|
intervention, compared with usual diet, significantly reduced HbA1c levels in middle-aged and older adults with type 2 diabetes. 10 Furthermore, in adults with newly diagnosed type 2 diabetes, there is evidence that following a Mediterranean diet not only significantly improves glycaemic control but also delays the need for diabetes medications by about two years, compared with a standard low-fat diet. 11
Mental health benefits
Australian researchers have led the way
when it comes to demonstrating the effectiveness of a Mediterranean diet on alleviating symptoms of depression and anxiety. For example, the SMILES and HELFIMED studies were among the first two clinical trials to show that a Mediterranean diet intervention can reduce depressive symptoms in adults with major depression or mild depressive symptoms. 12, 13 Importantly, these findings have since been corroborated in a recent systematic review and meta-analysis. 14
|
Box 1. Top tips for patients to follow a Mediterranean diet
• Use extra virgin olive oil as the main source of fat— both for cooking and as a dressing.
• Try to eat vegetables with every meal and include a wide variety of different types of vegetables, both raw and cooked in extra virgin olive oil. Think colour: green, red, orange, purple, yellow.
• Eat fresh fruit every day.
• Include 2-3 legume-based meals per week.
• Include 2-3 servings of fish per week— preferably oily fish such as salmon or sardines.
• Snack on nuts( walnuts and almonds in particular) 2-3 times per week. A handful is all that is needed.
• Eat smaller portions of meat( beef, pork, lamb and chicken) and less often( once or twice per week). Give preference to white meat over red meat.
• Select wholegrain breads and cereals over refined options.
• Eat plain Greek yoghurt( about 200g) daily.
• Limit intake of processed meats, sweets, pastries, biscuits, cakes and soft drinks.
• Drink wine in moderation( limit to one standard drink, 100ml, per day) and always consume with a meal. Try to include 1-2 alcohol-free days per week.
• Remember to enjoy food, and preferably eat in the company of friends and family.
function and memory in older adults without dementia. 16 The authors’ study showed that regular consumption of nuts( ≥3 servings per week), which is a key dietary component of the Mediterranean diet, was an important contributor to these findings. This is consistent with previous literature showing that moderate nut intake(~ 30g on most days) is positively associated with better global cognition and higher scores in multiple cognitive domains, including processing speed, language, visuospatial and executive functioning. 17
the gradual loss of muscle mass, strength and physical function, which heightens the vulnerability of middle-aged and older adults to disability, hospitalisations, frailty and loss of independence. 18 The evidence from nutritional epidemiology suggests a positive association between adherence to Mediterranean diet patterns and muscle function, including physical performance and mobility decline / physical frailty in older adults. 19
|
likely to relate to multiple factors including the anti-inflammatory potential of the diet, reductions in oxidative stress and a higher intake of antioxidants. The apparent anti-inflammatory benefits of a Mediterranean diet have been shown in several clinical trials, including subgroup analysis of the PREDIMED study, where adherence to a Mediterranean diet intervention significantly lowered pro-inflammatory biomarkers. 20
Can the Mediterranean diet be followed in Australia?
The authors analysed all Mediterranean diet
intervention studies performed in Australia to 2019. 21 They all demonstrated impressive and sustained adherence to a Mediterranean diet intervention, which translated to improvements in several health-related outcomes, including CVD risk, glycaemic control, cognition and inflammation. However, most studies had intensive support strategies to help facilitate adherence, including one-on-one personalised dietary prescription and counselling provided by accredited practising dietitians, written resources, cooking classes, information sessions, and the provision of key‘ staple’ foods such as extra virgin olive oil, nuts and legumes. Therefore, ongoing individualised counselling together with behavioural modification strategies, which are feasible to achieve within the current healthcare model, support adherence to key dietary principles of a Mediterranean diet in Australia.
|
Wine should be consumed in moderation and always with a meal. |
|
|
Benefits to cognitive decline
The authors’ research group has shown that
|
||||
greater adherence to a Mediterranean diet is positively associated with healthy physical and cognitive ageing. In a cohort of almost 300 older Australians, greater adherence to a Mediterranean diet was positively associated with functional ability and inversely associated with cognitive decline. 15 Importantly, these findings are consistent with meta-analytical data that show high adherence to a Mediterranean diet is cross-sectionally and longitudinally associated with maintenance of overall cognitive |
||||
|
Musculoskeletal health benefits
As life expectancy increases, preservation
of musculoskeletal health in older age is crucial. Ageing is associated with sarcopenia,
|
How and why?
The exact mechanisms by which a Mediterranean
diet exerts potential benefits on decreasing chronic disease risk and supporting healthy ageing is complex and still under investigation. It is thought most
|
References on request from kate. kelso @ adg. com. au |
||