and lutein are the main carotenoids in olive oil. Several xanthophylls are also present, such as antheraxanthin, beta-cryptoxanthin, luteoxanthin, mutatoxanthin, neoxanthin, and violaxanthin.
Olive oil’s color is the result of the presence of chlorophylls and carotenoids and of their green and yellow hues. Their presence is closely related.

 Triterpene acids

They are important components of the olive, and are present in trace amounts in the oil.
Oleanolic and maslinic acids are the main triterpene acids in virgin olive oil: they are present in the olive husk, from which they are extracted in small amount during processing.

Aliphatic and aromatic alcohols

Fatty alcohols and diterpene alcohols are the most important ones.
Aliphatic alcohols have a number of carbon atoms between 20 and 30, and are located mostly inside the olive stones, from where they are partially extracted by milling.

Fatty alcohols

They are linear saturated alcohols with more than 16 carbon atoms.
They are found in the free and esterified form and are present, in virgin olive oil, in amount not generally higher than 250 mg/kg.
Docosanol (C22), tetracosanol (C24), hexacosanol (C26), and octacosanol (C28) are the main fatty alcohols in olive oil, with tetracosanol and hexacosanol present in larger amounts.
Waxes, which are minor constituents of olive oil, are esters of fatty alcohols with fatty acids, mainly of palmitic acid and oleic acid. They can be used as a criterion to discriminate between different types of oils; for example, they must be present in virgin and extra virgin olive oil at levels <150 mg/kg, according to the IOOC standards.

 Diterpene alcohols

Geranylgeraniol and phytol are two acyclic diterpene alcohols, present in the free and esterified form. Among esters present in the wax fraction of extra virgin olive oil, oleate, eicosenoate , eicosanoate, docosanoate, and tetracosanoate have been found, mainly as phytyl derivatives.

Volatile compounds

More than 280 volatile compounds have been identified in olive oil, such as hydrocarbons, the most abundant fraction, alcohols, aldehydes, ketones, esters, acids, ethers and many others. However, only about 70 of them are present at levels higher than the perception threshold beyond which they may contribute to the aroma of virgin olive oil.

Minor components

Phospholipids are found among the minor components of olive oil; the main ones are phosphatidylserine, phosphatidylethanolamine, phosphatidylcholine, phosphatidylinositol.
In the unfiltered oils, trace amounts of proteins may be found.

 References

Gunstone F.D. Vegetable oils in food technology: composition, properties and uses. 2th. Edition. Wiley J. & Sons, Inc., Publication, 2011

Pasqualone A., Sikorska E., Gomes T. Influence of the exposure to light on extra virgin olive oil quality during storage. Eur Food Res Technol 2005;221:92-8 [Abstract]

Servili M., Sordini B., Esposto S., Urbani S., Veneziani G., Di Maio I., Selvaggini R. and Taticchi A. Biological activities of phenolic compounds of extra virgin olive oil. Antioxidants 2014;3:1-23 [Abstract]

Alkaline diet and health benefits

Alkaline diet and bone health

The acid-ash hypothesis posits that protein and grain foods, with a low potassium intake, produce a diet acid load, net acid excretion, increased urine calcium, and release of calcium from the skeleton, leading to osteoporosis.” (Fenton et al., 2009).
Is it true?
Calcium, present in bones in form of carbonates and phosphates, represents a large reservoir of base in the body. In response to an acid load such as the high protein diets these salts are released into the circulation to bring about pH homeostasis. This calcium is lost in the urine and it has been estimated that the quantity lost with the such diet over time could be as high as almost 480 g over 20 years or almost half the skeletal mass of calcium!
Even these losses of calcium may be buffered by ingestion of foods that are alkali rich as fruit and vegetables, and on-line information promotes an alkaline diet for bone health as well as a number of books, a recent meta-analysis has shown that the causal association between osteoporotic bone disease and dietary acid load is not supported by evidence and there is no evidence that the alkaline diet is protective of bone health (but it is protective against the risk for kidney stones).

Note: it is possible that fruit and vegetables are beneficial to bone health through mechanisms other than via the acid-ash hypothesis.

And protein?
Excess dietary protein with high acid renal load may decrease bone density, if not buffered by ingestion of foods that are alkali rich, that is fruit and vegetables. However, an adequate protein intake is needed for the maintenance of bone integrity. Therefore, increasing the amount of fruit and vegetables may be necessary rather than reducing protein too much.
Therefore it is advisable to consume a normo-proteic diet rich in fruits and vegetables and poor in sodium, that is, a Mediterranean Diet-like eating patterns, eating foods with a negative acid load together with foods with a positive acid load. Example: pasta plus vegetables or meats plus vegetables and fruits (see figure below).

