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Cited by 288Nutritional Studies and DietEdible Oils Quality and AnalysisPhytochemicals and Antioxidant Activities

Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing

Open access
Gantenbein, Katherina V., Kanaka-Gantenbein, Christina·2021·Nutrients
DOI 10.3390/nu13061951PMC PMC8227318
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Abstract

It has been established, worldwide, that non-communicable diseases such as obesity, diabetes, metabolic syndrome, and cardiovascular events account for a high percentage of morbidity and mortality in contemporary societies. Several modifiable risk factors, such as sedentary activities, sleep deprivation, smoking, and unhealthy dietary habits have contributed to this increase. Healthy nutrition in terms of adherence to the Mediterranean diet (MD), rich in fruits, legumes, vegetables, olive oil, herbs, spices, and high fiber intake may contribute to the decrease in this pandemic. The beneficial effects of the MD can be mainly attributed to its numerous components rich in anti-inflammatory and antioxidant properties. Moreover, the MD may further contribute to the improvement of reproductive health, modify the risk for neurodegenerative diseases, and protect against depression and psychosocial maladjustment. There is also evidence highlighting the impact of healthy nutrition in female people on the composition of the gut microbiota and future metabolic and overall health of their offspring. It is therefore important to highlight the beneficial effects of the MD on metabolic, reproductive, and mental health, while shaping the overall health of future generations. The beneficial effects of MD can be further enhanced by increased physical activity in the context of a well-balanced healthy lifestyle.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review argues that adherence to the Mediterranean diet (MD), through polyphenols, unsaturated fatty acids, fiber, and other bioactive components, can act as a natural antioxidant and anti-inflammatory strategy to improve metabolic, cardiovascular, reproductive, and mental health. It also highlights transgenerational and autoimmune-related benefits, while noting that adverse effects of polyphenols are mainly described with supraphysiological supplement intake rather than a balanced MD.

Key findings

  • Non-communicable diseases such as cardiovascular diseases, cancer, respiratory diseases, and diabetes account for 70% of all deaths worldwide, with the WHO European region most severely affected.
  • NAFLD affects around 20–30% of the general population in Western societies, and MD components are described as having lipid-lowering, anti-inflammatory, and antioxidant effects that may reduce hepatic steatosis.
  • A meta-analysis by Kastorini et al. of 50 studies and 534,906 individuals found that adherence to the MD was associated with lower rates of metabolic syndrome and its components, including abdominal obesity, low HDL levels, and hypertension.
  • The review reports benefits of MD across diabetes (lower HbA1c and fasting glucose), cardiovascular disease, PCOS and male fertility, pregnancy/offspring outcomes, autoimmune disease, neurodegeneration, and depression, largely attributed to polyphenols, omega-3 polyunsaturated fatty acids, and fiber-derived short-chain fatty acids.

Methods

  • Narrative review; no primary data collection or systematic search strategy is described.
  • Synthesizes mechanistic, animal, in vitro, and human evidence on MD components and health outcomes including obesity, diabetes, NAFLD, metabolic syndrome, cardiovascular disease, reproductive health, offspring health, autoimmune disease, neurodegeneration, and mental health.
  • Main analysis is qualitative narrative synthesis; no meta-analysis or pooled quantitative estimate is performed by the authors.

Limitations

  • The paper does not state limitations of the review itself.
  • Evident from the text: it is a narrative review without reported systematic search, inclusion criteria, or quality appraisal, so selection and synthesis may be non-exhaustive.
  • Evident from the text: evidence cited includes animal and in vitro studies alongside human trials, and the authors note that the exact role of individual MD components and mechanisms is often not fully elucidated, limiting causal conclusions.

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Integrity signals

Registry

Crossref · 10.3390/nu13061951

Cites

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Statistics

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Claims the paper makes

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  • Premisecitation

    High levels of trimethylamine-1-oxide are associated with an increased likelihood of cardiovascular events.

    “High levels of trimethylamine-1-oxide are associated with an increased likelihood of cardiovascular events [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Calabrese, 2020, Gut Microbiota and Type 1 Diabetes Mellitus: The Effect of Mediterranean Diet, Front. Nutr. source

      Not checked in the free run.

  • Interpretationnone given

    There is evidence that healthy nutrition in female people affects the composition of the gut microbiota and the future metabolic and overall health of their offspring.

    “There is also evidence highlighting the impact of healthy nutrition in female people on the composition of the gut microbiota and future metabolic and overall health of their offspring.”
    Quote in the paperNot a substantial claim
  • Interpretationreasoning

    Adherence to a Mediterranean diet rich in fruits, legumes, vegetables, olive oil, herbs, spices, and high fiber may contribute to decreasing the pandemic of non-communicable diseases.

    “Healthy nutrition in terms of adherence to the Mediterranean diet (MD), rich in fruits, legumes, vegetables, olive oil, herbs, spices, and high fiber intake may contribute to the decrease in this pandemic.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Oxidative stress is crucially implicated in the chronic inflammation process that is an important component in obesity pathogenesis.

    “As highlighted above, oxidative stress is crucially implicated in the chronic inflammation process that is an important component in obesity pathogenesis.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] Nani, A., Murtaza, B., Sayed Khan, A., Khan, N.A., and Hichami, A. (2021). Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules, 26. source

      Not checked in the free run.

    • cites [14] Stadler, J.T., and Marsche, G. (2020). Obesity-Related Changes in High-Density Lipoprotein Metabolism and Function. Int. J. Mol. Sci., 21. source

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    • cites [15] Knight, 2011, Diseases and disorders associated with excess body weight, Ann. Clin. Lab. Sci.

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  • Premisecitation

    People following a Mediterranean diet had lower hemoglobin A1c levels compared to the control group.

    “It has been demonstrated that people following MD had lower hemoglobin A1c (HbA1c) levels compared to the control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Esposito, 2014, Mediterranean diet and type 2 diabetes, Diabetes Metab. Res. Rev. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Epigenetic alterations, mainly due to intrauterine and extrauterine insults, may significantly contribute to the increase in non-communicable diseases.

    “However, the human genome has not been significantly modified during these last decades and there is growing evidence that epigenetic alterations, mainly due to both intrauterine but also extrauterine insults, may significantly contribute to this increase.”
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    Premisecitation

    Diet and behavior factors lead to obesity, hypertension, hyperlipidemia, and insulin resistance.

    “All these factors lead to obesity, hypertension, hyperlipidemia, and insulin resistance [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Iriti, M., Varoni, E.M., and Vitalini, S. (2020). Healthy Diets and Modifiable Risk Factors for Non-Communicable Diseases-The European Perspective. Foods, 9. source

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  • May combine two claims.

