Behavior, nutrition and lifestyle in a comprehensive health and disease paradigm: skills and knowledge for a predictive, preventive and personalized medicine

Abstract

Health and disease of individuals and of populations are the result of three groups of risk factors: genetics, environment and behavior. Assessment, interventions and tailored changes are possible with integrated approaches more effective if respectful of individuals and different cultures. Assessment tools and integrated interventional strategies are available, but widespread knowledge, skills and competence of well trained individual Medical Doctors still lack. Mediterranean diet is an appropriate reference paradigm because encompasses consistent research background, affordable sustainability, widespread comprehensibility and attractiveness inside a cultural framework of competences and skills in which the Medical Doctors can personally manage the need of prediction (early diagnosis), prevention (intervention on healthy persons) and tailored therapy and follow-up for patients. This profile is flexible and adjustable according to specific needs and preferences due to different economic and ethno-cultural milieus. It can enhanced through on-site/e-learning Continuous Medical Education (CME), by training and using friendly and affordable equipments.

Figure 1

Dietary/physical exercise Arcimboldo, which visually depicts guidelines and ideas is expressly designed by Giuliano Cangiano, by courtesy. It represents the preferred food, according to current guidelines, from those to be most frequently chosen to those to be exceptionally included. The Arcimboldo is running, obviously: practicing physical exercise.

Figure 2

This pyramid is more focused to the physical activity suggestions merged using the current guidelines and our clinical strategy. Physical activity is recommended with a daily exercise habit (10.000 steps, no elevators, no cars) and regular aerobic more intensive physical exercise (3 times/week) according to specific needs and possibilities.

Figure 3

This pyramid represents both the nutritional and the physical activity suggestions merged using the current guidelines and our clinical strategy. According to the Harvard-led group a dietary pyramid has been developed to describe the Mediterranean dietary pattern. This pattern consist of: 1) daily consumption of nonrefined cereals and products (e.g., whole-grain bread, pasta, brown rice, and the like), fruits (4 to 6 servings/day), vegetables (2 to 3 servings/day), olive oil (as the main added lipid), and non-fat or low-fat dairy products (1 to 2 servings/day); 2) weekly consumption of fish, poultry, potatoes, olives, pulses, and nuts (4 to 6 servings/week), as well as more rarely eggs and sweets (1 to 3 servings/week), and monthly consumption of red meat and meat products (4 to 5 servings/month). It is also characterized by moderate consumption of wine (1 to 2 wine glasses/day), moderate consumption of fat, and a high monounsaturated to saturated fat ratio. The quality of food is characterized by three main features: 1) short trade chain; 2) certified quality and 3) preference to the use of season's food, particularly fruits and vegetables.

Figure 4

Mediterranean diet score adherence and mortality. Mortality and diseases increase along the decrease of the adherence to a Mediterranean diet profile, which is assumed as a proxy to the current European and North American lifestyle-nutritional guidelines.

Figure 5

Anti-inflammatory mechanisms of Mediterranean diet are presented according to EBM studies. Nutrients' profile of Mediterranean diet, and of the present Italian and USA guidelines is associated with lower inflammatory action and lower oxidative stress of its components. These are the two main features of Mediterranean diet composition which explain the lower prevalence of related disease (rheumatic, allergic, degenerative including atherosclerosis, neurological, metabolic, cancer) in clinical and epidemiological studies. Greater adherence to Mediterranean diet profile is associated with lower prevalence and severity of these conditions.

Figure 6

Pro-inflammatory mechanisms of Western diet are presented according to EBM studies. Nutrients' profile of western diet is associated with greater inflammatory action and greater oxidative stress of its components. These explain the greater prevalence of related disease (rheumatic, allergic, degenerative including atherosclerosis, neurological, metabolic, cancer) in clinical and epidemiological studies. Lower adherence to Mediterranean diet profile is associated with greater prevalence and severity of these conditions.

Figure 7

Adherence to nutritional guidelines shows a continuous decline in the past 15 years. This is our experience on Mediterranean diet score (range 0-55). It was assessed in 8138 healthy non-diabetic, overweight/obese subjects, 1996-2010, referred for US liver diagnostic and dietary counseling. In our population there is a trend throughout the last 15 years toward the loss of the adherence to Mediterranean diet from 37.06 ± 3.213 to 34.82 ± 5.014 p < 0,0001, not associated with BMI or physical activity change. This information, that can be also more generally interpreted as the loss of adherence to the most internationally recognized guidelines for healthy nutrition, reinforces reasons and need for coordinated and sustainable interventions.

Figure 8

Cluster of skills and knowledge for boosting a sustainable and effective PPPM. Knowledge and skills in health psychology, nutritional and physical activity assessment and prescribing can be enhanced through appropriate funding of Continuous Medical Education (CME), also by professionally targeted e-learning. Professional post-graduate training and facilitation for purchasing friendly and affordable equipment facilities, mostly along a professionally driven expertise in US non-invasive procedures, is the other fundamental tool for enhancing an effective bedside PPPM.