Numerous studies over several decades suggest that following the Mediterranean diet (MedDiet) can reduce the risk of cardiovascular disease and cancer, and improve cognitive health. However, there are inconsistencies among methods used for evaluating and defining the MedDiet. Through a review of the literature, we aimed to quantitatively define the MedDiet by food groups and nutrients. Databases PubMed, MEDLINE, Science Direct, Academic Search Premier and the University of South Australia Library Catalogue were searched. Articles were included if they defined the MedDiet in at least two of the following ways: (1) general descriptive definitions; (2) diet pyramids/numbers of servings of key foods; (3) grams of key foods/food groups; and (4) nutrient and flavonoid content. Quantity of key foods and nutrient content was recorded and the mean was calculated. The MedDiet contained three to nine serves of vegetables, half to two serves of fruit, one to 13 serves of cereals and up to eight serves of olive oil daily. It contained approximately 9300 kJ, 37% as total fat, 18% as monounsaturated and 9% as saturated, and 33 g of fibre per day. Our results provide a defined nutrient content and range of servings for the MedDiet based on past and current literature. More detailed reporting amongst studies could refine the definition further.

Background: Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale. Objective: This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach. Methods: This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based individualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure. Results: Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI –0.1 to –2.5 kg) and 2.1 cm from their waist circumference (95% CI –3.5 to –0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events). Conclusions: An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted.

Background: The consumption of a Mediterranean diet (MedDiet) is associated with a lower risk of cardiovascular disease. However, its impact on blood pressure and endothelial function is not clear.

Evidence from a limited number of randomised controlled intervention trials (RCTs) have shown that a Mediterranean dietary pattern may reduce the risk of cognitive decline and enhance cognitive function among healthy older adults. However, there are currently no data in non-Mediterranean older adult populations. The present study aimed to address this gap by examining the effect of a Mediterranean dietary pattern (MedDiet) for six months on aspects of cognitive function in a randomised controlled intervention trial (the MedLey study) that extended for a duration of 18 months. In the final analysed cohort, a total of 137 men and women (mean age of 72.1 ± 5.0 years) randomly assigned to either a MedDiet or control diet (HabDiet) (i.e., habitual dietary intake), were assessed on a comprehensive neuropsychological test battery, including 11 individual tests. In multivariable-adjusted models, the MedDiet group did not perform significantly better than the HabDiet control group for executive functioning (adjusted mean differences: +2.53, 95% CI −2.59 to 7.65, p = 0.33); speed of processing (adjusted mean differences: +3.24, 95% CI −1.21 to 7.70, p = 0.15); memory (adjusted mean differences: +2.00, 95% CI −3.88 to 7.88, p = 0.50); visual-spatial ability (adjusted mean differences: +0.21, 95% CI −0.38 to 0.81, 0.48); and overall age-related cognitive performance (adjusted mean differences: +7.99, 95% CI −4.00 to 19.9, p = 0.19). In conclusion, this study did not find evidence of a beneficial effect of a MedDiet intervention on cognitive function among healthy older adults.

Artificial intelligence virtual health assistants are a promising emerging technology. This study is a process evaluation of a 12-week pilot physical activity and diet program delivered by virtual assistant “Paola”. This single-arm repeated measures study (n = 28, aged 45–75 years) was evaluated on technical performance (accuracy of conversational exchanges), engagement (number of weekly check-ins completed), adherence (percentage of step goal and recommended food servings), and user feedback. Paola correctly asked scripted questions and responded to participants during the check-ins 97% and 96% of the time, respectively, but correctly responded to spontaneous exchanges only 21% of the time. Participants completed 63% of weekly check-ins and conducted a total of 3648 exchanges. Mean dietary adherence was 91% and was lowest for discretionary foods, grains, red meat, and vegetables. Participants met their step goal 59% of the time. Participants enjoyed the program and found Paola useful during check-ins but not for spontaneous exchanges. More in-depth knowledge, personalized advice and spontaneity were identified as important improvements. Virtual health assistants should ensure an adequate knowledge base and ability to recognize intents and entities, include personality and spontaneity, and provide ongoing technical troubleshooting of the virtual assistant to ensure the assistant remains effective.

The Mediterranean diet (MedDiet) offers benefits to cardiovascular health but may not meet Western recommendations for calcium and dairy intake, which could impede long-term adoption. The current study aimed to determine the effect of a MedDiet supplemented with dairy foods on cardiovascular risk factors. A randomized, controlled, crossover design compared a MedDiet with 3-4 daily servings of dairy (MedDairy) and a low-fat (LF) control diet. Forty-one participants aged ≥45 y and at risk of cardiovascular disease (CVD) were randomly allocated to their first intervention, either the MedDairy or LF diet. Participants followed each intervention for 8 wk, and an 8-wk washout period separated interventions. The primary outcome was home-measured systolic blood pressure (SBP) assessed in the morning, afternoon, and evening. Secondary outcomes included clinic-measured blood pressure (morning), body composition, blood lipids, C-reactive protein (CRP), plasma glucose, serum insulin, and the Framingham Risk Score. Compared with the LF intervention, the MedDairy intervention resulted in a significantly lower morning SBP (mean difference: -1.6 mm Hg; 95% CI: -2.8, -0.4 mm Hg; P = 0.01), lower morning diastolic blood pressure (mean difference: -1.0; 95% CI: -1.7, -0.2 mm Hg; P = 0.01) and clinic SBP (mean difference: -3.5 mm Hg; 95% CI: -6.4, -0.7 mm Hg; P = 0.02), significantly higher HDL cholesterol (mean difference: 0.04 mmol/L; 95% CI: 0.01, 0.06 mmol/L; P < 0.01), lower triglycerides (mean difference: = -0.05 mmol/L; 95% CI: -0.08, -0.01 mmol/L; P < 0.01), and lower ratio of total to HDL cholesterol (mean difference: -0.4; 95% CI: -0.6, -0.2; P < 0.001). No effects were observed for other outcome measures. Following a MedDiet with additional dairy foods led to significant changes in markers of cardiovascular risk over 8 wk. The MedDiet supplemented with dairy may be appropriate for an improvement in cardiovascular risk factors in a population at risk of CVD. This trial was registered at anzctr.org.au as ACTRN12616000309482.