    Interpretationnone given

    The important role of healthy nutrition in combating insulin resistance, obesity, and their consequences such as non-alcoholic fatty liver disease, polycystic ovarian syndrome, sleep apnea, type 2 diabetes, and cardiovascular events, all through the same pathogenetic mechanism of insulin resistance, has become evident through the beneficial effect of the Mediterranean diet.

    “The important role of a healthy nutrition to combat insulin resistance, obesity, and their deleterious consequences, such as non-alcoholic fatty liver disease (NAFLD), polycystic ovarian syndrome (PCOS), sleep apnea, type 2 Diabetes (T2D) and cardiovascular events, all through the same pathogenetic mechanism of insulin resistance, has become evident through the beneficial effect of the so-called”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The Mediterranean diet may contribute to the improvement of reproductive health.

    “Moreover, the MD may further contribute to the improvement of reproductive health, modify the risk for neurodegenerative diseases, and protect against depression and psychosocial maladjustment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Dietary fibers positively shape the composition of gut microbiota and immunity.

    “Furthermore, dietary fibers positively shape the composition of gut microbiota and immunity [2,3].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] Ramazzotti, 2017, Diet, Environments, and Gut Microbiota. A Preliminary Investigation in Children Living in Rural and Urban Burkina Faso and Italy, Front. Microbiol. source

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    • cites [3] Calabrese, 2020, Gut Microbiota and Type 1 Diabetes Mellitus: The Effect of Mediterranean Diet, Front. Nutr. source

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    Interpretationnone given

    The Mediterranean diet may modify the risk for neurodegenerative diseases.

    “Moreover, the MD may further contribute to the improvement of reproductive health, modify the risk for neurodegenerative diseases, and protect against depression and psychosocial maladjustment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The beneficial effects of the Mediterranean diet can be mainly attributed to its numerous components rich in anti-inflammatory and antioxidant properties.

    “The beneficial effects of the MD can be mainly attributed to its numerous components rich in anti-inflammatory and antioxidant properties.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Functional foods contain biologically active nutrients, such as polyphenols, which have a significant impact on the prevention and management of chronic non-communicable diseases due to their anti-oxidative, anti-bacterial, or anti-inflammatory effects.

    “They contain biologically active nutrients, such as polyphenols which have a significant impact on the prevention and management of chronic non-communicable diseases due to their beneficial anti-oxidative, anti-bacterial or anti-inflammatory effects [10].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Alkhatib, A., Tsang, C., Tiss, A., Bahorun, T., Arefanian, H., Barake, R., Khadir, A., and Tuomilehto, J. (2017). Functional Foods and Lifestyle Approaches for Diabetes Prevention and Management. Nutrients, 9. source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    The Mediterranean diet may protect against depression and psychosocial maladjustment.

    “Moreover, the MD may further contribute to the improvement of reproductive health, modify the risk for neurodegenerative diseases, and protect against depression and psychosocial maladjustment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Dietary fibers are not digested in the gastrointestinal tract but are fermented by the gut microbiota, leading to the generation of short-chain fatty acids with anti-inflammatory and anti-aging actions.

    “When ingested, dietary fibers are not digested in the gastrointestinal tract, but they are fermented by the gut microbiota, leading to the generation of short-chain fatty acids (SCFAs) with anti-inflammatory and anti-aging actions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    A Western type diet is characterized by big meals rich in fat and carbohydrate content with low fiber, while sweet beverages contribute to an obesogenic environment, facilitating visceral obesity and insulin resistance.

    “Western type diet is characterized by big meals rich in fat and carbohydrate content with a low content in fibers, while sweet beverages significantly contribute to the obesogenic environment, facilitating the development of visceral obesity and insulin resistance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Olive oil contains 3,3-dimethyl-1-butanol, which prevents the formation of trimethylamine-1-oxide.

    “As Calabrese et al. mentioned, olive oil also contains 3,3-dimethyl-1-butanol, which prevents the formation of trimethylamine-1-oxide.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Calabrese, 2020, Gut Microbiota and Type 1 Diabetes Mellitus: The Effect of Mediterranean Diet, Front. Nutr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The beneficial effects of the Mediterranean diet can be further enhanced by increased physical activity in the context of a well-balanced healthy lifestyle.

    “The beneficial effects of MD can be further enhanced by increased physical activity in the context of a well-balanced healthy lifestyle.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The main factors contributing to the emergence of non-communicable diseases are diet and behavior, such as increased food rich in saturated fat and carbohydrates, including sweetened beverages, lack of physical exercise, and smoking.

    “The main factors contributing to the emergence of these diseases are related to people’s diet and behavior, such as the increase in food rich in saturated fat and carbohydrates, including sweetened beverages, lack of physical exercise and smoking.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Iriti, M., Varoni, E.M., and Vitalini, S. (2020). Healthy Diets and Modifiable Risk Factors for Non-Communicable Diseases-The European Perspective. Foods, 9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A diet rich in fibers, such as the Mediterranean diet, is associated with a lower prevalence of cardiovascular diseases, diabetes, metabolic syndrome, and gastrointestinal diseases like gastroesophageal reflux disease, gastric ulcer, or diverticulitis.

    “According to Anderson et al., a diet rich in fibers, such as the MD, is associated with a lower prevalence of cardiovascular diseases, diabetes, metabolic syndrome, and gastrointestinal diseases like gastroesophageal reflux disease, gastric ulcer or diverticulitis [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Anderson, 2009, Health benefits of dietary fiber, Nutr. Rev. source

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    Premisecitation

    Consumption of fiber-rich food alters the gut microbiome and enriches microbiome diversity, which is important for the immune system and possesses anti-inflammatory capacities.

    “Furthermore, the consumption of fiber-rich food alters the gut microbiome and enriches the microbiome diversity, which is important for the immune system, possessing anti-inflammatory capacities [7,8].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Hooper, 2012, Interactions between the microbiota and the immune system, Science source

      Not checked in the free run.

    • cites [8] Bailey, 2018, Microbiome-Mediated Effects of the Mediterranean Diet on Inflammation, Adv. Nutr. source

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    Premisecitation

    The Mediterranean diet consists of many components rich in mono-unsaturated fatty acid such as oleic acid, omega-3-polyunsaturated fatty acid such as alpha-linolenic acid, flavonoids and antioxidants, and dietary fibers that impact gut microbiota, all considered health-promoting and to enhance longevity.

    “Moreover, the MD consists of many components rich in mono-unsaturated fatty acid such as oleic acid, in olive oil, omega-3-polyunsaturated fatty acid, such as alpha- linolenic acid in tree nuts, like walnuts, high amounts of flavonoids and antioxidants found in fruits and vegetables and high amounts of dietary fibers that have a great impact on the composition of gut microbiota—all considered to”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Widmer, 2015, The Mediterranean diet, its components, and cardiovascular disease, Am. J. Med. source

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    • cites [13] Renaud, 1994, Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease, Lancet source

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    Premisecitation

    Resveratrol inhibits NADPH-induced oxidative stress and activates the anti-inflammatory molecule peroxisome proliferator-activated receptor gamma.

