Mediterranean diet (MD)

地中海饮食 (md)
  • 文章类型: Journal Article
    营养对我们的健康和长寿有强大的影响。营养可能影响我们健康的机制之一是通过诱导表观遗传修饰,调节衰老的分子机制。观察性研究提供了营养与DNA甲基化差异之间关系的证据。然而,这些研究是有限的,因为它们可能无法准确控制不同营养素之间的相互作用,或营养和其他生活方式之间的行为。在这里,我们系统地回顾了研究营养策略对DNA甲基化影响的临床研究。我们检查了社区居住的成年人的临床研究,这些研究测试了营养干预对i)全球DNA甲基化及其代理的影响,和ii)表观遗传时钟。我们纳入了21项干预研究,重点关注健康营养模式的影响,特定的食物或营养素,以及多种维生素或多种矿物质补充剂的效果。在关于健康饮食模式甲基化效应的四项研究中,定义为富含蔬菜,水果,全谷物,和坚果,减少添加糖的摄入量,饱和脂肪,酒精,其中两个建议健康的饮食,与较低的表观遗传年龄加速有关,其中一个报告了全球DNA甲基化的增加,而另一个发现没有饮食影响。检查特定食物的表观遗传效应的研究,营养素,或者营养的混合物很少。对于叶酸和多不饱和脂肪酸,现有的独立研究结果相互矛盾.尽管仍需要更多证据来得出确切的结论,结果开始表明,健康的饮食模式对DNA甲基化有积极影响。需要来自大型随机对照临床试验的其他证据来支持健康营养对DNA甲基化组的影响。
    Nutrition has powerful impacts on our health and longevity. One of the mechanisms by which nutrition might influence our health is by inducing epigenetic modifications, modulating the molecular mechanisms that regulate aging. Observational studies have provided evidence of a relationship between nutrition and differences in DNA methylation. However, these studies are limited in that they might not provide an accurate control of the interactions between different nutrients, or between nutrition and other lifestyle behaviors. Here we systematically reviewed clinical studies examining the impact of nutrition strategies on DNA methylation. We examined clinical studies in community-dwelling adults testing the effects of nutrition interventions on i) global DNA methylation and its proxies, and ii) epigenetic clocks. We included 21 intervention studies that focused on the effects of healthy nutrition patterns, specific foods or nutrients, as well as the effect of multivitamin or multimineral supplements. In four studies on the methylation effects of healthy dietary patterns, as defined by being rich in vegetables, fruits, whole-grains, and nuts and reduced in the intake of added sugars, saturated fat, and alcohol, two of them suggested that a healthy diet, is associated with lower epigenetic age acceleration, one of them reported increases in global DNA methylation, while another one found no diet effects. Studies examining epigenetic effects of specific foods, nutrients, or mixtures of nutrients were scarce. For both folic acid and polyunsaturated fatty acids, the available independent studies produced conflicting findings. Although more evidence is still needed to draw firm conclusions, results begin to suggest that healthy dietary patterns have positive effects on DNA methylation. Additional evidence from large randomized-controlled clinical trials is needed to support the effects of healthy nutrition on the DNA methylome.
