OBJECTIVE: The Mediterranean Diet (MD) has been recognized for its benefits for human health and sustainability for the planet, but it has considered not easy to reproduce in other populations. The United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair on Health Education and Sustainable Development is fostering a research project (Planeterranea), aiming to identify a healthy dietary pattern based on local foods with the same MD features. The aim of our study is to develop a MD-based food pyramid for Asian populations.
METHODS: Asia was stratified into six areas according to pedo-climatic conditions. For each region a comprehensive scoping review of local crops and typical foods was conducted on several databases such as the US Department of Agriculture (USDA)\'s database, the Food and Agriculture Organization of the United Nations (FAO) website, and PubMed, focusing on both plant-based and animal-based foods. Narrative review was then conducted on the identified foods to determine their nutritional composition and planetary health impact. Finally, the collected information was used to build up the Asian food pyramid with details for each respective region.
RESULTS: We proposed a food pyramid for Asian countries, guaranteeing the same nutritional intake and health benefits as MD, by considering dietary habits and typical foods of this population. From the bottom to the top, Asian fruits and vegetables present similar nutritional profile as those in MD. Whole grains (barley) may represent valid alternative to white rice. Sesame oil represents a source of unsaturated fats and an alternative to olive oil. Legumes (soybean), edible insects, mushrooms and algae, guarantee an adequate intake of plant-based proteins with a complete amino-acid profile and a low environmental impact with respect to animal-based ones.
CONCLUSIONS: This work is a new insight of healthy and sustainable local food system based on MD principles for the Asian population.

Inflammatory bowel disease (IBD), which includes Crohn\'s disease and ulcerative colitis, involves chronic inflammatory disorders of the digestive tract. Oxidative stress, associated with increased reactive oxygen species generation, is a major risk factor for IBD pathogenesis. Industrialized lifestyles expose us to a variety of factors that contribute to deteriorating gut health, especially for IBD patients. Many alternative therapeutic strategies have been developed against oxidative stress along with conventional therapy to alleviate IBD pathogenesis. Polyphenol-rich foods have attracted growing interest from scientists due to their antioxidant properties. Polyphenols are natural compounds found in plants, fruits, vegetables, and nuts that exhibit antioxidant properties and protect the body from oxidative damage. This review presents an overview of polyphenol benefits and describes the different types of polyphenols. It also discusses polyphenols\' role in inhibiting oxidative stress and fungal growth prevention. Overall, this review highlights how a healthy and balanced diet and avoiding the industrialized lifestyles of our modern society can minimize oxidative stress damage and protect against pathogen infections. It also highlights how polyphenol-rich foods play an important role in protecting against oxidative stress and fungal growth.

OBJECTIVE: Unhealthy lifestyle increases the risk of comorbidities, reduced quality of life, and cancer recurrence among breast cancer survivors. It is important to identify emotional and cognitive factors that may affect the maintenance of a healthy lifestyle over time. This study examined the associations of perceived lifestyle discrepancy, self-compassion, and emotional distress with the maintenance of a healthy lifestyle among breast cancer survivors and the mediating role of emotion regulation patterns (cognitive reappraisal and expressive suppression) in these associations.
METHODS: A total of 145 female breast cancer survivors aged 31-77 completed self-reports on healthy lifestyle maintenance, perceived lifestyle discrepancy, self-compassion, emotional distress, and emotion regulation patterns. Structural equation modeling was used to analyze the data.
RESULTS: Mean physical activity and healthy diet maintenance scores were moderate. The structural equation modeling analysis showed good fit indicators (χ2 = 4.21, df = 10, p = .94; χ2/df = 0.42; NFI = .98; TLI = 1.09; CFI = 1.00; RMSEA = .00, 95% CI (.00, .02)). Lower perceived lifestyle discrepancy was directly associated with higher physical activity (β = -.34, p < .01) and healthy diet (β =-.39, p < .01). Cognitive reappraisal was associated with higher physical activity (β = .19, p < .01), and expressive suppression was associated with lower physical activity (β = -.19, p < .01), and both mediated the association between self-compassion and physical activity.
CONCLUSIONS: The mediated associations reported in this study indicate that psychosocial factors, especially self-compassion, perceived lifestyle discrepancy, and emotional regulation patterns, are relevant to healthy lifestyle maintenance among breast cancer survivors, because solely providing healthy lifestyle recommendations does not motivate individuals to adhere to them.
CONCLUSIONS: Short-term structured psychosocial interventions designed to reduce perceived health discrepancy and strengthen self-compassion should be implemented and their effect on lifestyle should be further evaluated.

