1. Dietetics and Nutrition in the Mediterranean By Dr. Alberto Fatticcioni

4. fruit (at least 4 pieces or 400 g a day)

5. legumes and pulses

6. grains, pasta and/or bread (mostly wholemeal and unrefined)

7. olive oil and nuts

8. an abundant use of herbs and spices

9. water (more than 2 liters per day)

11. cheese, recommended 1 - 4 times per week

12. milk, recommended 1 - 2 times per week

14. redmeat, recommended 0 - 1 time a week

15. sweets, recommended 0 - 1 time per week

17. Mediterranean Fruits Cherries Watermelon Fig, fresh and dried Kaki Melon Pomegranate Medlar Kiwi Clementine Peches Grapefruit Blackberry Raspberry Blueberry Redcurrant Lemon Persimmon Plum, fresh and dried Grape Apple Apricot Orange Strawberry Pear

19. Lentils

20. Fava beans (fresh and dried)

21. Borlotti beans (fresh and dried)

22. Cannellini beans (fresh and dried)

23. Peas

24. Black Eyed Beans

26. Soft wheat (whole bread or refined)

27. Farro

28. Rice (whole or refined)

30. Olive

31. Almond

32. Hazelnut

33. Walnut

34. Pine nuts

35. Pistachios

37. Sardines

38. Tuna

39. Swordfish

40. Mekerel

41. Eel

42. Trout

43. Oyster

44. Mussels

45. Clam

46. Octopus

47. Squid

48. Ray

49. Shrimp

50. Cod

51. Cuttlefish

52. John Dory

53. Ombrine

54. Dogfish

55. Pike

56. Lobster

57. Sole

59. fruit (at least 4 pieces or 400 g a day)

60. legumes and pulses

61. grains, pasta and/or bread (mostlywhole)

62. olive oil and nuts

63. water (more than 2 liters per day)

64. wine duringmeals ( maximum 2 glasses per day)

65. seafood (fish, shellfish, mollusc), 4-6 times a week

66. yoghurt, 2 - 4 times per week

67. cheese, 1 - 4 times per week

68. milk, 1 - 2 times per week

69. eggs, 1 - 4 eggs per week (maximun1 per day)

70. poultry, 1 - 2 times per week

71. redmeat, 0 - 1 time a week

73. Vegetariandiets: historicalcontext In the 18 thcentury, Benjamin Franklin wasperhaps the mostfamousof the scientists, physicians, and philosopherswhosupportedvegetariandiets. The vegetarianmovementexpandedconsiderably in the 19 th and 20 thcentury. A 1994 surveyreportedthat some 12.4 million people in the UnitedStatescallthemselvesvegetarians. The samepolladministered in the year 2000 concludedthat 2.5% of the USA population can beconsideredvegetarian.

74. Vegetariandiets: historicalcontext The reasonsforadopting a vegetarian lifestyle are varied. Historically, vegetarian diets were associated with certain religious practices. Currently, health appears to be the primary reason for adopting a vegetarian diet. Other reasons encompass ecologic and environmental issues relating to the large differences in resources necessary to support animal and plant based diets. Another common reason relates to ethical concerns about the treatment of animals for clothing or research. In many cases, however, multiple reasons underlie vegetarian dietary practices.

76. Lactovegetarians

77. Ovovegetarians

78. Vegans (exclude all animal products)

80. Vegetariandiets and protein Oneof the mostfrequentquestionsregarding the nutritionaladequacyofvegetariandietsrelatestoproteinrequirements. However, the inadequateenergyintake in some vegetariansmay compromise protein status aswell. Moreover, becauseof the lowerdigestibilityofplantproteins, the proteinrequirementofvegansmaybehigherthanthoseofnon-vegetarians. Foodsofplantorigin are oftensaidtolackcertainindispensable amino acids and thustoprovideproteinoflesserqualitythan in foodsofanimalorigin.