    “It has also been shown to inhibit the NADPH-induced oxidative stress and activate the anti-inflammatory molecule peroxisome proliferator-activated receptor gamma (PPARγ) [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Nani, A., Murtaza, B., Sayed Khan, A., Khan, N.A., and Hichami, A. (2021). Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules, 26. source

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    Premisecitation

    Curcumin is known for its protective properties against DNA mutations.

    “Curcumin, for example, is known for its protective properties against DNA-mutations [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Griffiths, K., Aggarwal, B.B., Singh, R.B., Buttar, H.S., Wilson, D., and De Meester, F. (2016). Food Antioxidants and Their Anti-Inflammatory Properties: A Potential Role in Cardiovascular Diseases and Cancer Prevention. Diseases, 4. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Increased monounsaturated fatty acids and reduced saturated fatty acids in the diet have been associated with increased insulin sensitivity and improved beta cell function.

    “Increased monounsaturated fatty acids and reduced saturated fatty acids in the diet have been associated with increased insulin sensitivity and improved beta cell function [26,27].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [26] Martín-Peláez, S., Fito, M., and Castaner, O. (2020). Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review. Nutrients, 12. source

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    • cites [27] Bhaswant, 2015, Mechanisms of enhanced insulin secretion and sensitivity with n-3 unsaturated fatty acids, J. Nutr. Biochem. source

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  • May combine two claims.

    Premisecitation

    Polyphenols have an anti-inflammatory function; they inhibit proinflammatory molecules and modulate inflammatory pathways like NF-κB, MAPK, and the arachidonic acid pathway.

    “It has been shown that polyphenols have an anti-inflammatory function. They inhibit proinflammatory molecules and modulate the inflammatory pathways like NF-κB, MAPK and the arachidonic acid pathway [17].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Yahfoufi, N., Alsadi, N., Jambi, M., and Matar, C. (2018). The Immunomodulatory and Anti-Inflammatory Role of Polyphenols. Nutrients, 10. source

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    Premisecitation

    Ingestion of green tea, rich in polyphenols such as epigallocatechin-3-O-gallate, contributes to diabetes management and has a lipid-lowering effect, while increasing energy expenditure and decreasing inflammation and oxidative stress through inhibition of the NF-κB pathway.

    “Moreover, the ingestion of herbal components such as green tea, rich in polyphenols such as epigallocatechin-3-O-gallate (EGCG), contributes to diabetes management and has a lipid-lowering effect, while increasing energy expenditure and decreasing inflammation and oxidative stress through the inhibition of the NF-κB pathway [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Nani, A., Murtaza, B., Sayed Khan, A., Khan, N.A., and Hichami, A. (2021). Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules, 26. source

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  • May combine two claims.

    Premisereasoning

    In the Mediterranean diet, more unsaturated fatty acids are consumed, especially as a component of olive oil or table olives, and less saturated fatty acids from animal fat, which has an inhibitory effect on the pathogenesis of diabetes mellitus.

    “In the MD, more unsaturated fatty acids are consumed, especially as a component of olive oil or table olives, and less saturated fatty acids from animal fat. This has an inhibitory effect on the pathogenesis of diabetes mellitus.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Polyphenols increase glucose uptake in muscle cells, reduce gluconeogenesis in the liver, and prevent inflammation-induced destruction of pancreatic β-cells.

    “In addition, there is evidence that polyphenols increase glucose uptake in muscle cells, reduce gluconeogenesis in the liver, and prevent the inflammation-induced destruction of the pancreatic β-cells [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Kim, Y., Keogh, J.B., and Clifton, P.M. (2016). Polyphenols and Glycemic Control. Nutrients, 8. source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Spices are a rich source of polyphenols and have anti-inflammatory, anti-carcinogenic, and antioxidant capacities.

    “Spices are a rich source of polyphenols as well and have anti-inflammatory, anti-carcinogenic and antioxidant capacities.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Faster shortening of telomeres and inhibition of telomerase activity have been observed in unhealthy obesity.

    “Faster shortening of the telomeres and an inhibition of the telomerase activity has therefore been observed in unhealthy obesity [22,23].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [22] Cheng, 2021, Diabetes, metabolic disease, and telomere length, Lancet Diabetes Endocrinol. source

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    • cites [23] Canudas, 2020, Mediterranean Diet and Telomere Length: A Systematic Review and Meta-Analysis, Adv. Nutr. source

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  • May combine two claims.

    Interpretationcitation

    The Mediterranean diet can be considered a natural antioxidant able to reduce mortality by reducing the incidence of cardiovascular, metabolic, endocrine, and neurodegenerative diseases through the beneficial effects of its components, mainly polyphenols.

    “MD can thus be considered as a natural antioxidant, able to reduce mortality, by reducing the incidence of cardiovascular, metabolic, endocrine, and neurodegenerative diseases through the beneficial effects of its components, mainly polyphenols [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Noce, 2017, Impact of Mediterranean diet on metabolic syndrome, cancer and longevity, Oncotarget source

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    Premisecitation

    Oxidative stress at the cellular level originates from an imbalance between endogenous reactive oxygen species production and the natural anti-oxidation system.

    “Oxidative stress at the cellular level originates from an imbalance between endogenous reactive oxygen species (ROS) production and the natural anti-oxidation system [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Nani, A., Murtaza, B., Sayed Khan, A., Khan, N.A., and Hichami, A. (2021). Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules, 26. source

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  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    One reason for the increase in incidence of diabetes is a high-fat, high-carbohydrate, and low-fiber diet.

    “One of the reasons for the increase in the incidence of diabetes is the high-fat, high-carbohydrate, and low-fiber diet.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Resveratrol, a component of grapes, promotes intracellular glucose transport and reduces insulin secretion.

    “Special interest has been laid to resveratrol, a component of grapes, that has been shown to promote intracellular glucose transport and reduce insulin secretion.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Nani, A., Murtaza, B., Sayed Khan, A., Khan, N.A., and Hichami, A. (2021). Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules, 26. source

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  • May combine two claims.

    Premisenone given

    GLP1 stimulates insulin secretion and inhibits glucagon secretion.

    “GLP1 stimulates insulin secretion and inhibits glucagon secretion.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Because the Mediterranean diet is rich in dietary fiber, fermentation of this fiber leads to formation of short-chain fatty acids, which stimulate GLP1 expression.

    “As MD is rich in dietary fiber, and the fermentation of this fiber leads to the formation of SCFAs, these then, in turn, stimulate GLP1 expression [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Martín-Peláez, S., Fito, M., and Castaner, O. (2020). Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review. Nutrients, 12. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Consumption of tea is associated with a reduced waist-to-hip ratio and lower levels of blood pressure.