UNASSIGNED: There is scarcity of data exploring the dynamics of barriers to changing physical activity (PA) and eating habits during a lifestyle intervention in a primary care setting. The aim of the present study was to investigate barriers to lifestyle change before and during a primary care lifestyle intervention in adults with different sociodemographic backgrounds.
UNASSIGNED: Barriers to healthy eating and PA were assessed in 114 adults (age = 55 ± 9 years) using a questionnaire before inclusion in the intervention. During the lifestyle intervention, factors perceived as obstacles to reach goals for PA and healthy eating habits were collected using focus group interviews in a sub-sample of 25 adults and analyzed using thematic analysis.
UNASSIGNED: At least 1 barrier to changing eating and PA habits was reported in 65% and 67% of the population, respectively, without differences due to sex, place of birth, and educational level. Before entering the lifestyle intervention, intrapersonal factors including lack of willpower and lack of enjoyment were the dominant barriers to PA and healthy eating, irrespective of place of birth, sex, and education level. In contrast, environmental factors such as lack of support from family and work-related constraints emerged as important barriers to overcome during the action phase of the lifestyle intervention.
UNASSIGNED: The present study highlights the dynamics of barriers to changing PA and eating habits in a primary care lifestyle intervention, emphasizing the need for barrier assessment during the different phases of an intervention to tailor support activities for successful lifestyle behavioral change.

BACKGROUND: Nutrition literacy (NL), stemming from health literacy, profoundly influences dietary habits and chronic diseases. Despite their pivotal societal role, scant research exists on NL levels among medical personnel. This study examined NL levels among tertiary hospital medical staff in Bengbu and identified influencing factors.
METHODS: Using cluster sampling, all Bengbu tertiary hospitals were selected, with 4-5 departments randomly chosen. A structured questionnaire assessed demographic characteristics, while the NL short-form scale (NL-SF12) evaluated NL. SPSS 26.0 and AMOS conducted statistical analysis, including confirmatory factor analysis and Cronbach\'s α for reliability. Chi-square tests and logistic regression analyzed group differences and influencing factors.
RESULTS: The NL-SF12 demonstrated robust reliability and validity. Of participants, 34.22% were male and 65.78% female; 41.03% were doctors and 42.16% nurses. Overall, 45.68% exhibited high NL. Females showed higher total NL (OR = 1.47, 95% CI: 1.08-1.98), cognition (OR = 1.66, 95% CI: 1.22-2.24), skills (OR = 1.48, 95% CI: 1.09-2.00), and interactive NL (OR = 2.21, 95% CI: 1.53-3.19) than males. Those with a master\'s or higher had higher total NL (OR = 2.20, 95% CI: 1.33-3.65) and cognition (OR = 3.23, 95% CI: 1.94-5.37) than those with an associate degree or less. Pharmacists, inspectors, and technicians had higher total NL (OR = 1.55, 95% CI: 1.06-2.26) and functional NL (OR = 1.49, 95% CI: 1.02-2.17). Gender, education level, and career were the influencing factors of nutrition literacy among medical personnel.
CONCLUSIONS: Female medical staff and those with a master\'s degree or higher showed higher nutrition literacy (NL), particularly in cognition and skills. Pharmacists, inspectors, and other technicians exhibited higher levels of total NL and functional NL. Gender, education level, and career were identified as significant influencing factors of nutrition literacy among medical personnel. Understanding and considering these factors are crucial for developing targeted strategies to enhance nutrition literacy among healthcare professionals. Future efforts to improve nutrition literacy through training and interventions should be tailored to the characteristics of different groups to effectively enhance the capabilities and proficiency of healthcare professionals in nutrition knowledge and practice.

