Annals of Neurology

Letter to the Editor

Refers to: Psaltopoulou T, Sergentanis TN, Panagiotakos DB, et al. Mediterranean diet and stroke,
cognitive impairment, depression: A meta-analysis. Ann Neurol. 2013 May 30. doi:
10.1002/ana.23944. [Epub ahead of print]

MEDITERRANEAN DIET: RELATIONSHIP WITH ANXIETY AND DEPRESSION

The comprehensive overview on the favorable effects of Mediterranean Diet on occurrence of

stroke, cognitive impairment and depression[1] is very important since outlines how neurological
conditions, often studied separately, are linked each other within their relationship with the
nutritional profile. We would add some comment: effects of other factors on cognitive decline and
depression should be considered concurrently, and among them the effects of physical activity[2]
and of perceived stress[3]. Recently we reported an effect of the promotion of a greater Adherence
to Mediterranean Diet on physical activity, and this effect was explained with a greater strength also
by the increase of daily olive oil intake[4]. Reassessing our data-base on 138 patients (age
49,95±14,88; men 61, women 77), without significant acute or chronic disease, under the
perspective of level of depression and of anxiety, evaluated by the HADS[4], we find that in the
group with lower adherence to Mediterranean Diet, there are higher Physical Activity score, no
difference of perceived stress, greater levels of depression and of anxiety; the two groups are
comparable for age and gender prevalence, but the group with greater adherence to Mediterranean
Diet have greater BMI and Insulin Resistance (HOMA-IR) (Table).
The presence of greater levels both of anxiety and depression in patients with lower adherence to
Mediterranean Diet is probably related with multidimensional nutritional, behavioral and social
aspects. The point is to define if these subjects are happier, with less anxiety and depression,
because have an healthier profile, or are the happier subjects which adhere more easily to healthier
dietary profiles. The contribution of Psaltopoulou et al.[1], which is a summary and a critical review
also of their own numerous personal studies, reinforces the need of an articulated approach in the
assessment and treatment of patients with possible, impending or actual cognitive-mood
impairment, and warrants a sustainable and rational preventive approach within a comprehensive
lifestyle framework. This must necessarily have a predictive component (nutritional and lifestyle
assessment) but also should include preventive and personalized tools of intervention, through
population campaigns and dietary and physical exercise prescriptions. In our experience, this last is
an affordable strategy with benefits for the patients and tangible economical advantages, especially
in the era of health budget constraints.

Guglielmo M. Trovato, MD, Daniela Catalano, MD, Giuseppe Fabio Martines, MD, Patrizia Pace,
PhD and Francesca M. Trovato, MD.

Dipartimento di Scienze Mediche e Pediatriche – University of Catania, Catania. Italy

This article has been accepted for publication and undergone full peer review but has not been
through the copyediting, typesetting, pagination and proofreading process which may lead to
differences between this version and the Version of Record. Please cite this article as an
‘Accepted Article’, doi: 10.1002/ana.23991
 Annals of Neurology Page 2 of 3

REFERENCES

[1] Psaltopoulou T, Sergentanis TN, Panagiotakos DB, et al. Mediterranean diet and stroke,
cognitive impairment, depression: A meta-analysis. Ann Neurol. 2013 May 30. doi:
10.1002/ana.23944. [Epub ahead of print]

[2] Scarmeas N, Luchsinger JA, Schupf N, et al. Physical activity, diet, and risk of Alzheimer
disease. JAMA. 2009;302:627-37.

[3] Trovato GM, Pace P, Martines GF, Trovato FM, Pirri C, Catalano D. Stress, abdominal
obesity and intrarenal resistive index in essential hypertension. Clin Ter. 2012;163:299-305.

[4] Catalano D, Trovato GM, Pace P, Martines GF, Trovato FM. Mediterranean diet and
physical activity: An intervention study. Does olive oil exercise the body through the mind?
Int J Cardiol. 2013 May 25. doi:pii: S0167-5273(13)00943-1. 10.1016/j.ijcard.2013.05.034.
[Epub ahead of print]

[5] Trovato GM. Behavior, nutrition and lifestyle in a comprehensive health and disease
paradigm: skills and knowledge for a predictive, preventive and personalized medicine.
EPMA J. 2012;3:8-23.

John Wiley & Sons

Page 3 of 3 Annals of Neurology

Lower AMDS Higher AMDS

(n 36) (n 102) p
Age (years) 49,81±14,79 50,00±14,99 0,947
MSP_TOT 94,06±24,00 92,33±24,60 0,717
Anxiety 10,75±2,01 9,29±2,15 <0,001
Depression 9,81±1,72 8,78±2,06 <0,009
Averages±SD of Age, Perceived Stress (PSM), Anxiety and Depression (HADS) in the group
with higher and lower percentiles of Adherence to Mediterranean Diet Score (AMDS).
Student’s t test.

John Wiley & Sons