**9.3 Benefits**

Benefits proved already in significant studies mentioned before are increased longevity, cardiovascular protection, diabetes decreased incidence, diabetes management, prevention of cognitive decline, dementia, depression, obesity, metabolic syndrome, chronic respiratory diseases but also impact on sustainability [15].

Important in obesity management and higher Med Diet adherence, realized in participants from EPIC-PANACEA study, showed lower weight gain at 5 years vs. participants with low adherence, but also the risk of becoming obese decreased by 10% [16].

Not only a diet, but a lifestyle model, Med Diet means daily consumption of whole grain products, various fresh vegetables and fruits, nuts, seeds, and legumes several times per week. The main source of fat is olive oil and adding herbs and spices will help to decrease salt at recommended intake of <2, 3 mg sodium per day. Sweets will mostly be replaced by fruits. Dairies' daily consumption was mainly represented by yogurt or kefir, cheese in smaller quantities. Up to three times per week were fish and seafood, eggs were 2–4 times/week, and red meat in small portions was very rare (1–2 times monthly). Hydration will be done mainly through water, drinking may be allowed in small quantities, and the wine will be preferred instead of beer (1 drink per day for women, 2 drinks for men). Med Diet means also


#### **Table 2.**

*Suggested food model for consumption.*

a philosophy of cooking at home or with friends, with a preference for local food, minimally processed, connection with nature, respect for nature, sustainability, moderate portion sizes, moderate physical activity, appropriate rest, eating in other people company.

A recent review published in Cardiovascular Research 2021 [17] points some elements related to cardiovascular/atherosclerosis protection. Moderate quantities of cheese and regular yogurt are linked with a protective effect, to replace high glycemic index food with whole grain and low glycemic index (GI) cereal food. A future target will be to promote appropriate food choices for atherosclerosis prevention in the general population, the authors are suggesting.

#### **9.4 A suggested food model for consumption**

It is presented in **Table** 2 adapted after [17].

All these recommendations should be followed, in a frame of negative energetic balance, in order to lose weight.

#### **10. Energy balance**

Creating a negative energy balance is the first principle for lifestyle intervention in obesity. A daily caloric deficit of 0.5–1 kg will ensure a healthy weight decrease. A healthy weight decrease means 0.5–1 kg/week weight decrease. The decrease has to be mainly from fat mass and not muscular mass, proportion has to be 80% fat and 20% lean mass.

### **11. As dietary guidelines for Americans for 2020–2025 is mentioning**

#### **11.1 Sodium**

This is an essential nutrient consumed primarily as salt—sodium chloride—is indicated in a daily maximum intake of 2–3 mg [18]**.**

#### **11.2 Coffee**

After some irrelevant studies, a new meta-analysis found that three cups of coffee per day are related to a 10%, respectively, 16% risk reduction of CHD incidence and mortality. But this benefic effect disappears at doses higher than five cups/day [17]. Coffee consumption is associated with higher insulin sensitivity and lower risk of type 2 diabetes together with a low concentration of inflammatory markers such as C reactive protein and E selectin. These benefits are due to its phenolic compounds and magnesium, potassium, and niacin. It has to be mentioned that unfiltered coffee, which contains cafestol may increase total cholesterol levels, with a detrimental effect. Special conditions, like hypertension and arrhythmias, will require special caution for coffee consumption. In conclusion, a moderate coffee consumption, below three cups/day may be suggested.

#### **11.3 Tea**

Tea intake is also associated with coronary heart disease (CHD) risk reduction, mainly green tea, and 20% risk decrease being reported at three cups per day. Atherosclerosis prevention is related to catechin content, with high antioxidative

properties, contributing to modulate plasma lipid profile, decreasing inflammation at endothelial level, atherogenesis and thrombogenesis**.**

## **12. Chrono-nutrition**

It is a concept detailed in lifestyle recommendations for the prevention of metabolic syndrome. Potential health problems may arise for shift workers. Overall night working or rotating working is associated with a higher risk of insulin resistance, metabolic syndrome, and heart disease. The recommendation is to eat the main meal of the day before 3 PM [19].

Actual society, westernized, 24/7 means that eating moments are distributed over day and night without a clear schedule. Many people eat late in the evening or even during the night, this leading to a metabolic risk similar to shift workers. Even short-term misalignment, like jet lag or long flights, may cause bowel problems or fatigue. Not surprisingly, circadian misalignment may contribute to different medical conditions, being incriminated in the etiology of type 2 diabetes. The mechanism is insulin resistance at the tissues level, caused by disrupted tissue clocks. As Oosterman is mentioning, it is maybe the time to include in dietary guidelines, in addition to quantity and quality of food the concept of time of meals, which is a critical determinant of metabolic health. Increasing awareness about the relation between eating time and metabolic implications will be a part of the complex system to fight against obesity [20].