Alkaline Diet: Food and Acid Load
Fig. 1 – Food and Acid Load

Alkaline diet and muscle mass


As we age, there is a loss of muscle mass, which predispose to falls and fractures. A diet rich in potassium, obtained from fruits and vegetables, as well as a reduced acid load, results in preservation of muscle mass in older men and women.

Alkaline diet and growth hormone

In children, severe forms of metabolic acidosis are associated with low levels of growth hormone with resultant short stature; its correction with potassium or bicarbonate citrate increases growth hormone significantly and improves growth. In postmenopausal women, the use of enough potassium bicarbonate in the diet to neutralize the daily net acid load resulted in a significant increase in growth hormone and resultant osteocalcin.
Improving growth hormone levels may reduce cardiovascular risk factors, improve quality of life, body composition, and even memory and cognition.

Conclusion

Alkaline diet may result in a number of health benefits.

  • Increased fruits and vegetables would improve the K/Na ratio and may benefit bone health, reduce muscle wasting, as well as mitigate other chronic diseases such as hypertension and strokes.
  • The increase in growth hormone may improve many outcomes from cardiovascular health to memory and cognition.
  • The increase in intracellular magnesium is another added benefit of the alkaline diet (e.g. magnesium, required to activate vitamin D, would result in numerous added benefits in the vitamin D systems).

It should be noted that one of the first considerations in an alkaline diet, which includes more fruits and vegetables, is to know what type of soil they were grown in since this may significantly influence the mineral content and therefore their buffering capacity.

References

Fenton T.R., Lyon A.W., Eliasziw M., Tough S.C., Hanley D.A. Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res 2009;24(11):1835-40 [Abstract]

Fenton T.R., Lyon A.W., Eliasziw M., Tough S.C., Hanley D.A. Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr J 2009;8:article 41 [Abstract]

Fenton T.R., Tough S.C., Lyon A.W., Eliasziw M., Hanley D.A. “Causal assessment of dietary acid load and bone disease: a systematic review and meta-analysis applying Hill’s epidemiologic criteria for causality.” Nutr J 2011;10:article 41 [Abstract]

Schwalfenberg G.K. The alkaline diet: is there evidence that an alkaline pH diet benefits health? J Environ Public Health 2012; Article ID 727630:7 pages doi:10.1155/2012/727630 [Abstract]

Metabolic acidosis and “modern diet”

Metabolic acidosis and pH level

Metabolic Acidosis: The pH Scale
Fig. 1 – The pH Scale

Life depends on appropriate pH levels around and in living organisms and cells.
We requires a tightly controlled pH level in our serum of about 7.4 (a slightly alkaline range of 7.35 to 7.45) to avoid metabolic acidosis and survive. As a comparison, in the past 100 years the pH of the ocean has dropped from 8.2 to 8.1 because of increasing carbon dioxide (CO2) deposition with a negative impact on life in the ocean (it may lead to the collapse of the coral reefs).
Even the mineral content of the food we eat (minerals are used as buffers to maintain pH within the aforementioned range) is considerabled influence by the pH of the soil in which plants are grown. The ideal pH of soil for the best overall availability of essential nutrients is between 6 and 7: an acidic soil below pH of 6 may have reduced magnesium and calcium, and soil above pH 7 may result in chemically unavailable zinc, iron, copper and manganese.

Metabolic acidosis and agricultural and industrial revolutions

In the human diet, there has been considerable change from the hunter gather civilization to the present in the pH and net acid load. With the agricultural revolution (last 10,000 years) and even more recently with industrialization (last 200 years) it has been seen:

  • an increase in sodium compared to potassium (the ratio potassium/sodium has reversed from 10 to 1 to a ratio of 1 to 3 in the modern diet) and in chloride compared to bicarbonate in the diet,;
  • a poor intake of magnesium and fiber;
  • a large intake of simple sugars and saturated fat.

This results in a diet that may induce metabolic acidosis which is mismatched to the genetically determined nutritional requirements.
Moreover, with aging, there is a gradual loss of renal acid-base regulatory function and a resultant increase in diet-induced metabolic acidosis.
Finally, a high protein low-carbohydrate diet with its increased acid load results in very little change in blood chemistry, and pH, but results in many changes in urinary chemistry: urinary calcium, undissociated uric acid, and phosphate are increased, while urinary magnesium, urinary citrate and pH are decreased.
All this increases the risk for kidney stones.

pH as a protective barrier

Metabolici Acidosis: pH of Selected Fluids, Organs, and Membranes
Fig. 2 – pH of Selected Fluids, Organs, and Membranes

The human body has an amazing ability to maintain a steady pH in the blood with the main compensatory mechanisms being renal and respiratory.
The pH in the body vary considerably from one area to another. The highest acidity is found in the stomach (pH of 1.35 to 3.5) and it aids in digestion and protects against opportunistic microbial organisms. The skin is quite acidic (pH 4-6.5) and this provides an acid mantle as a protective barrier to the environment against microbial overgrowth (this is also seen in the vagina where a pH of less than 4.7 protects against microbial overgrowth).
The urine have a variable pH from acid to alkaline depending on the need for balancing the internal environment.

