Fish represents one of the most important dietary sources of omega-3 polyunsaturated fatty acids, which are known to be associated with various health benefits. This study aimed to systematically review existing meta-analyses of observational studies exploring the association between fish intake and various health outcomes. A systematic search of electronic databases was conducted to retrieve a total of 63 studies. Evidence was deemed as possible for the association between higher fish intake and decreased risk of the acute coronary syndrome, liver cancer, and depression, and limited for other outcomes (including age-related macular degeneration, Alzheimer's disease, heart failure, all-cause and coronary heart disease mortality, total and ischaemic stroke) due to heterogeneity between results and potential otherwise inexplicable confounding factors. In conclusion, results from epidemiological studies support the mechanistic effects associated with omega-3 fatty acids from high fish consumption, but evidence needs to be further corroborated with more reliable results.

Meat consumption has represented an important evolutionary step for humans. However, modern patterns of consumption, including excess intake, type of meat and cooking method have been the focus of attention as a potential cause of rise in non-communicable diseases. The aim of this study was to investigate the association between total, red and processed meat with health outcomes and to assess the level of evidence by performing a systematic search of meta-analyses of prospective cohort studies. Convincing evidence of the association between increased risk of (i) colorectal adenoma, lung cancer, CHD and stroke, (ii) colorectal adenoma, ovarian, prostate, renal and stomach cancers, CHD and stroke and (iii) colon and bladder cancer was found for excess intake of total, red and processed meat, respectively. Possible negative associations with other health outcomes have been reported. Excess meat consumption may be detrimental to health, with a major impact on cardiometabolic and cancer risk.

Consumption of nuts and legumes has been associated with several health benefits. The aim of this study was to systematically review existing meta-analyses of observational studies on nut and legume intake and non-communicable diseases, and assess the level of evidence. Out of the six meta-analyses focussed on legume and 15 on nut intake, a possible association with decreased risk of colorectal adenoma and coronary heart disease was found for higher legume consumption, and a decreased risk of cardiovascular and cancer mortality, colon cancer, hypertension and ischaemic stroke for higher nut consumption. The association between legume consumption and cardiovascular diseases (CVDs), as well as nut consumption and risk of cancer, CVD incidence and all-cause mortality, was deemed as "limited" due to heterogeneity between results and/or potential confounding factors. General benefit towards better health can be observed for nut and legume consumption. Further studies are needed to better elucidate potential confounding factors.

Abstract Whole grains have been associated with a number of health benefits. We systematically reviewed existing meta-analyses of observational studies and evaluated the level of evidence for their putative effects based on pre-selected criteria. Of the 23 included studies, we found convincing evidence of an inverse association between whole grain consumption and risk of type-2 diabetes and colorectal cancer; possible evidence of decreased risk of colon cancer and cardiovascular mortality with increased whole grain intake, as well as increased risk of prostate cancer. Limited or insufficient evidence was available for all other outcomes investigated. Overall findings are encouraging for a positive effect of whole grain consumption on certain diseases, especially highly prevalent metabolic diseases, however, uncertainty of some negative associations deserves further attention. Abstract 44 Whole grains have been associated with a number of health benefits. We systematically reviewed 45 existing meta-analyses of observational studies and evaluated the level of evidence for their putative 46 effects based on pre-selected criteria. Of the 23 included studies, we found convincing evidence of 47 an inverse association between whole grain consumption and risk of type-2 diabetes and colorectal 48 cancer; possible evidence of decreased risk of colon cancer and cardiovascular mortality with 49 increased whole grain intake, as well as increased risk of prostate cancer. Limited or insufficient 50 evidence was available for all other outcomes investigated. Overall findings are encouraging for a 51 positive effect of whole grain consumption on certain diseases, especially highly prevalent 52 metabolic diseases, however, uncertainty of some negative associations deserves further attention. 53

Evidence on consumption of dairy foods and human health is contradictory. This study aimed to summarize the level of evidence of dairy consumption on various health outcomes. A systematic search for meta-analyses was performed: study design, dose-response relationship, heterogeneity and agreement of results over time, and identification of potential confounding factors were considered to assess the level of evidence. Convincing and probable evidence of decreased risk of colorectal cancer, hypertension and cardiovascular disease, elevated blood pressure and fatal stroke, respectively, was found for total dairy consumption; possible decreased risk of breast cancer, metabolic syndrome, stroke and type-2 diabetes, and increased risk of prostate cancer and Parkinson's disease was also found. Similar, yet not entirely consistent evidence for individual dairy products was reported. Among potential confounding factors, geographical localisation and fat content of dairy have been detected. In conclusions, dairy may be part of a healthy diet; however, additional studies exploring confounding factors are needed to ascertain the potential detrimental effects.