82. Children: 1.0-1.6 grams per kg of body weight.

83. Adults: 0.8 grams per kg of body weight.

84. Adultathletes: 1.5-2.0 grams per kg of body weight.Currentevidencesuggeststhat a lowerintakeofanimalproteinmaybebeneficial and maylowerurinarycalciumexcretion and slow the progressionofrenaldisease and osteoporosis; thisrelathionshipisnotseenwhenplantproteinisconsumed.

85. Vegetariandiets and protein Two amino acids are ofparticular interest in vegetariandiets; lysine, the limiting amino acid in cerealgrains, and methionine, the limiting amino acid in legumes.

86. Compositionof Dry Legumes

87. Vegetarians, Legumes and Protein Legumesare 20 to 25% proteinbyweight, whichisdouble the proteincontentofwheat and threetimesthatofrice. Forthisreason, legumesare called "vegetarian's meat". Whilelegumesare generally high in protein, and the digestibilityofthatproteinisalso high, theyare oftenrelativelypoor in the essential amino acid methionine. Grains (which are themselvesdeficient in lysine) are commonlyconsumedalongwithlegumestoform a complete proteindietforvegetarians.

88. Legumes and Aminoacids Legumescontainrelatively low quantitiesof the essential amino acid methionine. To compensate, the MediterraneanDietserveslegumesalongwithgrains, which are low in the essential amino acid lysine, whichlegumescontain. Thus a combinationoflegumeswithgrainsforms a well-balanceddietforvegetarians. Common examplesofsuchcombinations are pasta and beans “pasta e fagioli” andemmerwheat and legume soup “zuppa di legumi e farro”.

89. Complete proteinfoodforvegetarians Complete proteinscontain a balanced set ofessential amino acidsforhumans. Animalsourcessuchasmeat, poultry, eggs, fish, milk, and cheeseprovideallof the essential amino acids. Near-completeproteins are alsofound in some plantsourcessuchasquinoa,buckwheat, and amaranth. Soyaappearsaslower in methionine and cysteine. Itisnotnecessarytoconsumeplantfoodscontaining complete proteinsas long as a reasonablyvarieddietismaintained. Byconsuming a wide varietyofplantfoods, a full set ofessential amino acidswillbesuppliedand the human body can convert the amino acidsintoproteins.

90. Vegetarians and Iron Non-hemeironfromplant foods is less available than heme iron, and plant foods contain a variety of substances known to reduce iron availability. However, plant foods also contain other substances that enhance iron uptake, and well-planned vegetarian diets often contain more iron than omnivorous diets. Some studies suggest that long-term LOVs, even with a higher fiber intake, maintain iron status no different from that of omnivores. The high levels of iron in well planned vegetarian diets (15-20mg per day) combined with the frequent intake of fruits and vegetables rich in vitamin C appear to protect against iron deficiency.

91. Top 10 plant foods richest in iron/100 g 14,30 mg pure cocoa 10,00 mg germ of wheat 9,00 mg dried beans 8,00 mg lentils 7,80 mg green radicchio 7,30 mg pistachios 6,40 mg chickpeas 5,30 mg dried apricots 5,20 mg arugula, oats 5,00 mg dark chocolate, fava beans 4,50 mg peas

92. Top 10 plant foods richest in iron/100 g 4,00 mg buckwheat 3,90 mg dried plums 3,50 mg peanuts, olives 3,30 mg hazelnuts, raisins 3,00 mg dried figs, almonds, whole flour, dried dates 2,90 mg spinach 2,70 mg green beetroots 2,60 mg walnuts 2,00 mg chard 2,00 mg zucchini flowers 1,70 mg endives

93. Top 10 foodsforVitamin C content /100g Redcurrants 200 mg Red peppers 151 mg Broccoli and arugula 110 mg Kiwis 85 mg Brusselsprouts and turnip 81 mg Cauliflower 59 mg Strawberries, clementines, spinach 54 mg Oranges and lemons 50 mg Kale 47 mg Tangerines 42 mg

94. Top 10 fruitsforVitamin C content /100g Redcurrants 200 mg Kiwis 85 mg Strawberries and clementines 54 mg Oranges and lemons 50 mg Tangerines 42 mg Grapefruit 40 mg Melons 32 mg Raspberries 25 mg Persimmons 23 mg Blackberries 19 mg

95. Vegetarians and Vitamin B12 The usualdietarysources of this vitamin are animal products, plants do not synthesize or store vitamin B12; persons who include only plant foods in their diet, such as vegans and others who consume only raw foods, are at increased risk of deficiency. Vitamin B12 deficiency can result in serious and irreversible neurologic and neuropsychiatric abnormalities. Serum vitamin B12 levels in vegans are generally lower than those in omnivores, with intermediate levels found in LOVs. The requirement of vitamin B12 is very low and cases of B12 deficiency are rare.