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  • 文章类型: Journal Article
    了解孕妇的微量营养素摄入和饮食习惯如何影响妊娠期糖尿病(GDM)至关重要。对797名孕妇的数据进行前瞻性分析,以通过口服葡萄糖耐量试验(OGTT)评估GDM状态。使用经过验证的食物频率问卷(FFQ)评估了两个时期的营养摄入量:A期,涵盖怀孕前6个月,B期,从妊娠开始到妊娠中期(24周)。将微量营养素摄入量与欧洲食品安全局(EFSA)的饮食参考值(DRV)进行比较,并用于估计平均充足率(MAR)以评估饮食充足性。14.7%(n=117)的女性被诊断出GDM,其特征是平均孕产妇年龄(MA)和孕前体重指数(BMI)较高。在评估的13种维生素中,生物素,叶酸,烟酸,在GDM组中发现泛酸明显更高,就像铁一样,镁,锰,磷,和10种矿物质中的锌。结果受评估时间的影响。重要的是,MAR在怀孕期间较高,发现GDM的风险增加1%(95CI:1,1.02)。敏感性分析显示,降低MAR显著使GDM风险增加68%(95CI:1.02,2.79)。坚持地中海饮食(MD)与GDM风险之间没有相关性。这些发现强调了进一步调查涉及这些特定微量营养素的饮食调整是否可以有效影响GDM结局的领域。
    Understanding how maternal micronutrient intake and dietary habits impact gestational diabetes mellitus (GDM) is crucial. Data from 797 pregnant women were prospectively analyzed to assess GDM status with the oral glucose tolerance test (OGTT). Nutritional intake was evaluated using a validated food frequency questionnaire (FFQ) across two periods: Period A, covering 6 months before pregnancy, and Period B, from pregnancy onset to mid-gestation (24 weeks). Micronutrient intakes were compared against the European Food Safety Authority (EFSA) dietary reference values (DRVs) and were used to estimate the mean adequacy ratio (MAR) to assess dietary adequacy. GDM was diagnosed in 14.7% (n = 117) of women with the characteristics of a higher mean maternal age (MA) and pre-pregnancy body mass index (BMI). Out of the 13 vitamins assessed, biotin, folate, niacin, and pantothenic acid were found significantly higher in the GDM group, as did iron, magnesium, manganese, phosphorus, and zinc from the 10 minerals. The results were influenced by the timing of the assessment. Importantly, MAR was higher during pregnancy and was found to increase the risk of GDM by 1% (95%CI: 1, 1.02). A sensitivity analysis revealed that reducing MAR significantly raised the GDM risk by 68% (95%CI: 1.02, 2.79). No association was revealed between adherence to the Mediterranean diet (MD) and GDM risk. These findings highlight areas for further investigation into whether dietary modifications involving these specific micronutrients could effectively influence GDM outcomes.
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  • 文章类型: Review
    骨健康不仅包括骨矿物质密度,还包括可以影响骨强度的骨结构和机械性能。虽然已经提出了特定的饮食干预措施来治疗各种疾病,如肥胖症和糖尿病,它们对骨骼健康的影响尚不清楚。这篇综述的目的是研究过去十年发表的文献,总结目前流行的饮食对骨骼健康的影响,阐明潜在的机制,并提供解决方案以中和副作用。这篇综述中讨论的饮食包括生酮饮食(KD),地中海饮食(MD),热量限制(CR),高蛋白饮食(HP),间歇性禁食(IF)。虽然在KD和CR饮食中已经注意到对骨骼健康的有害影响,它仍然有争议,虽然MD和HP饮食显示出保护作用,和IF饮食的影响仍然不确定。这些作用的机制和衰减方法已引起人们的关注,并已在近年来进行了讨论:KD饮食中断能量平衡和钙代谢,降低骨骼质量。人参皂苷-Rb2,二甲双胍,和辛伐他汀已被证明可以减轻KD期间的骨丢失。CR饮食影响能量失衡,糖皮质激素水平,和脂肪组织,导致骨质流失.充足的维生素D和钙补充剂以及运动训练可以减轻这些影响。MD中的橄榄油可能是保护骨骼健康的有效组分。HP饮食也有保护骨骼健康的成分,但是他们的机制需要进一步调查。在IF中,动物研究显示对骨骼健康有不利影响,而人类研究还没有。因此,饮食对骨骼健康的影响各不相同。
    Bone health encompasses not only bone mineral density but also bone architecture and mechanical properties that can impact bone strength. While specific dietary interventions have been proposed to treat various diseases such as obesity and diabetes, their effects on bone health remain unclear. The aim of this review is to examine literature published in the past decade, summarize the effects of currently popular diets on bone health, elucidate underlying mechanisms, and provide solutions to neutralize the side effects. The diets discussed in this review include a ketogenic diet (KD), a Mediterranean diet (MD), caloric restriction (CR), a high-protein diet (HP), and intermittent fasting (IF). Although detrimental effects on bone health have been noticed in the KD and CR diets, it is still controversial, while the MD and HP diets have shown protective effects, and the effects of IF diets are still uncertain. The mechanism of these effects and the attenuation methods have gained attention and have been discussed in recent years: the KD diet interrupts energy balance and calcium metabolism, which reduces bone quality. Ginsenoside-Rb2, metformin, and simvastatin have been shown to attenuate bone loss during KD. The CR diet influences energy imbalance, glucocorticoid levels, and adipose tissue, causing bone loss. Adequate vitamin D and calcium supplementation and exercise training can attenuate these effects. The olive oil in the MD may be an effective component that protects bone health. HP diets also have components that protect bone health, but their mechanism requires further investigation. In IF, animal studies have shown detrimental effects on bone health, while human studies have not. Therefore, the effects of diets on bone health vary accordingly.