The potential of the EAT-Lancet reference diet, which promotes a healthy diet within planetary limits, to reduce greenhouse gas emissions (GHGe) remains understudied. This study examines the role of nutritional and acceptability constraints in reducing GHGe through diet optimization, and tests the alignment between GHGe reduction and the EAT-Lancet score. The study used data from 29,413 NutriNet-Santé participants to model French diets and evaluate their environmental, nutritional, economic, and health impact. The Organic Food Frequency Questionnaire was used to assess organic and conventional food consumed, and the Dialecte database was used to estimate the diet environmental impacts. Quality of diets were also evaluated based using the PNNS-GS2 (Programme National Nutrition-Santé 2 guidelines score). When testing minimizing GHGe under strict nutritional and acceptability constraints, it was possible to reduce GHGe up to 67 % (from 4.34 in the observed diet to GHGe = 1.45 kgeqCO2/d) while improving the EAT score by 103 % with 91 % of the food as organic. Greater reductions required relaxation of some constraints. When testing maximizing EAT score under gradual reduction in GHGe, the adherence to the EAT-Lancet diet was not significantly affected by the gradual reduction in GHGe. To maximize EAT score with 75 % reduction in GHGe (1.09 kgeqCO2/d), less strict constraints on the bioavailability of iron and zinc are necessary. The EAT score improved by 141 %, while land occupation decreased by 57 %, compared to the observed value. The diet contained 94 % of organic foods. There was some alignment between the degree of adherence to the EAT-Lancet diet and the reduction in GHGe, but other diets may also lead to a strong reduction in GHGe. Thus, GHGe can be greatly reduced by dietary choices, but require profound reshaping of diets which must be coupled with changes in other areas of the food chain.

OBJECTIVE: This study aims to identify the association between adherence to healthy eating, using the Lebanese Mediterranean Diet Scale (LMDS), and cardiovascular risk factors in the Lebanese population.
METHODS: A cross-sectional study using a multistage cluster sample was conducted in Lebanon. Sociodemographic characteristics were collected through structured interviews and self-administered questionnaires. The LMDS assessed dietary habits. The associations between diabetes, dyslipidemia, and cardiovascular disease were investigated using stratification analysis.
RESULTS: The study included 2048 people (mean age: 41.54 ± 17.09 years). Higher adherence to the Mediterranean diet was associated with older age (Beta = 0.175, p < 0.001), being female (Beta = 0.085, p = 0.001), being married (Beta = 0.054, p = 0.047), participating in regular physical activity (Beta = 0.142, p < 0.001), and having cardiovascular disease (Beta = 0.115, p < 0.001) and diabetes (Beta = 0.055, p = 0.043). Adherence was, however, negatively associated with being a smoker (Beta = -0.083, p = 0.002), a previous smoker (Beta = -0.059, p = 0.026), and having higher distress levels (Beta = -0.079, p = 0.002). Stratification analysis by diabetes, dyslipidemia, and cardiovascular disease (CVD) consistently demonstrated these associations.
CONCLUSIONS: These findings suggest that demographic and health factors influence the Lebanese population\'s adherence to the Mediterranean diet. Older age, female gender, married status, physical activity, CVD, and diabetes were all found to be associated with adherence to the Mediterranean diet in the Lebanese population. In contrast, smoking and distress were inversely associated with it.

Feeding a growing population with healthy food while preserving the natural ecosystem\'s resources is a critical challenge of our century. In Egypt, the increasing demand for food commodities and the intensive consumption of freshwater resources by the agricultural sector is hindering the food system capability to achieve sustainable food and nutrition security. The Egyptian government has recently prioritized the improvement of dietary supply through the efficient use of the locally available natural resources. However, strategies to transform the Egyptian agri-food system towards the sustainable satisfaction of healthy dietary needs have not been yet studied. Here, a novel approach has been introduced, able to combine the environmental advantages of an optimized crop allocation with the benefits of providing a healthy diet. First, a physically based agro-hydrological model is used to assess the crop water needs associated with the current cropland and diet (baseline). Subsequently, a linear optimization crop allocation algorithm is designed to replace crops in order to maximize green water productivity, while meeting the dietary requirements of the EAT-Lancet diet. Our results show that through an optimized crop allocation entailing the production of healthy and varied food, it is possible to reach an average 95 % satisfaction of the demand for healthy food items by local agricultural products, with an 8 % reduction in local freshwater consumption and a 90 % increase in crop profitability. Our study suggests the prioritization of the promotion of the dietary guidelines by the EAT-Lancet Commission at the national level in Egypt, to support human health against malnutrition and the development of a more sustainable and efficient food system.