    “Moreover, further studies have demonstrated that the consumption of tea is associated with a reduced waist-to-hip ratio and lower levels of blood pressure [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Alkhatib, A., Tsang, C., Tiss, A., Bahorun, T., Arefanian, H., Barake, R., Khadir, A., and Tuomilehto, J. (2017). Functional Foods and Lifestyle Approaches for Diabetes Prevention and Management. Nutrients, 9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Increased expression of proinflammatory cytokines leads to downregulation of AMP-activated protein kinase and induction of C-reactive protein.

    “The increased expression of proinflammatory cytokines leads to downregulation of the anti-inflammatory molecule, AMP-activated protein kinase (AMPK), and the induction of the acute-phase-protein C-reactive protein (CRP) [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Nani, A., Murtaza, B., Sayed Khan, A., Khan, N.A., and Hichami, A. (2021). Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules, 26. source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Quercetin induces secretion of the anti-inflammatory factor adiponectin in adipocytes, leading to a reduction in body weight in obese mice in vivo.

    “The inflammatory reaction can be further attenuated by the polyphenol quercetin since it induces the secretion of the anti-inflammatory factor, adiponectin, in adipocytes. This leads to a reduction in body weight in obese mice in vivo.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Rosemary polyphenols show antidiabetic effects: they inhibit α-glucosidase and intestinal glucose uptake, inhibit dipeptidyl peptidase 4, inhibit hepatic gluconeogenesis, and increase glucose uptake in muscle cells, thus counteracting hyperglycemia.

    “These molecules show important antidiabetic effects. They inhibit a-glucosidase and thus intestinal glucose uptake. They also inhibit dipeptidyl peptidase 4, which inactivates the enzyme GLP1. In addition, they inhibit hepatic gluconeogenesis and increase glucose uptake in muscle cells, thus counteracting hyperglycemia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Naimi, M., Vlavcheski, F., Shamshoum, H., and Tsiani, E. (2017). Rosemary Extract as a Potential Anti-Hyperglycemic Agent: Current Evidence and Future Perspectives. Nutrients, 9. source

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  • May combine two claims.

    Premisecitation

    Olive oil increases expression of anti-inflammatory molecules like PPARγ and reduces expression of proinflammatory molecules such as IL1β and cyclooxygenase 2.

    “In addition, it increases the expression of anti-inflammatory molecules like PPARγ and reduces the expression of proinflammatory molecules such as IL1β and cyclooxygenase (COX) 2 [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Nani, A., Murtaza, B., Sayed Khan, A., Khan, N.A., and Hichami, A. (2021). Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules, 26. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Plaques can lead to vascular stenosis and occlusion or break off with the blood flow inducing thrombus formation; both events lead to tissue blood underperfusion, tissue ischemia, and final necrosis.

    “These plaques can either lead to vascular stenosis and occlusion or break off with the blood flow inducing the formation of a thrombus. Both events subsequently lead to tissue blood underperfusion, tissue ischemia and final necrosis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a randomized control trial, a Mediterranean diet enriched in green plants with reduced red meat intake enhanced intrahepatic fat loss compared to the control diet, proving beneficial effects of the Mediterranean diet on reducing hepatic steatosis.

    “In a randomized control trial (RCT), Yaskolka et al. were able to demonstrate that an MD enriched in green plants with reduced red meat intake was able to enhance intrahepatic fat loss in comparison to the control diet, proving the beneficial effects of MD on reducing hepatic steatosis [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Yaskolka Meir, A., Rinott, E., Tsaban, G., Zelicha, H., Kaplan, A., Rosen, P., Shelef, I., Youngster, I., Shalev, A., and Blüher, M. (2021). Effect of green-Mediterranean diet on intrahepatic fat: The DIRECT PLUS randomised controlled trial. Gut. source

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  • May combine two claims.

    Premisereasoning

    Many components of the Mediterranean diet have lipid-lowering properties and reduce insulin resistance at the hepatic level, while having anti-inflammatory and antioxidant properties, further reducing endoplasmic stress.

    “Although the exact role of the different components of the MD on the prevention and management of NAFLD is not fully elucidated, it became clear that many components have lipid-lowering properties and reduce insulin resistance at the hepatic level, while they have anti-inflammatory and antioxidant properties, further reducing endoplasmic stress.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Rosemary has lipid-lowering and anti-inflammatory effects.

    “As shown in the review by Naimi et al. [34], rosemary also has lipid-lowering and anti-inflammatory effects [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Naimi, M., Vlavcheski, F., Shamshoum, H., and Tsiani, E. (2017). Rosemary Extract as a Potential Anti-Hyperglycemic Agent: Current Evidence and Future Perspectives. Nutrients, 9. source

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  • May combine two claims.

    Premisecitation

    Polyphenols have anti-inflammatory and antioxidant effects.

    “As mentioned previously, MD contains many biologically active molecules called polyphenols with anti-inflammatory and antioxidant effects [19].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Griffiths, K., Aggarwal, B.B., Singh, R.B., Buttar, H.S., Wilson, D., and De Meester, F. (2016). Food Antioxidants and Their Anti-Inflammatory Properties: A Potential Role in Cardiovascular Diseases and Cancer Prevention. Diseases, 4. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Cardiovascular events are mainly due to atherosclerosis and intravascular plaque formation.

    “Cardiovascular events are mainly due to atherosclerosis and intravascular plaques formation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    The susceptibility of LDL particles to aggregate constitutes a prothrombotic factor and a risk factor for future cardiovascular death.

    “In addition to the high LDL levels, conferring an atherosclerotic cardiovascular risk, it has recently become evident that the susceptibility of LDL particles to aggregate constitutes a further prothrombotic factor and a risk factor for future cardiovascular death.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Adherence to the Mediterranean diet has a positive effect on metabolism and is associated with a lower rate of metabolic syndrome and its components such as abdominal obesity, low HDL levels, and hypertension.

    “Kastorini et al. investigated the effects of the MD on metabolism through a meta-analysis. They found that adherence to the MD has a positive effect on metabolism. MD is associated with a lower rate of MetS and its components such as abdominal obesity, low HDL levels and hypertension [44].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Kastorini, 2011, The effect of Mediterranean diet on metabolic syndrome and its components: A meta-analysis of 50 studies and 534,906 individuals, J. Am. Coll. Cardiol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The incidence of metabolic syndrome is steadily increasing, mainly as a cause of modern lifestyle with increasing obesity rates, and the combination of increased sedentary activities and non-adherence to healthy nutrition.

    “Nowadays, the incidence of MetS is steadily increasing, mainly as a cause of modern lifestyle with increasing obesity rates, and the combination of increased sedentary activities and non-adherence to healthy nutrition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Garlic lowers blood pressure and inhibits platelet aggregation by inhibiting cyclooxygenase activity.

