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Background/Objectives: The primary objective of this study was to explore physicians' adherence to the dietary pattern known as the Mediterranean diet (MD). As a secondary objective we assessed physicians' awareness on the benefits of the MD and of the possibility of prescribing it. Subjects/Methods: Physicians' adherence to the MD was evaluated through the Spanish associations SEMERGEN and CAMFIC, who sent the validated PREDIMED screener to their affiliates. The results reflected a high, medium, low or very low level of adherence depending on total score. The sample was drawn between 2014 and 2016. The second questionnaire evaluated the physicians' knowledge of the MD and their opinion about recommending it. Results: The PREDIMED test was answered by 422 Spanish physicians. In 8 out of 14 questions, more than 50% of the individuals scored only 1 point. However, 3 questions resulted in 1 point being scored by almost all physicians. Thus, on average, 55% of questions obtained 1-point scoring. The second questionnaire was answered by 212 physicians; 70% of them considered themselves to be aware of the benefits of the MD. More than 60% said they could invest 5 min of their time to recommend the MD. Conclusions: Primary care physicians do not show a high level of adherence to the MD and emphasize the need for creating tools to evaluate it in their patients. This research can be useful as both a database and a justification for the creation of a new protocol to help physicians increase their own and their patient' MD adherence.

Background: From the 1960s to the early 21st-century adherence to the Mediterranean diet (MD) declined around the world. This was partly due to the westernization of eating habits. However, in the last decade a new variable came into play, the economic crisis, which may have affected dietary patterns. Objective: We analyzed worldwide trends of adherence to the MD between the periods 1961-1965, 2000-2003 and 2004-2011. Methods: Data was obtained from the Food and Agriculture Organization Food Balance Sheets in three study periods: 1961-1965, 2000-2003 and 2004-2011. The Mediterranean Adequacy Index (MAI) was calculated for 41 selected countries using the averages of available energy intake for different food groups. Changes in MAI indicated the trends in adherence in the different periods. Results: In many countries, MAI deteriorated from 1961 to 1965 and 2004 to 2011, yet an increase was observed in 16 countries. Between the last two observation periods, MAI values stabilized in 16 of the 41 selected countries. Regional rankings for the three study periods based on descending MAI scores were: Southern Mediterranean, Mediterranean Europe, Central Europe and Northern Europe. Discussion and Conclusions: Adherence to the MD significantly decreased between 1961-65 and 2000-03, whereas from 2004-2011 there was a stabilization of MAI values and even an increase among 16 countries. Efforts are needed to preserve the dietary traditions and lifestyle habits within the Mediterranean region in order to counteract increasing rates of chronic disease.

Components of the Mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease. OBJECTIVE: To evaluate associations between components of the Mediterranean diet and circulating markers of inflammation in a large cohort of asymptomatic subjects at high risk for cardiovascular disease. SUBJECTS/METHODS: A total of 339 men and 433 women aged between 55 and 80 years at high cardiovascular risk because of presence of diabetes or at least three classical cardiovascular risk factors, food consumption was determined by a semi-quantitative food frequency questionnaire. Serum concentrations of high-sensitivity C-reactive protein (CRP) were measured by immunonephelometry and those of interleukin-6 (IL-6), intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) by enzyme-linked immunosorbent assay. RESULTS: After adjusting for age, gender, body mass index, diabetes, smoking, use of statins, non-steroidal antiinflammatory drugs and aspirin, a higher consumption of fruits and cereals was associated with lower concentrations of IL-6 (P for trend 0.005;both). Subjects with the highest consumption of nuts and virgin olive oil showed the lowest concentrations of VCAM-1, ICAM-1, IL-6 and CRP; albeit only for ICAM-1 was this difference statistically significant in the case of nuts (for trend 0.003) and for VCAM-1 in the case of virgin olive oil (P for trend 0.02). Participants with higher adherence to the Mediterranean-type diet did not show significantly lower concentrations of inflammatory markers (P

Background Dietary patterns can substantially vary the resource consumption and environmental impact of a given population. Dietary changes such as the increased consumption of vegetables and reduced consumption of animal products reduce the environmental footprint and thus the use of natural resources. The adherence of a given population to the Mediterranean Dietary Pattern (MDP) through the consumption of the food proportions and composition defined in the new Mediterranean Diet pyramid can thus not only influence human health but also the environment. The aim of the study was to analyze the sustainability of the MDP in the context of the Spanish population in terms of greenhouse gas emissions, agricultural land use, energy consumption and water consumption. Furthermore, we aimed to compare the current Spanish diet with the Mediterranean Diet and in comparison with the western dietary pattern, exemplified by the U.S.A. food pattern, in terms of their corresponding environmental footprints. Methods The environmental footprints of the dietary patterns studied were calculated from the dietary make-up of each dietary pattern, and specific environmental footprints of each food group. The dietary compositions were obtained from different sources, including food balance sheets and household consumption surveys. The specific environmental footprints of food groups were obtained from different available life-cycle assessments. Results The adherence of the Spanish population to the MDP has a marked impact on all the environmental footprints studied. Increasing adherence to the MDP pattern in Spain will reduce greenhouse gas emissions (72%), land use (58%) and energy consumption (52%), and to a lower extent water consumption (33%). On the other hand, the adherence to a western dietary pattern implies an increase in all these descriptors of between 12% and 72%. Conclusions The MDP is presented as not only a cultural model but also as a healthy and environmentally-friendly model, adherence to which, in Spain would have, a significant contribution to increasing the sustainability of food production and consumption systems in addition to the well-known benefits on public health.