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      Adherence to the Mediterranean diet in Cyprus and its relationship to multi-morbidity: an epidemiological study

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          To examine the adherence to the Mediterranean diet in the adult general population of Cyprus and assess its relationship with multi-morbidity.


          A representative sample of the adult population of Cyprus was selected in 2018–2019 using stratified sampling. Demographics, Mediterranean diet, smoking and physical activity, as well as the presence of chronic, clinical and mental conditions, were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision.


          The five government-controlled municipalities of the Republic of Cyprus.


          A total of 1140 Cypriot men and women over 18 years.


          The average Mediterranean diet score was 15·5 ± 4·0 with males and residents of rural regions being more adherent to the Mediterranean diet compared with females and residents of urban regions ( P < 0·05). Being in the higher tertile of adherence to the Mediterranean diet was associated with lower odds of multi-morbidity compared with the lower tertile, and this result was statistically significant even after adjusting for age, gender, smoking habits and physical activity (OR = 0·68, 95 % CI 0·46, 0·99).


          The study provides evidence of the adherence to the Mediterranean diet in Cypriot population and its association with multi-morbidity. Adherence to the Mediterranean diet was associated with lower risk of multi-morbidity. Future research would attempt to replicate such results that could add solid pieces of evidence towards meeting some criteria of causality and severity tests; hence, prevention programmes and practice guidelines in Cyprus and elsewhere should take into account those beneficial effects.

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          Most cited references 4

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          Is Open Access

          Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study

          Objective To investigate the relative importance of the individual components of the Mediterranean diet in generating the inverse association of increased adherence to this diet and overall mortality. Design Prospective cohort study. Setting Greek segment of the European Prospective Investigation into Cancer and nutrition (EPIC). Participants 23 349 men and women, not previously diagnosed with cancer, coronary heart disease, or diabetes, with documented survival status until June 2008 and complete information on nutritional variables and important covariates at enrolment. Main outcome measure All cause mortality. Results After a mean follow-up of 8.5 years, 652 deaths from any cause had occurred among 12 694 participants with Mediterranean diet scores 0-4 and 423 among 10 655 participants with scores of 5 or more. Controlling for potential confounders, higher adherence to a Mediterranean diet was associated with a statistically significant reduction in total mortality (adjusted mortality ratio per two unit increase in score 0.864, 95% confidence interval 0.802 to 0.932). The contributions of the individual components of the Mediterranean diet to this association were moderate ethanol consumption 23.5%, low consumption of meat and meat products 16.6%, high vegetable consumption 16.2%, high fruit and nut consumption 11.2%, high monounsaturated to saturated lipid ratio 10.6%, and high legume consumption 9.7%. The contributions of high cereal consumption and low dairy consumption were minimal, whereas high fish and seafood consumption was associated with a non-significant increase in mortality ratio. Conclusion The dominant components of the Mediterranean diet score as a predictor of lower mortality are moderate consumption of ethanol, low consumption of meat and meat products, and high consumption of vegetables, fruits and nuts, olive oil, and legumes. Minimal contributions were found for cereals and dairy products, possibly because they are heterogeneous categories of foods with differential health effects, and for fish and seafood, the intake of which is low in this population.
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            Long-term adoption of a Mediterranean diet is associated with a better health status in elderly people; a cross-sectional survey in Cyprus.

            There is increasing evidence that there are protective health effects from diets which are high in fruits, vegetables, legumes, and whole grains, and which include fish, nuts, and low-fat dairy products. We sought to investigate the association of Mediterranean diet on clinical status of 150 elderly men and women. During 2004 - 2005, we studied 53 men and 97 women, aged 65 to 100 years, from various areas of Cyprus. A diet score that assesses the inherent characteristics of the Mediterranean diet was developed for each individual (range 0-55). Adoption of the Mediterranean diet was evaluated against the presence of cardiovascular risk factors like hypertension, diabetes, hypercholesterolemia and obesity. 26% of men and 18% of women had diabetes, 60% of men and 58% of women had hypertension, 60% of men and 68% of women had hypercholesterolemia, and 34% of men and 52% of women were obese. More than 90% of the participants reported consistency in their dietary habits for at least the past 3-4 decades. A significant inverse correlation was observed between diet score and the number of the investigated risk factors (rho= -0.26, p< 0.001). When we took into account age, sex, smoking habits, and physical activity status, we observed that a 10-unit increase in the diet score was associated with 21% lower odds of having one additional risk factor in women (p< 0.001) and with 14% lower odds in men (p = 0.05). Adherence to a Mediterranean diet is associated with reduced odds of having hypercholesterolemia, hypertension, diabetes and obesity among elderly people.
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              Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort


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                Public Health Nutrition
                Public Health Nutr.
                Cambridge University Press (CUP)
                October 27 2020
                : 1-10
                © 2020


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