Background: Current scientific literature suggests healthy dietary patterns may have less environmental impact than current consumption patterns, but most of the studies rely on theoretical modeling. The aim of this study was to assess the impact on resources (land, water, and energy) use and greenhouse gas (GHG) emissions of healthy dietary patterns in a sample of Italian adults. Methods: Participants (n = 1806) were recruited through random sampling in the city of Catania, southern Italy. Dietary consumption was assessed through a validated food frequency questionnaire (FFQ); dietary patterns were calculated through dietary scores. The specific environmental footprints of food item production/processing were obtained from various available life-cycle assessments; a sustainability score was created based on the impact of the four environmental components calculated. Results: The contribution of major food groups to the environmental footprint showed that animal products (dairy, egg, meat, and fish) represented more than half of the impact on GHG emissions and energy requirements; meat products were the stronger contributors to GHG emissions and water use, while dairy products to energy use, and cereals to land use. All patterns investigated, with the exception of the Dietary Approach to Stop Hypertension (DASH), were linearly associated with the sustainability score. Among the components, higher adherence to the Mediterranean diet and Alternate Diet Quality Index (AHEI) was associated with lower GHG emissions, dietary quality index-international (DQI-I) with land use, while Nordic diet with land and water use. Conclusions: In conclusion, the adoption of healthy dietary patterns involves less use of natural resources and GHG emissions, representing eco-friendlier options in Italian adults.

Overweight and obesity have increased dramatically over the last decades becoming the leading public health issue of the modern era. The transition from a traditional dietary patterns to a "Westernized" pattern, including consumption of fast-processed foods, "junk" foods and sweet beverages contribute to the development of overweigh and obesity. The aim of this study was to evaluate the relation between out of home eating and metabolic parameters in adolescents living in a Mediterranean area. The study had a cross-sectional design. Data were collected during two scholastic years (2012-13 and 2013-14) on 1643 adolescents of 13-16 years attending 15 secondary schools randomly selected in the urban area of the municipality of Catania. Demographic characteristics, physical activity status and eating habits were collected though a validated questionnaire and then the KIDMED score was calculated. Weight status was assessed by medical visit. Out-of-home eating was associated with being obese (OR 1.15, 95% CI: 1.01-1.15), especially when occurring for a main meal rather than for snack (OR 1.07, 95% CI: 1.02-1.22). These results were no longer significant after the adjustment for KIDMED score. Moreover, having a good adherence to Mediterranean diet was associated with 6% decreased odds of being obese (OR 0.94, 95% CI: 0.89-0.99). Adolescent eating out more than once per week were eating significantly less fruit and vegetables and more fast-foods and sweetened beverages. In conclusion, out-of-home eating is associated with unhealthy dietary choices among adolescents living in a Mediterranean country. The promotion of alternative nutritious snacks (such as nuts, fresh fruit and vegetables) in school setting should be considered.

The aim of this study was to provide a comprehensive evaluation of current evidence on fruit and vegetable consumption and health outcomes. A systematic search for quantitative syntheses was performed. Several criteria, including study design, dose-response relationship, heterogeneity and agreement of results over time, and identification of potential confounding factors, were used to assess the level of evidence. The strongest (probable) evidence was found for cardiovascular disease protection; possible evidence for decreased risk of colon cancer, depression and pancreatic diseases was found for fruit intake; and colon and rectal cancer, hip fracture, stroke, depression and pancreatic diseases was found for vegetable intake. Suggestive and rather limited associations with other outcomes have been found. Evidence of potential confounding by sex and geographical localisation has been reported. Despite findings are consistent enough for hypothesising causation (at least for cardiovascular-related outcomes), further studies are needed to clarify the role of potential confounding factors.

Egg consumption has been an area of controversy regarding its impact on human health largely due to the content in cholesterol and its potential role in cardio-metabolic outcomes. This study aimed to summarise the level of evidence of egg consumption on various health outcomes. A systematic search for meta-analyses was performed: study design, dose-response relationship, heterogeneity and agreement of results over time, and identification of potential confounding factors were considered to assess the level of evidence. Results from this umbrella review showed a substantial no association between egg consumption and a number of health outcomes, including cancer, cardiovascular and metabolic disorders. In contrast, evidence of possible beneficial effects toward stroke risk has been found. In conclusions, egg may be part of a healthy diet; however, additional studies exploring confounding factors are needed to ascertain the potential detrimental effects.