96. Foodsrich in VitaminA mcg/100g Carrots 1149 Pumpkin 599 Spinach 485 Pecorino 380 Parmigiano 373 Apricots 360 Cicory 267 Chard 263 Kaki 237 Lettuce 229 Broccoli and eggs 225 Brusselsprouts 220 Mozzarella 219 Endives213 Celery 207 Melon 189 Medlar 170 Escarole 167 Sweetpeppers139 Ricotta 128

97. Vegetarians: Calcium and Vitamin D Adequatecalcium and vitamin D intakes are importanttoensureoptimalbone status over lifetime. Evidence suggests that calcium may also be important in regulating blood pressure and preventing colon cancer (milk and dairy products supply 70% of calcium in US diets). Calcium intake among LOVs appears to be similar to that of omnivores, whereas intake in vegans is less; in addition, vegans, consume less vitamin D. The low consumption of vitamin D may be further exacerbated in some cases by limited exposure to light.

98. Vegetarians: Calcium and Vitamin D Low vitamin D concentrations and secondaryhyperparathyroidismweredocumentedduring the winter in vegans living at northernlatitudes. In some casesbonemineral density tended to be lower in the vegan group compared with lactovegetarians and omnivores. A high intake of sodium increases calcium excretion (the same for animal protein). Vegans may need to give attention to obtaining an appropriate calcium intake especially during periods of growth.

99. Foodsrichest in Calciumcontent mg/100g Pecorino 1160 Parmigiano 1159 Arugula 309 Ricotta 295 Almonds 240 Driedfigs 186 Oysters 186 Green beet 160 Mozzarella 160 Hazelnuts 152 Cicory 150 Anchovies 148 Octopus 144 Squid 143 Chickpeas 142 Cannellini 132 Walnuts 131 Agretti 131 Pistachios 130 Yogurt 125 Milk 119 Radicchio 115 Shrimps 110 Buckwheat 110 Borlotti 102 Broccoli 97 Cardoons 96 Endives 93 Fava beans 90 Mussels 88 Artichokes 86 Driedapricots 85 Spinach 78 Raisins 78 Dates 69 Chard 67 JhonDory 65 Hare 64 Olives 63 Kale 62 Cauliflower 60

100. Foodsrichest in Vitamin D contentmcg/100g Tuna 16.30 Anchovies 11 Swordfish 11 Trout 10.60 Pike 10.60 Carp 10.60 Shark 9.10 Salmon 8 Eel 4.90 Sardines 4.50 Butter 4.35 Eggs 1.75

101. Vegetarians and Zinc Meat, fish, and poultryprovide 40 to 45% of the zinc in the US diet; the absorptionforzincisreducedwithvegetariandiets. An Australian study found that vegetarian women had significantly lower zinc intake than omnivores, but their zinc concentration was not different. A lower zinc intake was found among vegetarian children and adolescents, but growth was not affected; the vegetarians in the study were slightly taller than the non-vegetarians.

102. Foodswithrichestzinccontent mg/100g Beefliver 6 Beef 5,70 Ham 5,20 Octopus 5,10 Anchovies 4,20 Cuttlefish 4,20 Parmigiano 4 Rabbit 3,90 Bresaola 3,87 Horsemeat 3,72 Hare 3,65 Cannellini 3,6 Pecorino 3,50 Chickpeas 3,20 Squid 3,10 Oats 3,10 Walnuts 3 Whole pasta 3 Artichoke 2,90 Borlotti 2,90 Lentils 2,90 Mozzarella 2,60 Mushrooms 1,50 Spinach 1,43

103. Vegetarians and omega-3 Vegetariandiets are typically low in omega-3 polyunsaturatedfattyacids. Sourcesrich in omega-3 suchasflaxseed, walnuts, canolaoils and soyoilsshouldbeincluded in the vegetariandiet, and the intakeofrich omega-6 fattyacidsshouldbedecreasedtooptimizeconversiontoeicosapentanoic acid and DHA.