    “Furthermore, this lowers the blood pressure and inhibits platelet aggregation by inhibiting cyclooxygenase (COX) activity [53].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Rahman, 2006, Garlic and cardiovascular disease: A critical review, J. Nutr. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Metabolic syndrome is associated with numerous other complications as well as an increased risk of neoplasia.

    “Furthermore, the MetS is associated with numerous other complications as well as with an increased risk of neoplasia [42,43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] Esposito, 2012, Metabolic syndrome and risk of cancer: A systematic review and meta-analysis, Diabetes Care source

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    • cites [43] Uzunlulu, 2016, Association between Metabolic Syndrome and Cancer, Ann. Nutr. Metab. source

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  • May combine two claims.

    Premisecitation

    An antihypertensive and cardioprotective effect has been associated with the consumption of olive oil.

    “An antihypertensive and cardioprotective effect has also been associated with the consumption of olive oil [54].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Gorzynik-Debicka, M., Przychodzen, P., Cappello, F., Kuban-Jankowska, A., Marino Gammazza, A., Knap, N., Wozniak, M., and Gorska-Ponikowska, M. (2018). Potential Health Benefits of Olive Oil and Plant Polyphenols. Int. J. Mol. Sci., 19. source

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  • May combine two claims.

    Premisecitation

    Tomato has anti-inflammatory and antioxidant effects.

    “According to Ghavipour et al., the tomato has anti-inflammatory and antioxidant effects [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Ghavipour, 2013, Tomato juice consumption reduces systemic inflammation in overweight and obese females, Br. J. Nutr. source

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  • May combine two claims.

    Premisecitation

    Quercetin reduces metabolic stress in mitochondria and acts like the antidiabetic drug metformin.

    “An example of these beneficial molecules is the polyphenol quercetin, which reduces the metabolic stress in mitochondria and acts like the widely used antidiabetic drug metformin [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Eid, 2010, Stimulation of AMP-activated protein kinase and enhancement of basal glucose uptake in muscle cells by quercetin and quercetin glycosides, active principles of the antidiabetic medicinal plant Vaccinium vitis-idaea, Mol. Nutr. Food Res. source

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  • May combine two claims.

    Premisecitation

    The inflammatory state in metabolic syndrome is characterized by ectopic deposition of lipids, leading to insulin resistance in muscle cells, liver steatosis with altered metabolism in the liver, and beta-cell dysfunction in pancreatic cells, and consequently decreased insulin secretory activity that progressively cannot compensate for increased insulin demands necessary to counteract peripheral

    “This inflammatory state is characterized by the ectopic deposition of lipids, which leads to insulin resistance in muscle cells, liver steatosis with altered metabolism in the liver and beta-cell dysfunction in pancreatic cells and consequently decreased insulin secretory activity that progressively cannot compensate for the increased insulin demands necessary to counteract the peripheral insulin”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Noce, 2017, Impact of Mediterranean diet on metabolic syndrome, cancer and longevity, Oncotarget source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The increase in incidence of non-alcoholic fatty liver disease occurs in parallel with the increasing incidence of obesity and insulin resistance.

    “This increase in incidence occurs in parallel with the increasing incidence of obesity and insulin resistance [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Angelico, F., Ferro, D., and Baratta, F. (2021). Is the Mediterranean Diet the Best Approach to NAFLD Treatment Today?. Nutrients, 13. source

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  • May combine two claims.

    Premisecitation

    Garlic consumption improves lipid status by lowering LDL and increasing HDL, by inhibiting enzymes in the cholesterol synthesis pathway, for example monooxygenase and HMG-CoA reductase.

    “Moreover, in vitro and in vivo studies have shown that the consumption of garlic can improve the lipid status, by lowering the level of LDL and increasing the level of HDL. This is achieved by inhibiting enzymes in the pathway of cholesterol synthesis, for example, monooxygenase and 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMG-CoA-reductase).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Rahman, 2006, Garlic and cardiovascular disease: A critical review, J. Nutr. source

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  • May combine two claims.

    Premisereasoning

    A diet rich in olive oil consumption, especially extra-virgin olive oil, allows intake of phytosterols and polyphenols that have a protective function on the endothelium, preventing arteriosclerosis and cardiovascular events.

    “A diet rich in olive oil consumption, especially of extra-virgin olive oil, allows the intake of phytosterols and polyphenols that have a protective function on the endothelium preventing arteriosclerosis and cardiovascular events.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Advanced glycation end products bind to their receptors expressed in ovarian tissue, induce an inflammatory response that stimulates oxidative stress, accumulate in ovarian tissue, and lead to ovarian dysfunction.

    “AGEs bind to their receptors (receptor of advanced glycation end products, RAGE), which are also expressed in the ovarian tissue. By binding to RAGE, they induce an inflammatory response that stimulates oxidative stress. AGEs thus accumulate in the ovarian tissue, leading to ovarian dysfunction [74].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Garg, 2015, Advanced Glycation End Products: Link between Diet and Ovulatory Dysfunction in PCOS?, Nutrients source

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  • May combine two claims.

    Premisecitation

    Xenoestrogens are found in increased amounts in meat products and reduce ejaculate volume, sperm motility, and vitality.

    “Another parameter associated with impaired male fertility is the presence of xenoestrogens, which are found nowadays in increased amounts in meat products [90]. Xenoestrogents are shown to reduce the ejaculate volume, the sperm motility and vitality [91].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [90] 2017, Dietary patterns, foods and nutrients in male fertility parameters and fecundability: A systematic review of observational studies, Hum. Reprod. Update source

      Not checked in the free run.

    • cites [91] Rozati, 2002, Role of environmental estrogens in the deterioration of male factor fertility, Fertil. Steril. source

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  • May combine two claims.

    Premisecitation

    Increased consumption of trans lipids is associated with reduced sperm quality and lower testosterone levels.

    “Furthermore, it has been observed that increased consumption of trans lipids is associated with reduced sperm quality and lower testosterone levels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] Nassan, 2018, Diet and men’s fertility: Does diet affect sperm quality?, Fertil. Steril. source

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  • May combine two claims.

    Premisecitation

    Oxidative stress is induced by internal and external factors; internal factors include cryptorchidism or testicular inflammation, and external factors include obesity, smoking, and an unhealthy diet.

    “Oxidative stress is induced by both internal and external factors. Internal factors can be the result of cryptorchidism or testicular inflammation. External factors that lead to enhanced oxidative stress include obesity, smoking and an unhealthy diet [88].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] Rahman, S.U., Huang, Y., Zhu, L., Feng, S., Khan, I.M., Wu, J., Li, Y., and Wang, X. (2018). Therapeutic Role of Green Tea Polyphenols in Improving Fertility: A Review. Nutrients, 10. source

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  • May combine two claims.

    Premisecitation

    Resveratrol decelerates ovarian ageing in rodent experiments and increases fertility.

