Dietary Patterns in the Ageing European Population: an Interdisciplinary Approach to combat Overweight-Related Metabolic Diseases. The EURODIET project
|Partner Organization||Partner Country|
|Hospital Clínico Universitario in Valencia, INCLIVA,||Spain|
|Department of Economics, University of Barcelona||Spain|
|Alma Mater Studiorum-University of Bologna- Dept. of Experimental, Diagnostic and Specialty Medicine;||Italy|
1. Overall project description
An epidemic of overweight/obesity, metabolic syndrome and cardio-metabolic diseases is emerging at planetary level, and healthy nutrition represents a critical help to counteract this trend. Unfortunately, simplistic guidelines failed totally or partially, mainly because of the complexity and heterogeneity of nutrition/dietary habits in humans. EURODIET will tackle such complexity and the urgent/unmet need of integrated studies by investigating how the combination of variables usually analyzed separately (ethnicity/geography, sex/gender, socio-economic status/education, previous dietary habits, physical activity and smoking) affects adoption of healthy dietary habits and conventional as well as novel metabolic and inflammatory biomarkers in a large number of subjects spanning from 50 to 79 years of age.
The main objectives are: i) To integrate existing cohorts and collect new ad hoc data (e.g. omics-based biomarker identification); ii) To perform a follow-up study on dietary habits, health status and incident diseases on a subsample of subjects based on existing data collected at two time points within the NU-AGE project; iii) To perform two proof-of-concept randomized controlled trials to assess the effects of adherence to a healthy a whole-diet approach in adults with elevated metabolic risk as well as in patients with diagnosed metabolic disease; iv) To determine facilitators and barriers for adherence to healthy dietary patterns; v) To bridge the gap between academic research, public health practice and the food production industry; vi) To provide state-of-the-art training to young scientists focusing on the importance of addressing/combining biological and non-biological variables in dietary interventions and metabolic diseases.
At this stage of the project, the main findings are: i) generation of sociodemographic-adjusted new data on the beneficial impacts of the Mediterranean diet on metabolic diseases in a large cohort of European adults; ii) elucidation of the impacts of different fat subtypes, protein amount and source and fruit and vegetable on muscle health and metabolic health, while considering the potential effect of adherence to physical activity recommendations; iii) design of an educational approach enabling increased adherence to healthy diet; iv) generation of new data on the impact of increased fruit and vegetable intake on metabolic health and systemic inflammatory environment; v) identifying attitudes and barriers for adopting healthier dietary habits in men and women with different socioeconomic status; vi) through participation in a Social Impact Lab for multidisciplinary teambuilding and impact mapping, establishment of a regional network supporting the implementation of healthy dietary habits for prevention of overweight-related metabolic diseases in primary care settings; viii) development of a research course for ECS aiming to extend basic knowledge and evaluate current research about evidence-based impacts of dietary patterns and physical activity behaviours on metabolic health, integrating biological, medical, psychological and cultural perspectives.
Expected impacts: The impacts of EURODIET are monitored by the dissemination task force comprising representatives from the regional and local health authorities and primary care centres, non-profit organizations of end-users, and the industry sector. The expected impacts of EURODIET are:
(i) synthesis of key messages about the importance of healthy diet for the reduction of metabolic disease risk translated into appropriate user-friendly formats (synthesis and translation activity)
(ii) supporting dissemination of knowledge on behavioural change focusing on healthy diet into public health practice (support activity)
(iii) supporting dissemination of knowledge on healthy diet for the reduction of metabolic disease risk for development of healthy foods by the food production industry (support activity)
(iv) supporting implementation of evidence-based prevention models based on healthy lifestyle habits within the workflow of primary health care centres
(v) supporting the generation of a new breed of researchers through an education package addressing the role of lifestyle behaviours in the prevention of chronic diseases from a medical, psychological and socioeconomical perspective.
In the first year of the project, EURODIET has generated sociodemographic-adjusted new data evidencing the beneficial impact of Mediterranean diet on the occurrence of chronic diseases in older European adults and provided in depth-knowledge on the role of fat subtypes and protein amount and source on muscle health, an important metabolic organ. Further experimental work is warranted in order to elucidate the mechanisms underpinning the action of dietary fibre on muscle health.