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  • 文章类型: Journal Article
    肠易激综合征(IBS)是一种非常普遍的胃肠道疾病,对普通人群有重大影响。可用于IBS的次优医学治疗导致其巨大的经济负担。IBS的病理生理学是复杂的,治疗通常侧重于管理特定的症状。许多患有IBS的人将他们的症状与特定的食物摄入量相关联,导致关于饮食在管理IBS中的作用的科学研究增加。饮食管理已成为IBS治疗的关键方面,最初的建议侧重于采用健康的饮食习惯和生活方式。这篇全面的综述旨在综合目前关于饮食对IBS影响的文献,探索管理IBS的各种饮食方法,包括低可发酵的低聚糖,二糖,单糖,和多元醇(FODMAP)饮食,无麸质饮食,地中海饮食,和以三餐为基础的饮食。它提供了来自实验和观察性研究的证据,并总结了IBS中潜在的饮食触发因素,包括肠道微生物群失调,内脏过敏,和免疫激活。此外,它探讨了饮食指南和科学文献提供的关键饮食和生活方式建议的功效和局限性,强调针对不同类型IBS患者的独特需求量身定制的个性化饮食策略的重要性。通过阐明饮食和IBS病理生理学之间复杂的相互作用,这篇综述为优化饮食管理方法以改善IBS患者的症状控制和生活质量提供了有价值的见解。
    Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder that has a significant impact on the general population. The suboptimal medical treatments available for IBS contribute to its large economic burden. The pathophysiology of IBS is complex, and treatments often focus on managing specific symptoms. Many individuals with IBS associate their symptoms with specific food intake, leading to increased scientific research on the role of diet in managing IBS. Dietary management has become a crucial aspect of IBS treatment, with initial recommendations focusing on adopting a healthy eating pattern and lifestyle. This comprehensive review aims to synthesise the current literature on the impact of diet on IBS, exploring various dietary approaches to managing IBS, including the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, gluten-free diet, Mediterranean diet, and tritordeum-based diet. It presents evidence from both experimental and observational studies and summarises the underlying dietary triggers in IBS, including gut microbiota dysbiosis, visceral hypersensitivity, and immune activation. In addition, it explores the efficacy and limitations of the key diet and lifestyle recommendations provided by dietary guidelines and scientific literature, highlighting the importance of individualised dietary strategies tailored to the unique needs of different types of IBS patients. By elucidating the complex interplay between diet and IBS pathophysiology, this review provides valuable insights into optimising dietary management approaches for improving symptom control and enhancing the quality of life for individuals with IBS.
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  • 文章类型: Journal Article
    这篇叙述性综述总结了观察性研究的主要发现,系统评价,以及饮食和饮食模式在胰腺癌风险中的作用的荟萃分析。病因胰腺癌是多因素的。有证据表明营养素之间存在关联,饮食模式,还有胰腺癌.在PubMed上进行了广泛的文献检索,科克伦,谷歌学者。彻底搜索了截至2023年5月以英文发表的与评论相关的文章。所有大量营养素之间的关系,微量营养素,并评估了各种饮食模式与胰腺癌的风险。结论是,富含红肉和加工肉等营养素的饮食,精制糖,饱和和单不饱和脂肪,酒精,铜,西方的饮食模式可以增加胰腺癌的可能性。与此相反,由水果组成的饮食,蔬菜,适量的维生素和矿物质,地中海饮食模式与胰腺癌风险降低有关。
    This narrative review summarizes the principal findings of observational studies, systematic reviews, and meta-analyses on diet and dietary patterns\' role in the risk of pancreatic cancer. Etiologically pancreatic cancer is multifactorial. Evidence exists of an association between nutrients, dietary patterns, and pancreatic cancer. An extensive literature search was conducted on PubMed, Cochrane, and Google Scholar. A thorough search of articles published in English till May 2023 and related to the review was performed. The relationship between all macronutrients, micronutrients, and various dietary patterns with the risk of pancreatic cancer was assessed. It is concluded that a diet high in nutrients like red and processed meat, refined sugars, saturated and monounsaturated fats, alcohol, copper, and a Western dietary pattern can increase the likelihood of pancreatic cancer. Contrary to this, a diet consisting of fruits, vegetables, appropriate quantities of vitamins and minerals, and a Mediterranean dietary pattern is associated with a decreased risk of pancreatic cancer.