    “It has also been shown that resveratrol decelerates ovarian ageing in rodent experiments and thus increases fertility [85].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Chen, 2010, Effects of plant polyphenols on ovarian follicular reserve in aging rats, Biochem. Cell Biol. source

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  • May combine two claims.

    Premisecitation

    Cinnamon reduces insulin resistance and fasting insulin levels.

    “Studies have shown that cinnamon, for example, reduces insulin resistance and fasting insulin levels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Ashkar, 2020, The Role of medicinal herbs in treatment of insulin resistance in patients with Polycystic Ovary Syndrome: A literature review, Biomol. Concepts source

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  • May combine two claims.

    Premisecitation

    The constellation of these diets contributes to the inflammatory state and induces oxidative stress.

    “The constellation of these diets contributes to the inflammatory state and induces oxidative stress [76].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76] Barrea, L., Arnone, A., Annunziata, G., Muscogiuri, G., Laudisio, D., Salzano, C., Pugliese, G., Colao, A., and Savastano, S. (2019). Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients, 11. source

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  • May combine two claims.

    Premisecitation

    In an LPS-induced sepsis model, resolvin downregulates proinflammatory mediators and limits the inflammatory response.

    “It was observed that resolvin leads to a downregulation of proinflammatory mediators and thus to a limitation of the inflammatory response [79].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] Zhang, 2020, The Anti-inflammatory Mediator Resolvin E1 Protects Mice Against Lipopolysaccharide-Induced Heart Injury, Front. Pharmacol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Low-grade inflammation is present in polycystic ovarian syndrome and drives the clinical picture.

    “It is claimed that low-grade inflammation is present in PCOS, which drives the clinical picture [73].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] 2012, Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction, Steroids source

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  • May combine two claims.

    Premisecitation

    Resveratrol has proapoptotic properties on theca cells and can antagonize the insulin effect.

    “According to Wong, the polyphenol resveratrol has proapoptotic properties on the theca cells and can thus antagonize the insulin effect [82].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [82] Wong, 2010, Effects of resveratrol on proliferation and apoptosis in rat ovarian theca-interstitial cells, Mol. Hum. Reprod. source

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  • May combine two claims.

    Premisecitation

    Green tea stimulates metabolism and has a lipolytic effect.

    “Green tea stimulates metabolism and has a lipolytic effect.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Ashkar, 2020, The Role of medicinal herbs in treatment of insulin resistance in patients with Polycystic Ovary Syndrome: A literature review, Biomol. Concepts source

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  • May combine two claims.

    Premisecitation

    Oxidative stress can contribute to male infertility, and a high amount of reactive oxygen species is associated with reduced sperm quality, vitality, concentration, and DNA damage in spermatocytes.

    “Oxidative stress, for example, can contribute to male infertility. A high amount of reactive oxygen species is associated with reduced sperm quality, vitality, and concentration as well as DNA damage in spermatocytes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88] Rahman, S.U., Huang, Y., Zhu, L., Feng, S., Khan, I.M., Wu, J., Li, Y., and Wang, X. (2018). Therapeutic Role of Green Tea Polyphenols in Improving Fertility: A Review. Nutrients, 10. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Resveratrol induces expression of SIRT1, which has protective effects against oxidative stress in ovarian tissue.

    “In addition, this leads to an induction of the expression of SIRT1, which also seems to have protective effects against oxidative stress in the ovarian tissue [84].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Ochiai, 2020, Preconception resveratrol intake against infertility: Friend or foe?, Reprod. Med. Biol. source

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  • May combine two claims.

    Premisecitation

    Polyunsaturated fatty acids have positive effects on insulin sensitivity and can limit hyperandrogenism.

    “As Amini et al. have described, polyunsaturated fatty acids have positive effects on insulin sensitivity and can limit hyperandrogenism [78].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [78] Amini, 2015, Antioxidants and management of polycystic ovary syndrome in Iran: A systematic review of clinical trials, Iran J. Reprod. Med.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Advanced glycation end products mainly result from ingestion of a high sugar diet and may be found in animal fat- and protein-rich products and less represented in fruits and vegetables.

    “They are mainly the result of the ingestion of high sugar diet and may also be found in animal fat- and protein-rich products and less represented in fruits and vegetables [75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Uribarri, 2010, Advanced glycation end products in foods and a practical guide to their reduction in the diet, J. Am. Diet. Assoc. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Chamomile has positive effects on weight control and lowers insulin levels.

    “Chamomile has positive effects on weight control and lowers insulin levels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Ashkar, 2020, The Role of medicinal herbs in treatment of insulin resistance in patients with Polycystic Ovary Syndrome: A literature review, Biomol. Concepts source

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  • May combine two claims.

    Premisecitation

    Marrubium vulgare lowers cholesterol, glucose, and oxidative stress.

    “Finally, Marrubium vulgare lowers cholesterol, glucose, and oxidative stress [80].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Ashkar, 2020, The Role of medicinal herbs in treatment of insulin resistance in patients with Polycystic Ovary Syndrome: A literature review, Biomol. Concepts source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Advanced glycation end products are important in the pathogenesis of polycystic ovarian syndrome and are either endogenously produced or exogenously supplied through food ingestion.

    “Another parameter that is important in the pathogenesis of PCOS is the presence of advanced glycation end products (AGEs). These substances are either endogenously produced or exogenously supplied through food ingestion [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Garg, 2015, Advanced Glycation End Products: Link between Diet and Ovulatory Dysfunction in PCOS?, Nutrients source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A high cholesterol diet leads to the formation of abnormal sperm and reduced sperm motility in animal models.

    “The results showed that the high cholesterol diet led to the formation of abnormal sperm and reduced sperm motility [93].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [93] Saez Lancellotti, T.E., Boarelli, P.V., Monclus, M.A., Cabrillana, M.E., Clementi, M.A., Espínola, L.S., Cid Barría, J.L., Vincenti, A.E., Santi, A.G., and Fornés, M.W. (2010). Hypercholesterolemia impaired sperm functionality in rabbits. PLoS ONE, 5. source

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  • May combine two claims.

    Premisecitation

    Polyphenols lead to an improvement in cognition, which can be shown by both cognitive tests and functional MRI studies.

    “Polyphenols instead lead to an improvement in cognition, which can be shown by both cognitive tests and functional MRI (fMRI) studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [113] Rajaram, 2019, Plant-Based Dietary Patterns, Plant Foods, and Age-Related Cognitive Decline, Adv. Nutr. source

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  • May combine two claims.

    Premisecitation

    Bacteroides-dominant gut flora results in the formation of proprionate, succinate, and acetate, which have proinflammatory effects and promote autoimmunity by increasing the epithelial permeability of the gut.