References

Fenton T.R., Lyon A.W., Eliasziw M., Tough S.C., Hanley D.A. Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res 2009;24(11):1835-40 [Abstract]

Fenton T.R., Lyon A.W., Eliasziw M., Tough S.C., Hanley D.A. Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr J 2009;8:article 41 [Abstract]

Fenton T.R., Tough S.C., Lyon A.W., Eliasziw M., Hanley D.A. “Causal assessment of dietary acid load and bone disease: a systematic review and meta-analysis applying Hill’s epidemiologic criteria for causality.” Nutr J 2011;10:article 41 [Abstract]

Schwalfenberg G.K. The alkaline diet: is there evidence that an alkaline pH diet benefits health? J Environ Public Health 2012; Article ID 727630:7 pages doi:10.1155/2012/727630 [Abstract]

Fruits and vegetables in season

Health benefits of seasonal fruits and vegetables

Numerous studies showed that seasonality plays a key role in optimizing the antioxidant properties of fruits and vegetables. For example, a recent Chinese study have investigated the influence of growing season (summer vs winter) on the synthesis and accumulation of phenolic compounds and antioxidant properties in five grape cultivars. The study showed that both phenolic compounds and antioxidant properties in the skin and seed of winter berries were significantly higher than those of summer berries for all of the cultivars investigated. Finally, to choose seasonal fruits and vegetables also ensures considerable saving of money.

List of fruits and vegetables in season

Fruits and Vegetables: Fruits in Season
Fig. 1 – Fruits in Season

 

 

 

 

 

Fruits and Vegetables: Vegetables in Season
Fig. 2 – Vegetables in Season

 

 

 

 

 

 

Xu C., Zhang Y., Zhu L., Huang Y., and Jiang Lu J. Influence of growing season on phenolic compounds and antioxidant properties of grape berries from vines Grown in Subtropical Climate. J Agric Food Chem 2011:59(4);1078–1086

Income, education, adherence to a Mediterranean diet pattern and obesity prevalence

Income, education, Mediterranean diet and obesity

In a study published on British Medical Journal a research team has examined cross-sectional associations of income and education with an adherence to a Mediterranean dietary pattern and obesity prevalence on a sample of 13262 subjects (mean age 53±11, 50% men) out of 24 318 citizens (citizens of Molise, a region placed between Central and Southern Italy) randomly enrolled in the Moli-sani Project, a population based cohort study.
Household net income categories were considered as:

  • high (>40000 Euro/year);
  • medium–high (>25000 <40000 Euro/year);
  • low–medium (>10000<25000 Euro/year);
  • low (< 10000 Euro/year).

Education level was divided into three categories:

  • ≤8 (low) years of studies;
  • >8 and ≤13 (medium) years of studies;
  • >13 (high) years of studies.

Household higher income were significantly associated with greater adherence to a Mediterranean diet and to olive oil and vegetables dietary pattern, with odds of having the highest adherence to a Mediterranean diet clearly increased according to income levels (diet quality showed a continued improvement across the relatively small range of economic strata). Obesity prevalence was higher in the lowest-income group in comparison with the highest-income category.
Education was positively associated with adherence to Mediterranean diet and lower prevalence of obesity.

Conclusion

The study showed that a higher income and education are independently associated with a greater adherence to Mediterranean diet-like eating patterns and a lower prevalence of obesity.