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  • 文章类型: Journal Article
    科学文献已经证明了积极的生活方式对人们心理健康的好处。根据上述说法,目的是(A)评估和调整包含变量焦虑的结构方程模型,自我概念,和地中海饮食依从性,以及(b)通过根据558名大学生样本中每周体育锻炼的水平研究变量之间的差异来对比所提出的理论模型。
    非实验性的,探索性,提出了横断面调查。诸如PREDIMEDQuestionnaire之类的工具,贝克焦虑量表,国际体育活动问卷,并使用表格5自我概念问卷收集数据。
    结果表明,对地中海饮食依从性低的学生的焦虑水平(M=0.95)高于对地中海饮食依从性高的学生(M=0.75)。还观察到,与坚持程度低的年轻人相比,坚持地中海饮食的年轻人在自我概念的不同维度上的得分更高。总之,可以肯定的是,对这种饮食模式表现出高度坚持的年轻人表现出较低的焦虑水平和对自我概念的不同领域的更多认可。
    UNASSIGNED: Scientific literature has now demonstrated the benefits of an active lifestyle for people\'s psychological health. Based on the above statement, the aim was to (a) evaluate and adjust a structural equation model containing the variables anxiety, self-concept, and Mediterranean diet adherence and (b) contrast the proposed theoretical model by studying the differences between the variables according to the level of weekly physical activity in a sample of 558 university students.
    UNASSIGNED: A non-experimental, exploratory, cross-sectional investigation has been proposed. Instruments such as the PREDIMED Questionnaire, the Beck Anxiety Inventory, the International Physical Activity Questionnaire, and the Form 5 Self-Concept Questionnaire were used to collect data.
    UNASSIGNED: The results illustrate that students showing low adherence to the Mediterranean diet had higher levels of anxiety (M = 0.95) than those showing a high degree of adherence (M = 0.75). It is also observed that young people with a high degree of adherence to the Mediterranean diet report higher scores in the different dimensions of self-concept compared to young people with a low degree of adherence. In conclusion, it is affirmed that young people who show a high degree of adherence to this dietary pattern show lower levels of anxiety and greater recognition of the different areas of their self-concept.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    未经证实:地中海饮食(MD)已被提议为一种健康饮食,具有降低几种癌症发病率的潜力,但没有关于甲状腺癌(TC)的数据。我们调查了MD依从性,及其组成部分,以及欧洲癌症和营养前瞻性调查(EPIC)队列中的分化TC风险。
    UNASISIGNED:来自9个欧洲国家的超过450,000名男性和女性平均随访14.1年。在此期间,发现了712例分化型TC病例。使用相对MD(rMED)评分估计对MD的依从性,包括酒精在内的18分量表,和改编的rMED(arMED)评分,不包括酒精的16分制。使用Cox回归模型对潜在混杂因素进行校正,估计危险比(HR)和95%置信区间(CI)。
    UNASSIGNED:坚持arMED评分与分化TC的风险无关(HRhighvs.低依从性=0.94,95%CI:0.70-1.25;p-趋势0.27),虽然一个暗示,但与rMED无统计学意义的负相关(HRhighvs.低依从性=0.88,95%CI:0.68-1.14;p趋势0.17)。低肉(HRlow与高肉摄入量=0.81,95%CI:0.67-0.99;p-趋势=0.04)和中度酒精(HR中度vs.非中度摄入量=0.88,95%CI:0.75-1.03)摄入量与较低的TC风险相关。
    UNASSIGNED:我们的研究表明,对MD的高依从性与分化TC风险并不密切相关,尽管需要进一步的研究来确认MD的影响,尤其是,肉类摄入量中的TC风险。
    UNASSIGNED: The Mediterranean diet (MD) has been proposed as a healthy diet with a potential to lower the incidence of several types of cancer, but there is no data regarding thyroid cancer (TC). We investigated the association between MD adherence, and its components, and the differentiated TC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.
    UNASSIGNED: Over 450,000 men and women from nine European countries were followed up for a mean of 14.1 years, during which 712 differentiated TC cases were identified. Adherence to MD was estimated using the relative MD (rMED) score, an 18-point scale including alcohol, and the adapted rMED (arMED) score, a 16-point scale excluding alcohol. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models adjusted for potential confounding factors.