    “In contrast, Bacteroides-dominant gut flora results in the formation of proprionate, succinate and acetate, which have proinflammatory effects and promote autoimmunity by increasing the epithelial permeability of the gut [102].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [102] Barca, 2015, Diet, Microbiota and Immune System in Type 1 Diabetes Development and Evolution, Nutrients source

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  • May combine two claims.

    Premisecitation

    Polyphenols, mainly catechins, contained in green tea have a protective effect on sperm quality and protect against spontaneous mutations and chromosomal aberrations.

    “The polyphenols, mainly catechins, contained in green tea also have a protective effect on sperm quality. They protect against spontaneous mutations and chromosomal aberrations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] Rahman, S.U., Huang, Y., Zhu, L., Feng, S., Khan, I.M., Wu, J., Li, Y., and Wang, X. (2018). Therapeutic Role of Green Tea Polyphenols in Improving Fertility: A Review. Nutrients, 10. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Isocyanates found in cruciferous vegetables and olecanthal act as natural COX inhibitors and thus limit inflammatory responses.

    “Isocyanates found in cruciferous vegetables and olecanthal act as natural COX inhibitors and thus limit inflammatory responses [117,118,119].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [117] Grodzicki, W., and Dziendzikowska, K. (2020). The Role of Selected Bioactive Compounds in the Prevention of Alzheimer’s Disease. Antioxidants, 9. source

      Not checked in the free run.

    • cites [118] Li, 2009, Inhibition of tau fibrillization by oleocanthal via reaction with the amino groups of tau, J. Neurochem. source

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    • cites [119] Radan, 2018, Isothiocyanates: Cholinesterase inhibiting, antioxidant, and anti-inflammatory activity, J. Enzyme Inhib. Med. Chem. source

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  • May combine two claims.

    Premisecitation

    Consumption of a polyphenol-rich diet, such as the Mediterranean diet, increases the amount of beneficial bacterial species and suppresses the growth of pathogenic bacterial species.

    “According to Yang et al., the consumption of a polyphenol-rich diet, such as the MD, increases the amount of beneficial bacterial species and suppresses the growth of pathogenic bacterial species [107].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [107] Yang, Q., Liang, Q., Balakrishnan, B., Belobrajdic, D.P., Feng, Q.J., and Zhang, W. (2020). Role of Dietary Nutrients in the Modulation of Gut Microbiota: A Narrative Review. Nutrients, 12. source

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  • May combine two claims.

    Premisecitation

    Hesperidin scavenges free oxygen radicals, suppresses the formation of proinflammatory cytokines, increases cerebral blood flow, and prevents cognitive decline.

    “Hesperidin, for example, which is found in citrus fruits, scavenges free oxygen radicals. Furthermore, it suppresses the formation of proinflammatory cytokines and thus also has an anti-inflammatory effect. In addition, according to several studies, it has been shown that hesperidin increases cerebral blood flow, which further prevents cognitive decline.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [115] Hajialyani, M., Hosein Farzaei, M., Echeverría, J., Nabavi, S.M., Uriarte, E., and Sobarzo-Sánchez, E. (2019). Hesperidin as a Neuroprotective Agent: A Review of Animal and Clinical Evidence. Molecules, 24. source

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  • May combine two claims.

    Premisecitation

    Anthocyanins and olecanthal prevent the aggregation of Aβ amyloids and tau protein.

    “Further studies have shown that anthocyanins and the compound of olive oil, olecanthal, prevent the aggregation of Aβ amyloids and tau protein [116].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [116] Li, 2017, Health benefits of anthocyanins and molecular mechanisms: Update from recent decade, Crit. Rev. Food Sci. Nutr. source

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  • May combine two claims.

    Interpretationreasoning

    Polyphenols, and thus also the Mediterranean diet, have a preventive effect against neurodegenerative diseases such as Alzheimer's or Parkinson's disease.

    “In summary, it can be said that polyphenols, and thus also the MD, have a preventive effect against neurodegenerative diseases such as Alzheimer’s or Parkinson’s disease.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Children whose mothers had a high adherence to the Mediterranean diet are less likely to develop atopic diseases and behavioral problems.

    “It has been shown that children whose mothers had a high adherence to the MD are less likely to develop atopic diseases and behavioral problems [97].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [97] Amati, F., Hassounah, S., and Swaka, A. (2019). The Impact of Mediterranean Dietary Patterns During Pregnancy on Maternal and Offspring Health. Nutrients, 11. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Polyphenols regulate the composition of gut bacteria by stimulating the growth of beneficial bacteria and inhibiting the growth of harmful bacteria.

    “Polyphenols regulate the composition of gut bacteria by stimulating the growth of beneficial bacteria and inhibiting the growth of harmful bacteria.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Zhou, 2020, Gut Microbiota: A Pivotal Hub for Polyphenols as Antidepressants, J. Agric. Food. Chem. source

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  • May combine two claims.

    Premisecitation

    High body weight of the mother is associated with lower fertilization rate and miscarriage.

    “Furthermore, the high body weight of the mother is associated with lower fertilization rate and miscarriage [99].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [99] Mehta, 2008, Nutrition and pregnancy, Clin. Obstet. Gynecol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Depression is nowadays one of the leading causes of disability.

    “Depression is nowadays one of the leading causes of disability [122].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [122] James, 2018, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017, Lancet source

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  • May combine two claims.

    Premisecitation

    Adherence to the Mediterranean diet is associated with a reduced likelihood of gestational diabetes and hypertensive pregnancy diseases.

    “Adherence to the MD is further associated with a reduced likelihood of gestational diabetes and hypertensive pregnancy diseases [100].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [100] Mulligan, 2017, Maternal modifiers of the infant gut microbiota: Metabolic consequences, J. Endocrinol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Flavonoids have a remyelination-promoting effect.

    “It has been further suggested that flavonoids have a remyelination-promoting effect [110,111].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [110] Zhang, 2017, Icariin enhances remyelination process after acute demyelination induced by cuprizone exposure, Brain. Res. Bull. source

      Not checked in the free run.

    • cites [111] 2018, The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence, Curr. Nutr. Rep. source

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  • May combine two claims.

    Premisecitation

    In a randomized controlled trial, the group that followed the Mediterranean diet had less stress and negative emotions and scored better on depression scores.

    “They showed that the group that followed MD had less stress and negative emotions and scored better on depression scores.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [124] Parletta, 2019, A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED), Nutr. Neurosci. source

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  • May combine two claims.

    Premisecitation

    Maternal nutrition before and during pregnancy has a major impact on fetal health and greatly contributes to the gut microbiota diversity of the offspring.

    “As described in the review by Amati et al., maternal nutrition before and during pregnancy has a major impact on fetal health greatly contributing to the gut microbiota diversity of the offspring [97,100].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [97] Amati, F., Hassounah, S., and Swaka, A. (2019). The Impact of Mediterranean Dietary Patterns During Pregnancy on Maternal and Offspring Health. Nutrients, 11. source

      Not checked in the free run.