Adolescence overweight and obesity have increased considerably, and the misperception of their weight status could reduce the efficiency of intervention programs. The aim of this study was to evaluate the prevalence rate of misperception and to assess the relationship between weight perception and anthropometric parameters, self-perception, physical activity, and adherence to the Mediterranean diet.

A decline in adherence to the Mediterranean dietary pattern has been observed over the last years. The aim of this study was to assess the level of adherence to the Mediterranean diet and possible determinants in the Mediterranean healthy Eating, Aging and Lifestyle (MEAL) study cohort. Demographic and dietary data of 1937 individuals were collected in 2014-2015 from the general population of Catania, Sicily (Italy). Food frequency questionnaires and the MEDI-LITE score were used to assess adherence to the Mediterranean diet. The score well characterised consumption of major food groups, micro- and macro-nutrients. The cohort had a general good adherence, but only a minority was highly adherent. High adherence was directly associated with education, non-smoking and physical activity and inversely with high occupational status. In conclusions, Mediterranean diet is still followed in Sicily; however, nutrition education campaigns should promote healthy traditional dietary patterns in certain groups of individuals.

Background: Mediterranean diet has been demonstrated to exert beneficial effects toward various health outcomes. Among the compounds that may be responsible for such benefits, polyphenols have been proposed as potential candidates. The aim of this study was to evaluate whether dietary polyphenols were associated with adherence to the Mediterranean diet in a Sicilian cohort. Methods: A total of 1937 adults were recruited in the urban area of Catania, southern Italy. Background characteristics and dietary habits were collected through validated questionnaires. Adherence to the Mediterranean diet was evaluated through application of a validated score (MEDI-LITE score). Dietary intake of polyphenols was estimated through the Phenol-explorer database. Differences in mean intake between quartiles of the MEDI-LITE score and association between quartiles of polyphenol intake and high adherence to the Mediterranean diet (highest quartile of the score) were calculated though logistic regression analyses. Results: Mean intake of most polyphenols was significantly different between quartiles of the MEDI-LITE score, being generally higher in individuals more adherent to the Mediterranean diet. Only few compounds, such as lignans, anthocyanins, and flavanones, showed a linear positive association with high adherence to the Mediterranean diet, while other polyphenol classes were associated in a non-linear manner. Among individual polyphenols, apigenin, hesperetin, naringenin, lariciresinol, matairesinol, pinoresinol, secoisolariciresinol, and ferulic acid were associated with high adherence to Mediterranean diet in a linear manner, while all the others (except for myricetin) were associated in a non-linear way. Conclusions: Mean polyphenol intake was higher in individuals more adherent to the Mediterranean diet compared to less adherent. However, dietary sources of polyphenols not included in the traditional foods comprised in the Mediterranean diet may contribute to total and specific classes of polyphenols irrespectively of their inclusion within the context of the Mediterranean diet.

BACKGROUND: Metabolic profiles of individuals living in the Mediterranean area is changing over time, with significant increase of average body weight, blood pressure, blood glucose and lipids.OBJECTIVE: The main aim was to assess the prevalence of excess weight, hypertension, diabetes and dyslipidemia and their interrelationships between specific background characteristics (age, sex, educational, occupational, physical activity, smoking and marital status, and alcohol drinking habits).METHODS: The paper is based on the Mediterranean healthy Eating, Lifestyle and Aging (MEAL) study cohort, which is a cross-sectional survey carried out in Sicily between 2014 and 2015. A final sample of 1,814 individuals with complete information on demographic and lifestyle characteristics was examined.RESULTS: The overall prevalence of overweight and obesity was 35.7% and 17.6%, respectively; 57.6% of men and 45.3% of women were hypertensive, 11.1% of men and 5.1% of women were diabetic, and 14.6% of men and 21.2% of women suffered by dyslipidemia. Besides various expected associations, such as better metabolic status in high physical active and non-smoker individuals, with higher education or occupational status were more likely, to a various extent, to suffer of metabolic disorders.CONCLUSIONS: Public health prevention campaigns should better target individuals more likely to suffer of metabolic disorders, including those with higher education and occupational level, which were supposed to be at lower risk of cardio-metabolic diseases. Future studies should better investigate the possible positive associations and determining factors of excess body weight and hypertension with higher socio-economic status in Southern Italy.