    UNASSIGNED: Adherence to the arMED score was not associated with the risk of differentiated TC (HRhigh vs. low adherence = 0.94, 95% CI: 0.70-1.25; p-trend 0.27), while a suggestive, but non-statistically significant inverse relationship was observed with rMED (HRhigh vs. low adherence = 0.88, 95% CI: 0.68-1.14; p-trend 0.17). Low meat (HRlow vs. high meat intake = 0.81, 95% CI: 0.67-0.99; p-trend = 0.04) and moderate alcohol (HRmoderate vs. non-moderate intake = 0.88, 95% CI: 0.75-1.03) intake were related with lower differentiated TC risk.
    UNASSIGNED: Our study shows that a high adherence to MD is not strongly related to differentiated TC risk, although further research is required to confirm the impact of MD and, especially, meat intake in TC risk.
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  • 文章类型: Systematic Review
    认知障碍的患病率越来越高,因此需要对饮食对认知健康的影响进行全面的系统评价。研究表明,地中海(Medi)饮食具有预防代谢性疾病的作用。然而,关于MeDi饮食对认知功能下降的影响的综合系统评价是有限的。我们调查了坚持使用MeDi饮食是否可以降低老年人认知障碍的风险或改善认知功能。
    在本系统综述和荟萃分析中,PubMed,WebofScience,PsycINFO,Scopus,和Cochrane数据库从开始到2021年6月进行了搜索。包括队列研究和随机对照试验(RCT)。效应大小以对数风险比和标准平均差(SMD)和95%置信区间(CI)估计。纽卡斯尔-渥太华评分和Cochrane协作工具用于评估队列研究和随机对照试验中的偏倚风险。分别。
    在1687项筛选研究中,31项队列研究和5项RCT符合定性分析的资格标准;26项队列研究和2项RCT纳入荟萃分析。在队列研究中,坚持美迪饮食与轻度认知障碍(MCI)[风险比(RR)=0.75(0.66-0.86)]风险较低相关,和阿尔茨海默病(AD)[RR=0.71(0.56-0.89)]。在RCT中,与最低组相比,对MeDi饮食的高依从性与更好的情节记忆[SMD=0.20(0.09-0.30)]和工作记忆[SMD=0.17(0.01-0.32)]相关。
    坚持MeDi饮食可能会降低MCI和AD的风险。然而,与认知结果的其他关联(全球认知,工作记忆,和情景记忆)仍然可以解释。总的来说,建议使用MeDi饮食来预防或延缓认知障碍并改善认知功能。Further,有必要进行长期随机对照试验以加强证据.
    [https://www.crd.约克。AC.英国],标识符[CRD42021276801]。
    UNASSIGNED: An increasing prevalence of cognitive disorders warrants comprehensive systematic reviews on the effect of diet on cognitive health. Studies have suggested that the Mediterranean (MeDi) diet has protective effects against metabolic diseases. However, comprehensive systematic reviews on the effect of the MeDi diet on the cognitive decline are limited. We investigated whether adherence to the MeDi diet could lower the risk of the cognitive disorder or improve cognitive function in older adults.
    UNASSIGNED: In this systematic review and meta-analysis, PubMed, Web of Science, PsycINFO, Scopus, and Cochrane databases were searched from inception to June 2021. Cohort studies and randomized controlled trials (RCTs) were included. The effect sizes were estimated as log risk ratios and standard mean differences (SMDs) with 95% confidence intervals (CIs). The Newcastle-Ottawa score and Cochrane Collaboration\'s tool were used to assess the risk of bias in cohort studies and RCTs, respectively.
    UNASSIGNED: Of the 1,687 screened studies, 31 cohort studies and five RCTs met the eligibility criteria for qualitative analysis; 26 cohort studies and two RCTs were included in the meta-analysis. In the cohort studies, high adherence to the MeDi diet was associated with lower risk of mild cognitive impairment (MCI) [risk ratio (RR) = 0.75 (0.66-0.86)], and Alzheimer\'s disease (AD) [RR = 0.71 (0.56-0.89)]. In the RCTs, high adherence to the MeDi diet was associated with better episodic [SMD = 0.20 (0.09-0.30)] and working memories [SMD = 0.17 (0.01-0.32)] than lowest group.