Bonaccio M., Bonanni A.E., Di Castelnuovo A., De Lucia F.,Donati M.B.,de Gaetano G.,Iacoviello L., on behalf of the Moli-sani Project Investigators. Low income is associated with poor adherence to a Mediterranean diet and a higher prevalence of obesity: cross-sectional results from the Moli-sani study. BMJ Open 2012;2:e001685. doi:10.1136/bmjopen-2012-001685

Potassium intake and cardiovascular risk factors

Potassium intake and health

In a study published on British Medical Journal a research team has conducted a systematic review of the literature and meta-analyses on potassium intake and health in apparently healthy adults and children without renal impairment that might compromise its handling.
Eleven cohort studies (127038 participants) reporting all cause mortality, stroke, cardiovascular disease, or coronary heart disease in adults and twenty-two randomized controlled trials (1606 participants) reporting blood lipids, blood pressure, renal function, and catecholamine concentrations were included in the study.
In adult with hypertension an increased potassium intake reduced systolic blood pressure by 3.49 mm Hg and diastolic blood pressure by 1.96 mm Hg.
No effect was seen in adult without hypertension (however, the studies were of relatively short duration and did not consider the effect that increased potassium intake may have over time) and in children (there is a lack of data in children: only three controlled studies with 156 partecipants).
There was no adverse effect of increased potassium intake on blood lipids, or catecholamine concentrations in adults whereas an inverse statistically significant association was seen between its intake and the risk of incident stroke (a 24% lower risk).
In healthy adult there was no significant adverse effect on renal function.
This study suggests that, in people without impaired renal function, increased potassium intake (at least 90 mmol/day) is potentially beneficial for the prevention and control of elevated blood pressure and stroke.

How to increase potassium intake

Potassium Intake: Fruits and Vegetables: Rich in Potassium
Fig. 1 – Fruits and Vegetables: Rich in Potassium

It should be noted that an increased potassium intake can be achieved following the largely plant-based Mediterranean Diet, which is characterized by the consumption of large quantities of fresh fruit, vegetable, legumes and unrefined cereals, all rich in potassium (that is also accompanied by a variety of other nutrients).

Aburto N.J., Hanson S., Gutierrez H., Hooper .L, Elliott P., Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013;346:f1378

Adherence to the Mediterranean Diet, cognitive status and cognitive decline in women

Adherence to the Mediterranean Diet and cognitive status in women
Adherence to the Mediterranean Diet: Cognitive status in women

In a large-scale prospective epidemiological study published on Journal of Nutrition a research team examined associations of long-term adherence to the Mediterranean Diet (adherence was based on intakes of: vegetables, legumes, fruits, nuts, whole grains, fish, red and processed meats, moderate alcohol, and the ratio of monounsaturated:saturated fat) and subsequent cognitive function and its decline.
The participants, 16,058 women from the Nurses’ Health Study, aged ≥70 y, underwent cognitive testing 4 times during 6 y.
The study showed that long-term Mediterranean Diet adherence was related to moderately better cognition but not with cognitive decline in this very large cohort of older women.

Samieri C., Okereke O.I., E. Devore E.E. and Grodstein F. Long-Term adherence to the Mediterranean Diet is associated with overall cognitive status, but not cognitive decline, in women. J Nutr 2013;143:493-9

Primary prevention of cardiovascular disease and Mediterranean Diet

Mediterranean diet and primary prevention of cardiovascular disease

Primary prevention: Walnuts and extra-virgin olive oil: healthy fats
Fig. 1 – Walnuts and extra-virgin olive oil: healthy fats

A Spanish research team conducted a multicenter randomized trial of Mediterranean Diet pattern for the primary prevention of cardiovascular events.
The participants (7447; age range 55 to 80 years; 57% women) were with no cardiovascular disease but at high cardiovascular risk at enrollment (they had either type 2 diabetes mellitus or at least three of the following major risk factors: hypertension, smoking, overweight or obesity, elevated low-density lipoprotein cholesterol levels, low high-density lipoprotein cholesterol levels or a family history of premature coronary heart disease).
They were randomly assigned to one of three diets:

  • a Mediterranean Diet supplemented with mixed nuts (30 g of mixed nuts: 7.5 g of almonds, 7.5 g of hazelnuts and 15 g of walnuts);
  • a Mediterranean Diet supplemented with extra-virgin olive oil (≥4 tbsp/day);
  • a control diet (advice to reduce dietary fat).

It should be noted that extravirgin olive oil is the cornerstone of Mediterranean Diet.

Moreover, in comparison with those in the control group, participants in the two Mediterranean-Diet groups significantly increased weekly servings of legumes and fish. These were the only between-group differences.
No physical activity was promoted, nor total calorie restriction advised.
Participants were followed for a median of 4.8 years.
The primary end point was the rate of myocardial infarction, stroke, or death from cardiovascular causes that is the rate of major cardiovascular events.

This study have shown that among persons at high cardiovascular risk, a Mediterranean Diet supplemented with nuts or extra-virgin olive oil has proved to be effective in the primary prevention of cardiovascular disease, reducing the incidence of major cardiovascular events.

Estruch R., Ros E., Salas-Salvadó J., et al. Primary prevention of cardiovascular disease with a Mediterranean Diet. N Engl J Med 2013