Using isocaloric substitution modelling, a reduced sarcopenia risk was observed when increasing plant protein to the detriment of animal protein, while holding total protein intake constant. Further, this result remained significant after stratifying the analysis by adherence to different levels of protein intake. Our findings suggest that older adults may benefit from increasing protein intakes above current recommendations. Besides total amount, protein source should be considered when promoting health dietary habits in older adults for the prevention of sarcopenia. We have also shown that a reduction of saturated fatty acids for the benefit of polyunsaturated fatty acids is associated with a lower sarcopenia risk, particularly in those with a protein intake below current guidelines, irrespective of age, smoking habits, metabolic disturbances, and adherence to physical activity guidelines.
In the second year of the project, we have addressed the role of plant-based diets in the prevention of metabolic diseases and found that fruit and vegetable (FV) intake is associated to a reduced likelihood of having the metabolic syndrome in older adults. The novelty in this finding is that the beneficial effect is independent of adherence to health-enhancing physical activity and time spent sedentary. Additionally, we have shown for the first time that adherence to healthy dietary patterns is related to beneficial impacts on indicators of muscle health. We have also conducted a randomized controlled trial to determine the effect of increased FV intake on metabolic and inflammatory biomarkers in older men and women. An educational approach was employed in order to facilitate the dissemination and implementation of the prevention model to wider settings. The education-based approach successfully doubled the FV intake in the experimental group only. Importantly, the increased FV intake was accompanied by a significant reduction in pro-inflammatory biomarkers, indicating the potential of plant-based diets in reducing systemic inflammation. We have also collected a large set of qualitative data regarding attitudes and barriers for adoption of healthy dietary habits in men and women with elevated metabolic risk and with varying socioeconomic status. This data will be used in implementation of the prevention model in populations with different socioeconomic status.
In the third year of the project, as a result of participation in a Social Impact Lab for multidisciplinary teambuilding and impact mapping, we have established a network comprising regional representatives of health care system that together will support the implementation of healthy dietary habits for prevention of overweight-related metabolic diseases in primary care settings. Currently, recruitment of patients with type 2 diabetes in the second randomized controlled trial of the EURODIET is ongoing. We have also developed a research course for early career scientists (ECS) aiming to extend basic knowledge and evaluate current research about evidence-based impacts of dietary patterns and physical activity behaviours on metabolic health, integrating biological, medical, psychological, and cultural perspectives. Fifteen PhD students and postdocs have applied for the course (Impacts of diet on overweight-related metabolic diseases, 5 credit).
4.1 List of publications
|Authors||Title||Year, Issue, PP||Partners Number||Doi|
|Diego Montiel-Rojas *, Andreas Nilsson* , Aurelia Santoro * , Alberto Bazzocchi , Lisette C P G M de Groot , Edith J M Feskens , Agnes A M Berendsen , Dawid Madej, Joanna Kaluza , Barbara Pietruszka , Amy Jennings , Susan Fairweather-Tait , Giuseppe Battista , Miriam Capri , Claudio Franceschi* , Fawzi Kadi*||Fighting Sarcopenia in Ageing European Adults: The Importance of the Amount and Source of Dietary Proteins||doi: 10.3390/nu12123601.|
|Judit Vall Castelló* , Charisse Tubianosa||Linking Mediterranean Diet and Lifestyle with Cardio Metabolic Disease and Depressive Symptoms: A Study on the Elderly in Europe||doi: 10.3390/ijerph17197053|