    UNASSIGNED: Adherence to the MeDi diet may reduce the risk of MCI and AD. However, other associations with cognitive outcomes (global cognition, working memory, and episodic memory) remain open to interpretation. Overall, the MeDi diet is recommended to prevent or delay cognitive disorders and improve cognitive function. Further, long-term RCTs are warranted to strengthen the evidence.
    UNASSIGNED: [https://www.crd.york.ac.uk], identifier [CRD42021276801].
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  • 文章类型: Journal Article
    碘缺乏是甲状腺结节性疾病发展的最重要的营养危险因素。然而,据我们所知,迄今为止,尚无研究关注地中海饮食(MD)依从性与甲状腺结节性疾病之间的关联.使用PREvenciónCONDIetaMEDiterránea(PREDIMED)问卷评估对MD的依从性。身体活动,吸烟习惯,并对人体测量参数进行了研究。PREDIMED用于评估对MD的坚持程度。基于2013年意大利甲状腺细胞学分类体系的甲状腺病变细针穿刺细胞学评价[J].通过超声引导下细针穿刺对甲状腺结节进行细胞学检查,并将患者分为5类:TIR2,TIR3a,TIR3b,TIR4和TIR5。研究人群包括794名受试者(554名女性,69.8%),18-65岁,BMI范围为19.4至55.3kg/m2。391名参与者(49.2%)出现甲状腺结节性疾病,最常见的细胞学类别是TIR2(18.3%),其次是TIR4(8.9%)。甲状腺结节的存在也与MD的最低依从性显著相关(OR6.16,p<0.001)。与其他TIR相比,TIR5患者对MD的依从性较低(2.15±1.12分)(p<0.001)。具有恶性肿瘤高风险的细胞学类别(TIR4/TIR5)与最低的MD依从性(OR137.55,p<0.001)和PREDIMED评分(OR=0.33,p<0.001,95%IC=0.26-0.41,R2=0.462)显着相关。在多元回归分析中,PREDIMED评分是存在结节(p<0.001)和具有恶性肿瘤高风险的细胞学类别(p<0.001)的主要预测因子。在ROC分析中,PREDIMED评分≤5和≤4(p=0.001)是预测甲状腺结节性疾病和细胞学类别与恶性肿瘤高风险的存在的值,分别。总之,我们的研究表明,对MD的低依从性与甲状腺结节性疾病的存在相关,特别是与恶性肿瘤高危人群相关.
    Iodine deficiency is the most important established nutritional risk factor for the development of thyroid nodular disease. Nevertheless, to the best of our knowledge, to date no study focused on the association between the adherence to the Mediterranean diet (MD) and thyroid nodular disease. Adherence to the MD was evaluated using the PREvención con DIetaMEDiterránea (PREDIMED) questionnaire. Physical activity, smoking habits, and anthropometric parameters were studied. PREDIMED was used to evaluate the degree of adherence to the MD. Evaluation of fine needle aspiration cytology of thyroid lesions based on 2013 Italian thyroid cytology classification system. Cytology of thyroid nodules was carried out through sonography-guided fine-needle aspiration and patients were divided into 5 categories: TIR2, TIR3a, TIR3b, TIR4, and TIR5. The study population consisted of 794 subjects (554 females, 69.8%), aged 18-65 years, with BMIs ranging from 19.4 to 55.3 kg/m2. Thyroid nodular disease was present in 391 participants (49.2%), and the most frequent cytological categories was TIR2 (18.3 %), followed by a TIR4 (8.9 %). The presence of thyroid nodules was also significantly associated with the lowest adherence to the MD (OR 6.16, p < 0.001). Patients with TIR5 had the lower adherence to the MD (2.15 ± 1.12 score) compared to other TIRs (p < 0.001). The cytological category with high-risk of malignancy (TIR4/TIR5) was significantly associated with the lowest adherence to the MD (OR 137.55, p < 0.001) and PREDIMED score (OR = 0.33, p < 0.001, 95% IC = 0.26-0.41, R 2 = 0.462). At multiple regression analysis, PREDIMED score was the main predictor of both the presence of nodules (p < 0.001) and the cytological category with high-risk of malignancy (p < 0.001). At ROC analysis PREDIMED score ≤ 5 and ≤ 4 (p = 0.001) were the values that predicted the presence of thyroid nodular disease and cytological category with high-risk of malignancy, respectively. In conclusion, our study demonstrated that the low adherence to the MD is associated with the presence of thyroid nodular disease and in particular with those at high-risk of malignancy.
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