Backgrounds: There is growing evidence from both observational and intervention studies that Whole Grain (WG) cereals exert beneficial effects on human health, especially on the metabolic profile. The aim of this study was to perform a meta-analysis of randomised controlled trials (RCT) to assess the acute and medium/long-term effect of WG foods on glycaemic control and insulin sensitivity in healthy individuals. Methods: A search for all the published RCT on the effect of WG food intake on glycaemic and insulin response was performed up to December 2016. Effect size consisted of mean difference (MD) and 95% CI between the outcomes of intervention and the control groups using the generic inverse-variance random effects model. Results: The meta-analysis of the 14 studies testing the acute effects of WG foods showed significant reductions of the post-prandial values of the glucose iAUC (0–120 min) by −29.71 mmol min/L (95% CI: −43.57, −15.85 mmol min/L), the insulin iAUC (0–120 min) by −2.01 nmol min/L (95% CI: −2.88, −1.14 nmol min/L), and the maximal glucose and insulin response. In 16 medium- and long-term RCTs, effects of WG foods on fasting glucose and insulin and homeostatic model assessment-insulin resistance values were not significant. Conclusions: The consumption of WG foods is able to improve acutely the postprandial glucose and insulin homeostasis compared to similar refined foods in healthy subjects. Further research is needed to better understand the long-term effects and the biological mechanisms.

Aim: To explore the association between Sugar-Sweetened Beverages (SSBs) consumption and salt intake in relation to blood pressure and body composition in adolescents living in Sicily, southern Italy. Methods: From September 2012 to June 2014, 1643 students attending 15 secondary schools in the district of Catania were invited to participate. The information collected included demographics, anthropometric data (bioelectrical impedance), physical activity level, and dietary habits based a food frequency questionnaire validated for the Italian youth population. Results: The mean age of participants was 12.4 years and more than half (53.8%) were boys. The 30.1% and 24.5% of the sample was overweight or obese, respectively. The 30.5% of participants consumed sugary drinks every day. After adjusting for confounding factors, SSBs consumption was positively associated with salt intake, BMI, and fat mass. Blood pressure was associated with SSBs intake only in overweight/obese subjects, which was no more significant after adjustment for salt intake. Conclusion: There is an association between salt intake and SSBs consumption. SSBs intake has been linked to increased BMI and fat mass. SSBs and salt consumption should be discouraged, particularly among children and adolescents, and obesity prevention strategies should include information and education about both SSBs and salt.

OBJECTIVE:The aim of the present study was to systematically review and perform a meta-analysis of prospective cohort studies exploring the association between dietary legume consumption and CVD risk, including CHD and stroke. DESIGN:The PubMed and EMBASE databases were searched up to December 2015. A meta-analysis of the highest v. lowest (reference) category of dietary legume consumption was performed through random-effects models. RESULTS:Fourteen studies conducted on eleven cohorts and accounting for a total of 367 000 individuals and 18 475 cases of CVD (7451 CHD and 6336 stroke cases) were considered for the analyses. Compared with lower legume consumption, the highest category of exposure was associated with a decreased risk of 10 % in both CVD and CHD (relative risk=0·90; 95 % CI 0·84, 0·97) with no or little evidence of heterogeneity and no publication bias. Null results were found regarding legume consumption and stroke risk. No substantial confounding factors were evident in stratified analyses. CONCLUSIONS:Legume consumption was associated with lower risk of CVD. Legumes' intrinsic characteristics, because they are often part of an overall healthy diet, or because they are a substitute for unhealthy sources of protein may potentially explain the current findings.

The aim of this study was to estimate the dietary intake and major food sources of polyphenols in the Mediterranean healthy Eating, Aging and Lifestyles (MEAL) study cohort. A total of 1937 individuals (18+y) of urban population of Catania, Italy, completed a validated 110-item food frequency questionnaire; Phenol-Explorer database was used to estimate polyphenol intake. Mean intake of polyphenols was 663.7mg/d; the most abundant classes were phenolic acids (362.7mg/d) and flavonoids (258.7mg/d). The main dietary sources of total polyphenols were nuts, followed by tea and coffee as source of flavanols and hydroxycinnamic acids, respectively, fruits (i.e. cherries were sources of anthocyanins and citrus fruits of flavanones) and vegetables (i.e. artichokes and olives were sources of flavones and spinach and beans of flavonols); chocolate, red wine and pasta contributed to flavanols and tyrosols, respectively. These findings will be useful to assess the potential benefits of foods with high polyphenol content.