104. Percentageof Omega-3, Omega 6, and Omega-9 FattyAcids In Some SaladCookingOils

105. OSTEOPOROSIS

106. Osteoporosis One and halfmillionosteoporotic fractures of the spine, wrist, hip and other sites occur each year, primarily in postmenopausal white women. In the United States, direct medical costs of fractures among the population age 45 an older totaled nearly $14 billion in 1995. Treatment of men accounted for approximately $3 billion, or 20% of the total amount. Physical inactivity and diet are the most important risk factors of this pathology.

107. Osteoporosis The term osteoporosis refers to a condition in which the skeleton is subject to an increased risk of fractures due to the decreased mass and alteration of bone microarchitecture.Osteoporosis, although generally considered as a disease of the bones, for some is a paraphysiological process; the presence of which predisposes to a greater development of diseases and a consequent reduction in life expectancy, if not properly treated.

108. Types Osteoporosis is divided into primary (original) or a secondary event related to or achieved (hyperparathyroidism, osteotoxic drugs, etc.). The primary form is the most exclusive form (95% of cases). Primaryosteoporosis * Idiopathicosteoporosis (the rarestformofall, the cause isunclear * Type I osteoporosis or postmenopausal (due to a fall in hormone production) * Type II or senile osteoporosis (due tovariouscauses, includingimmobilization, reduced production ofsomatotropin, testosterone, calcium, magnesium, vitamin D and otherimportantmicronutrients, reducedfunctionof the enzyme 1a-hydroxylase whichproduces the activehormonevitamin D, ie, calcitriol). Occurs mainly in trabecular bone, this is the shape with a greater number of fractures. Secondaryosteoporosis The secondaryosteoporosisis a group full ofvariations, buttheyrepresentonly 5% ofosteoporosis. The mainones are classifiedascausedby: * Hyperparathyroidism * Osteopenizzantidruguse (steroids, antiepilepticdrugs, heparin, oralanticoagulants, loopdiuretics) * Low body weight * Prolongedimmobilization * Hypersurrenalism * Hypercalciuria * COPD (chronicobstructivepulmonarydisease) * Rheumatoidarthritis Sarcoidosis * * Celiacdisease * Malignancy * Reducedintestinalabsorptionofnutrients

109. Etiology The cause is the loss of the balance between osteoblasts and osteoclasts. The first category of cells contributes to bone formation, the latter contributes to bone reabsorption, where osteoclasts working faster than osteoblasts, the bone deteriorates. Menopause (form I) there is an increased production of osteoclasts, due to loss of estrogen that leads to a possible elevation of cytokines, related to the production of osteoclasts. In the second form, with advancing age the activity of osteoblasts decreases.

110. Symptomatology Osteoporosis is manifested initially by a decrease in tone calcium in bone mass (osteopenia). The bones more easily affected by the decrease in tone lime are the vertebrae back injury, the femur and the wrist.Initially asymptomatic, that is for 2 / 3 of people. The first signs appear with fractures, bone pain and muscle such as is typical of the presence of fractures, but they may also go unnoticed by the individual and can show even the least traumatic. Usually the pain is back, is acute and growing in the presence of load. With the further development of osteopenia vertebral collapse or fracture of femoral neck may occur.The fractures can lead to cervical cyphosis and lordosis.

