Promoting health and preventing non-communicable diseases: evaluation of the adherence of the Italian population to the Mediterranean Diet by using the PREDIMED questionnaire
Keywords:
Non-Communicable Diseases (NCD), Behavioral risk factors, Health Promotion, Nutrition Education, PREDIMEDAbstract
A health promotion program was conducted in the Veneto Region in Italy. Participants were screened for non-communicable diseases and were referred to the nutrition clinic. The aim of this study was to assess the adherence to the Mediterranean diet in the Italian population by using the “PREvención con DIeta MEDiterránea” questionnaire.
The data showed that 63% of the participants were overweight, 57% presented hypercholesterolemia, 36% were hypertensive and 43% had high blood glucose levels. The results highlighted a low consumption of protective foods against non-communicable diseases such as fruit, vegetables, fresh fish, legumes and oily dried fruit. Overall, only 6% of the subjects who visited the nutritional clinic had the maximum adherence to the Mediterranean diet, 73% had an average adherence, followed by 21% with low adherence. Multivariable analysis between risk factors and socio-demographic characteristics and the adherence to Mediterranean diet revealed that male gender relates directly (p =0.002, AOR = 2.95) to a low adherence.
There are three criteria in the questionnaire for a point in favour of Mediterranean diet which we believe to be inadequate, as they are not in accordance with the Italian guidelines for healthy eating. The “PREvención con DIeta MEDiterránea” questionnaire, if associated with a food frequency questionnaire or a food intake record, could become a useful tool for nutritional counseling in our Country.
References
1. World Health Organization (WHO). Non communicable diseases. Geneva, Switzerland: World Health Organization, 2018.
2. World Health Organization (WHO). Global Health Observatory (GHO) data; NCD Mortality and morbidity. Geneva, Switzerland: World Health Organization, 2016.
3. Alonzo E, Fardella M, Cannizzaro V, et al. Mediterranean diet as a natural supplemental resource for athletes and physical activity. Ann Ig 2019; 31(6): 576-81. doi: 10.7416/ai.2019.2317.
4. World Health Organization (WHO). Diet, Nutrition and Prevention of Chronic diseases; Report of the joint consultation of WHO / FAO experts. Geneva, Switzerland: World Health Organization, 2002.
5. Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol 2017; 18(8): e457-71. doi:10.1016/ S1470-2045(17)30411-4).
6. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37(29): 2315-81. doi:10.1093/ eurheartj/ehw106.
7. Keys A. How to eat well and stay well the Mediterranean way. Doubleday, 1975.
8. Martínez-González MA, García-Arellano A, Toledo E, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One 2012; 7(8): e43134. doi:10.1371/journal. pone.0043134.
9. Couto E, Boffetta P, Lagiou P, et al. Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br J Cancer 2011; 104(9): 1493-9. doi:10.1038/bjc.2011.106.
10. Buckland G, Agudo A, Luján L, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Am J Clin Nutr 2010; 91(2): 38190. doi:10.3945/ajcn.2009.28209.
11. Bamia C, Lagiou P, Buckland G, et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. Eur J Epidemiol 2013; 28(4): 317-28. doi.org/10.1007/s10654-013-9795-x.
12. Buckland G, Ros MM, Roswall N, et al. Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study. Int J Cancer 2014; 134(10): 2504-11. doi:10.1002/ ijc.28573.
13. Turati F, Bravi F, Polesei J, et al. Adherence to the Mediterranean diet and nasopharyngeal cancer risk in Italy. Cancer Causes Control 2017; 28(2): 89-95. doi: 10.1007/s10552-0170850-x.
14. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 2010; 92(5): 1189-96. doi:10.3945/ajcn.2010.29673.
15. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012; 70(1): 3-21. doi:10.1111/j.1753-4887.2011.00456.x.
16. Papandreou C, Mourad TA, Jildeh C, Abdeen Z, Philalithis A, Tzanakis N. Obesity in Mediterranean region (1997-2007): a systematic review. Obes Rev 2008; 9(5): 389-99. doi:10.1111/ j.1467-789X.2007.00466.x.
17. Turrini A, Saba A, Perrone D, Cialfa E, D’Amicis A. Food consumption patterns in Italy: the INN-CA Study 1994-1996. Eur J Clin Nutr 2001; 55(7): 571-88. doi:10.1038/sj.ejcn.1601185.
18. Maugeri A, Barchitta M, Fiore V, et al. Determinants of Adherence to the Mediterranean
Diet: Findings from a Cross-Sectional Study in Women from Southern Italy. Int J Environ Res Public Health 2019; 16(16): 2963. doi:10.3390/ ijerph16162963.
19. Archero F, Ricotti R, Solito A, et al. Adherence to the Mediterranean Diet among School Children and Adolescents Living in Northern Italy and Unhealthy Food Behaviors Associated to Overweight. Nutrients 2018; 10(9). pii: E1322. doi: 10.3390/nu10091322.
20. Chaker L, Falla A, van der Lee SJ, et al. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol 2015; 30(5): 357-95. doi: 10.1007/s10654-015-0026-5.
21. Gnagnarella P, Dragà D, Misotti AM, et al. Validation of a short questionnaire to record adherence to the Mediterranean diet: An Italian experience. Nutr Metab Cardiovasc Dis 2018; 28(11): 1140-7. doi: 10.1016/j.numecd.2018.06.006.
22. Ministry of Health. Guidelines for the prevention of atherosclerosis, 2004.
23. Williams B, Mancia G, Spiering W, et al. ESC / ESH guidelines for the management of high blood pressure. Euro Heart J 2018; 39(33): 3021-3104.
https://doi.org/10.1093/eurheartj/ehy339.
24. Italian Society of Diabetology (SID), Association of Medical Diabetologists (AMD). Italian Standards for the treatment of diabetes mellitus, 2018, 5th ed.
25. Council’s Food and Nutrition Research Center for Agricultural Research and Agricultural Economy Analysis (CREA). Guidelines for healthy eating, 2018. Available on:https://www.crea.gov. it/web/alimenti-e-nutrizione/-/linee-guida-peruna-sana-alimentazione-2018 [Last accessed: 2020, July 4].
26. World Cancer Research Fund (WRCF). Limit alcohol consumption, 2018. Available on: https:// www.wcrf.org/dietandcancer/recommendations/ limit-alcohol-consumption [Last accessed: 2020, July 4].
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