Many studies have reported that higher adherence to Mediterranean diet may decrease cardiovascular disease (CVD) incidence and mortality. We performed a meta-analysis to explore the association in prospective studies and randomized control trials (RCTs) between Mediterranean diet adherence and CVD incidence and mortality. The PubMed database was searched up to June 2014. A total of 17 studies were extracted and 11 qualified for the quantitative analysis. Individuals in the highest quantile of adherence to the diet had lower incidence [relative risk (RR): 0.76, 95% confidence intervals (CI): 0.68, 0.83] and mortality (RR: 0.76, 95% CI: 0.68, 0.83) from CVD compared to those least adherent. A significant reduction of risk was found also for coronary heart disease (CHD) (RR: 0.72, 95% CI: 0.60, 0.86), myocardial infarction (MI) (RR: 0.67; 95% CI: 0.54, 0.83), and stroke (RR: 0.76; 95% CI: 0.60, 0.96) incidence. Pooled analyses of individual components of the diet revealed that the protective effects of the diet appear to be most attributable to olive oil, fruits, vegetables, and legumes. An average reduced risk of 40% for the aforementioned outcomes has been retrieved when pooling results of RCTs. A Mediterranean dietary pattern is associated with lower risks of CVD incidence and mortality, including CHD and MI. The relative effects of specific food groups should be further investigated.

Introduction: Adherence to the traditional Mediterranean diet has been associated with health benefits in young populations. The aim of this study was to evaluate the association between adherence to the Mediterranean diet and cardio-metabolic parameters in adolescents living in Sicily, Southern Italy.Methods: A cross-sectional study was conducted during two school years (2012-2013 and 2013-2014) on 1643 adolescents of 11-16 years attending 15 secondary schools. Socio-demographic, dietary, lifestyle, and anthropometric data were collected. The KIDMED score was used to evaluate the adherence to the Mediterranean diet. Linear and logistic regression models were used to test the association between the variable of interest and the outcomes.Results: A higher percentage of boys compared with girls was overweight (30.8% vs. 25.4%) and obese (28.7% vs. 18.5%) and only 9.1% had high adherence to the Mediterranean diet. Vegetable intake was negatively associated with being overweight/obese whereas higher intake of sweets, sugar-sweetened beverages, and fast foods was associated with overweight and obesity. A good adherence to the Mediterranean diet resulted in 30% decreased odds of being overweight or obese (odd ratio 0.70, 95% confidence interval: 0.56-0.87) in both boys and girls. An inverse correlation was found between KIDMED score and BMI, waist circumference and fat mass. No relation with blood pressure was found.Conclusions: Mediterranean dietary pattern resulted significantly associated with weight status in adolescents. These results underline the importance of providing lifestyle and dietary habits education to prevent overweight and obesity in adolescent. (C) 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

The aim of this study was to evaluate the association between sleeping habits, Mediterranean diet pattern, and weight status in an adolescent population. The sample consisted of 1586 individuals aged 11–14 years attending 15 secondary schools of Sicily, Southern Italy. School were randomly selected and the data collected during two school years. Anthropometric data was collected and body composition was assessed by bioelectrical impedance analysis. Demographic information, sleep duration, pediatric daytime sleepiness questionnaire (PDSS), physical activity and dietary habits (including adherence to the Mediterranean Diet using the KIDMED score) were further collected. The mean age was 12±0.7 and about 24% were overweight and obese. An inverse correlation between total sleep time and body mass index (β=−0.829, P=0.021), fat mass (β=−0.526, P=0.025), and waist circumference (β=−0.426, P=0.045) was found. Similar results were found for weekdays sleep time, while an inverse relationship was found with PDSS score. Adherence to Mediterranean Diet was higher in under/normal weight adolescent with a significant linear association between the KIDMED score and the PDSS, weekdays sleep time and total sleep time. Sleep duration was also associated positively with fruits and vegetable intake and negatively with sweet and snack consumption and eating outside habits. Short sleep duration and poor sleep were associated with an increase in BMI and fat mass as well as to unhealthy eating behaviors. These findings suggest that sleep patterns could be a potential target for obesity prevention programs in young adolescence.