|Diego Montiel-Rojas* , Aurelia Santoro* , Andreas Nilsson*, Claudio Franceschi *, Miriam Capri, Alberto Bazzocchi , Giuseppe Battista , Lisette C P G M de Groot, Edith J M Feskens , Agnes A M Berendsen , Agata Bialecka-Debek , Olga Surala , Barbara Pietruszka, Susan Fairweather-Tait , Amy Jennings , Frederic Capel , Fawzi Kadi *||Beneficial Role of Replacing Dietary Saturated Fatty Acids with Polyunsaturated Fatty Acids in the Prevention of Sarcopenia: Findings from the NU-AGE Cohort||doi: 10.3390/nu12103079.|
|Nilsson A*, Cano A*, Bergens O*, Kadi F*.||Randomized Controlled Trial for Promotion of Healthy Eating in Older Adults by Increasing Consumption of Plant-Based Foods: Effect on Inflammatory Biomarkers.||doi: 10.3390/nu13113753|
|Papaioannou KG, Nilsson A, Nilsson LM, Kadi F||Healthy Eating Is Associated with Sarcopenia Risk in Physically Active Older Adults||doi: 10.3390/nu13082813.|
|Bergens O, Nilsson A, Kadi F.||Associations between Circulating Inflammatory Biomarkers and Indicators of Muscle Health in Older Men and Women.||doi: 10.3390/jcm10225316.|
|Edholm P, Veen J, Kadi F, Nilsson A. .||Muscle mass and aerobic capacity in older women: Impact of regular exercise at middle age||doi: 10.1016/j.exger.2021.11125|
|Veen J, Montiel-Rojas D, Nilsson A, Kadi F||Engagement in Muscle-Strengthening Activities Lowers Sarcopenia Risk in Older Adults Already Adhering to the Aerobic Physical Activity Guidelines.||doi: 10.3390/ijerph18030989|
|Santoro A, Zhao J, Wu L, Carru C, Biagi E, Franceschi C||Microbiomes other than the gut: inflammaging and age- related diseases.|
|Tavella T, Rampelli S, Guidarelli G, Bazzocchi A, Gasperini C, Pujos-Guillot E, Comte B, Barone M, Biagi E, Candela M, Nicoletti C, Kadi F, Battista G, Salvioli S, O'Toole PW, Franceschi C, Brigidi P, Turroni S, Santoro A. . . .||Elevated gut microbiome abundance of Christensenellaceae, Porphyromonadaceae and Rikenellaceae is associated with reduced visceral adipose tissue and healthier metabolic profile in Italian elderly|
|Conte M, Martucci M, Mosconi G, Chiariello A, Cappuccilli M, Totti V, Santoro A, Franceschi C, Salvioli S.||GDF15 Plasma Level Is Inversely Associated With Level of Physical Activity and Correlates With Markers of Inflammation and Muscle Weakness|
|Conte M, Sabbatinelli J, Chiariello A, Martucci M, Santoro A, Monti D, Arcaro M, Galimberti D, Scarpini E, Bonfigli AR, Giuliani A, Olivieri F, Franceschi C, Salvioli S. . . .||Disease-specific plasma levels of mitokines FGF21, GDF15, and Humanin in type II diabetes and Alzheimer's disease in comparison with healthy aging|
|Conte M, Santoro A, Collura S, Martucci M, Battista G, Bazzocchi A, Morsiani C, Sevini F, Capri M, Monti D, Franceschi C, Salvioli S.||Circulating perilipin 2 levels are associated with fat mass, inflammatory and metabolic markers and are higher in women than men|
|Santoro A, Bientinesi E, Monti D.||Immunosenescence and inflammaging in the aging process: age-related diseases or longevity?|
|Jort Veen, Diego Montiel-Rojas, Fawzi Kadi, Andreas Nilsson||Effects of Reallocating Time Spent in Different Physical Activity Intensities on Sarcopenia Risk in Older Adults: An Isotemporal Substitution Analysis||doi: 10.3390/biology11010111|
|Papaioannou KG, Kadi F, Nilsson A.||Benefits of Fruit and Vegetable Consumption on Prevalence of Metabolic Syndrome Are Independent of Physical Activity Behaviors in Older Adults||doi: 10.3390/nu14020263|
|Bauset C, Martínez-Aspas A, Smith-Ballester S, García-Vigara A, Monllor-Tormos A, Kadi F, Nilsson A, Cano A||Nuts and Metabolic Syndrome: Reducing the Burden of Metabolic Syndrome in Menopause||doi: 10.3390/nu14081677|
4.2 Presentation of the project
|Target group||Authors||Means of communication||Hyperlink|
|Members of the Swedish part of the European Society for Clinical Nutrition and Metabolism; Swedish society for dietitians; Swedish society of nursing||Dietary habits, physical activity and metabolic health in older adults, Swedish part of the European Society for Clinical Nutrition and Metabolism, Sweden, 2022- partner Coordinator.||Oral presentation|
4.3 List of submitted patents and other outputs
|Patent licence||Partners involved||Year||International eu or national patent||Comment|