Although it is well established that a vegetable-rich (Mediterranean) diet is associated with health benefits in later life, the mechanisms and biological origins of this benefit are not well established. This review seeks to identify the components a healthful diet that reduce the individual\'s suffering from non-communicable disease and extend longevity. We note the difference between the claims made for an essential diet (that prevents deficiency syndromes) and those argued for a diet that also prevents or delays non-communicable diseases and ask: what chemicals in our food induce this added resilience, which is effective against cardiovascular and neurodegenerative diseases, diabetes and even cancer? Working in the framework of acquired resilience (tissue resilience induced by a range of stresses), we arguethat the toxins evolved by plants as part of allelopathy (the competition between plant species) are key in making the \'healthful difference\'. We further suggest the recognition of a category of micronutrients additional to the established \'micro\' categories of vitamins and trace elements and suggest also that the new category be called \'trace toxins\'. Implications of these suggestions are discussed.

BACKGROUND: There have been mixed results reported internationally when associating vegetarian dietary patterns with all-cause and cause-specific mortalities.
OBJECTIVE: This study aimed to extend our previous results by evaluating, with a larger number of deaths (N = 12,515), cause-specific mortalities comparing different vegetarian types with nonvegetarians.
METHODS: This prospective study used data from the Adventist Health Study-2 cohort. Mortality was ascertained between study baseline, 2002-2007, and follow-up through 2015. Dietary data were collected at baseline using a validated quantitative food frequency questionnaire and then categorized into 5 dietary patterns: nonvegetarian, semivegetarian, pescovegetarian, lacto-ovovegetarian, and vegan. Main outcomes and measures include all-cause and cause-specific mortalities using Cox proportional hazards regression models and competing risk methods.
RESULTS: The analytic sample included 88,400 participants who provided 971,424 person-years of follow-up. We report results pairwise as estimated at ages 65 and 85 y owing to age dependence of many hazard ratios (HRs). Compared with nonvegetarians, vegetarians had lower risks of mortality, overall (HR: 0.89; 95% confidence interval [CI]: 0.83, 0.95; HR: 0.98; 95% CI: 0.91, 1.04), from renal failure (HR: 0.52; 95% CI: 0.38, 0.70; HR: 0.65; 95% CI: 0.55, 0.76), infectious disease (HR: 0.57; 95% CI: 0.40, 0.82; HR: 0.90; 95% CI: 0.70, 1.17), diabetes (HR: 0.51; 95% CI: 0.33, 0.78; HR: 0.69; 95% CI: 0.53, 0.88), select cardiac (HR: 0.75; 95% CI: 0.65, 0.87; HR: 0.89; 95% CI: 0.83, 0.95), and ischemic heart disease causes (HR: 0.73; 95% CI: 0.59, 0.90; HR: 0.84; 95% CI: 0.75,0.94). Vegans, lacto-ovovegetarians, and pescovegetarians were also observed to have lower risks of total mortality and several similar cause-specific mortalities. However, higher cause-specified neurologic mortalities were observed among older vegetarians (estimated at age 85 y), specifically stroke (HR: 1.17; 95% CI: 1.02, 1.33), dementia (HR: 1.13; 95% CI: 1.00, 1.27), and Parkinson\'s disease (HR: 1.37; 95% CI: 0.98, 1.91). Results in Black subjects for vegetarian/nonvegetarian comparisons largely followed the same trends, but HRs were less precise owing to smaller numbers.
CONCLUSIONS: Vegetarian diets are associated with lower risk for all-cause and many cause-specific mortalities, especially among males and in younger subjects. However, higher risks are observed among older vegetarians for stroke and dementia. These results need further support and investigation.