111. Riskfactors Uneditable * Age - is the highest risk factor, as usually happens in old age deterioration of bone mass, very important for women is also the age at which you reach the menopause * Genetic factors, including whether or not you are completely * Lack of hormones such as estrogen (for females), somatotropin, testosterone (for both males and females, the only form II); * Presence of diseases like cirrhosis, rheumatoid arthritis * Hereditary diseases: osteogenesisimperfecta, homocystinuria, renal tubular acidosis * Endocrine abnormalities, Cushing's syndrome (excess cortisol) Invariant * Diet, lackofcalcium, protein, vitamin C. and vitamin D * Low body weightmustbelessthan 85% ofthatconsideredideal, or otherwisegenerallyaround 55 kg; * Abuseofalcohol * Cigarette smoking * Algodystrophy * Anorexia nervosa * Physicalinactivity, whichrangesfrom a sedentarylifestyleuntil the paralysis; * Hypercalciuria (urine pH low acid) Hypogonadism * Useofdrugssuchasheparin, methotrexate, ethanol and glucocorticoids, which alter the metabolism and produce damagetobones * Neoplasmsbonemarrow

113. vitamin D, A, K

114. potassium

115. protein

116. Sodium

117. caffeine

119. Foodsrichest in Calciumcontent mg/100g Pecorino 1160 Parmigiano 1159 Arugula 309 Ricotta 295 Almonds 240 Driedfigs 186 Oyster 186 Green beet 160 Mozzarella 160 Hazelnuts 152 Cicory 150 Anchovies 148 Octopus 144 Squid 143 Chickpeas 142 Cannellini 132 Walnuts 131 Agretti 131 Pistachios 130 Yogurt 125 Milk 119 Radicchio 115 Shrimp 110 Buckwheat 110 Borlotti 102 Broccoli 97 Cardoons 96 Endive 93 Fava beans 90 Mussels 88 Artichoke 86 Driedapricot 85 Spinach 78 Raisin 78 Dates 69 Chard 67 JhonDory 65 Hare 64 Olive 63 Kale 62 Cauliflower 60

120. Top 10 foodsforVitamin C content/100g Redcurrant 200 mg Red pepper 151 mg Broccoli and arugula 110 mg Kiwi 85 mg Brusselssprouts and turnip 81 mg Cauliflower 59 mg Strawberry, clementines, spinach 54 mg Orange and lemon 50 mg Kale 47 mg Tangerines 42 mg

121. Top 10 fruitsforVitamin C content /100g Redcurrant 200 mg Kiwi 85 mg Strawberry and clementines 54 mg Orange and lemon 50 mg Tangerines 42 mg Grapefruit 40 mg Melon 32 mg Raspberries 25 mg Persimmon 23 mg Blackberries 19 mg

122. Bone density and Vitamin D The roleofvitamin D insufficiency in osteoporosis is recognized. Increasing intake of vitamin D can increase intestinal calcium absorption, lower the circulating levels of PTH (parathyroid hormone) and reduce rate of bone loss. There is also evidence that supplementation with vitamin D can lower fractures.

123. VitaminD richestfoodmcg/100g Tuna 16,30 Anchovies 11 Swordfish 11 Trout 10,60 Pike 10,60 Carp 10.60 Shark 9,10 Salmon 8 Eel 4,90 Sardines 4,50 Butter 4,35 Eggs 1,75 40 to 80 mcgofvitamin D are recommended in osteoporosis

124. Bone density and potassium An increase in serum potassium concentration arising from high dietary potassium intake, stimulates intestinal calcium absorption; increasing potassium has an opposing effect on calcium lost through the urine. Prolonged dietary potassium deficiency can deplete the serum level and result in enhanced resorption of this mineral from bone. For a portion of the elderly population, potassium deficiency is a concern.

125. Top 10 fruitsforpotassiumcontent/100g kiwi 400 bananas350 melon333 apricots320 pomegranate290 watermelon280 figs270 peches, blackberries260 ananas, medlar, 250 grapefruit230 cherries229 raspberries220 clementines210 oranges200 grape192 plums, susine 190 kaki 170 strawberries, blueberries160 pear127 apple125

126. Bone density and sodium Sodium causes an increase in renal calcium excretion. At the high levels of sodium intake typical in US, more than 90% of ingested sodium is excreted. Optimal intake to minimize bone loss were estimated at approximately 1000 mg/day of calcium, 4000 mg/day of potassium and no more than 2000 mg of sodium