    • cites [100] Mulligan, 2017, Maternal modifiers of the infant gut microbiota: Metabolic consequences, J. Endocrinol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both adherence to the Mediterranean diet and a low BMI are beneficial against depression.

    “As Riera-Sampol et al. have shown, both adherence to MD and a low BMI are beneficial against depression.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [123] Riera-Sampol, A., Bennasar-Veny, M., Tauler, P., Nafría, M., Colom, M., and Aguilo, A. (2021). Association between Depression, Lifestyles, Sleep Quality and Sense of Coherence in a Population with Cardiovascular Risk. Nutrients, 13. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Consumption of saturated fatty acids and especially long-chain fatty acids is associated with aggravation of multiple sclerosis symptomatology and an increase in immune cell recruitment.

    “It has been observed that the consumption of saturated fatty acids and especially long-chain fatty acids is associated with an aggravation of the symptomatology and an increase in immune cell recruitment [108].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [108] Timmermans, 2014, High fat diet exacerbates neuroinflammation in an animal model of multiple sclerosis by activation of the Renin Angiotensin system, J. Neuroimmune Pharmacol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk of developing gestational diabetes is increased in overweight women, which entails complications for the newborn including adverse metabolic health and future neurodevelopment.

    “In contrast, the risk of developing gestational diabetes is increased in overweight women, which also entails many complications for the newborn, including both adverse metabolic health [100] and future neurodevelopment [99,101].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [100] Mulligan, 2017, Maternal modifiers of the infant gut microbiota: Metabolic consequences, J. Endocrinol. source

      Not checked in the free run.

    • cites [99] Mehta, 2008, Nutrition and pregnancy, Clin. Obstet. Gynecol. source

      Not checked in the free run.

    • cites [101] Friedman, 2018, Developmental Programming of Obesity and Diabetes in Mouse, Monkey, and Man in 2018: Where Are We Headed?, Diabetes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lack of dietary fiber leads to an excess of lipopolysaccharide-producing bacteria in the microbiome, resulting in damage to the intestinal barrier and mitochondrial function.

    “The lack of dietary fiber leads to an excess of lipopolysaccharide-producing bacteria in the microbiome, resulting in damage to the intestinal barrier and mitochondrial function [112].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [112] Jackson, 2019, Diet in Parkinson’s Disease: Critical Role for the Microbiome, Front. Neurol. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Healthy nutrition may modify the risk for neurodegenerative diseases such as Alzheimer's disease or Parkinson's disease, or even protect against depression and psychosocial maladjustment.

    “Moreover, healthy nutrition may modify the risk for neurodegenerative diseases such as Alzheimer disease, or Parkinson’s disease, or even protect against depression and psychosocial maladjustment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    The Mediterranean diet may further contribute to reproductive health in both men and women.

    “Moreover, it seems that MD may further contribute to reproductive health in both men and women, since higher rates of subfertility have been noted nowadays in westernized societies and may further contribute to the overall health of future generations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Healthy nutrition of the woman impacts the composition of gut microbiota and metabolic health of her offspring and may further protect from congenital malformations or adverse neurodevelopment in the offspring.

    “There is a lot of evidence highlighting the impact of healthy nutrition of the woman on the composition of gut microbiota and metabolic health of her offspring and may further protect from congenital malformations or even adverse neurodevelopment in the offspring.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    EGCG present in tea has been associated with adverse effects when administered at high concentrations, including a hepatotoxic effect with an increase in hepatic transaminase in animal experiments and in humans.

    “EGCG present in tea has also been associated with adverse effects when administered at high concentrations. A hepatotoxic effect with an increase in hepatic transaminase has been reported in animal experiments as well as in humans.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [130] Hayat, 2015, Tea and its consumption: Benefits and risks, Crit. Rev. Food Sci. Nutr. source

      Not checked in the free run.

98 of 98

  • The paper relies on this without support.

    Non-communicable diseases account for a high percentage of morbidity and mortality in modern westernized societies.

    “It has been established, worldwide, that non-communicable diseases, such as obesity, diabetes, non-alcoholic fatty liver disease, metabolic syndrome, and cardiovascular events account for a high percentage of morbidity and mortality in modern westernized societies.”

  • The paper relies on this without support.

    Modifiable factors such as increase in sedentary activities, sleep deprivation, smoking, and unhealthy dietary habits have significantly contributed to the increase in non-communicable diseases.

    “Several modifiable factors, such as increase in sedentary activities, sleep deprivation, smoking, and unhealthy dietary habits have significantly contributed to this increase.”

  • The paper relies on this without support.

    Women with polycystic ovarian syndrome have an increased risk of developing type 2 diabetes mellitus.

    “Women with PCOS have an increased risk of developing type 2 diabetes mellitus.”

  • The paper relies on this without support.

    High advanced glycation end product levels are associated with increased insulin resistance, which drives sex-hormone binding globulin reduction and androgen excess.

    “High AGE levels are associated with increased insulin resistance, that in turn, drives sex-hormone binding globulin (SHBG) reduction and androgen excess.”

  • The paper relies on this without support.

    Polycystic ovarian syndrome patients have lower levels of adiponectin and adiponectin receptors, and adiponectin is beneficial for metabolism as it improves glucose homeostasis and has lipid-lowering effects.

    “It is known that PCOS patients have lower levels of adiponectin and adiponectin receptors. As widely known, adiponectin is beneficial for metabolism as it improves glucose homeostasis and has lipid-lowering effects.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The Mediterranean Diet, which widely includes flavanols, flavanones, flavones and anthocyanins, is characterized by beneficial effects on health, including healthy aging as it hinders pathogenesis of many chronic diseases and extends life expectancy.

    “An indirect confirmation of this concept could be deduced by the fact that the Mediterranean Diet, which widely includes both flavanols, flavanones, flavons and anthocyanins, is characterized by well-known beneficial effects on health, including a healthy aging as it hinders the pathogenesis of many chronic diseases and extends life expectancy [317,318].”

    From The Role of Antioxidants in the Interplay between Oxidative Stress and Senescence (2022) · cites this paper as [318]

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Authors
Gantenbein, K. V., & Kanaka-Gantenbein, C.
Affiliations
  • National and Kapodistrian University of Athens (GR)
  • Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Aghia Sophia Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
Venue
Nutrients
Publisher
MDPI AG
Published
2021-06-06
Volume
13
Issue
6
Pages
1951
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu13061951
PMC
PMC8227318
OpenAlex
W3171615839
Semantic Scholar
8b64e811ebb60c3197344f72eddc5824df6cbb3a
Cited by
288
References
132
Citations by year
2026: 47 · 2025: 83 · 2024: 66 · 2023: 60 · 2022: 30 · 2021: 2
FWCI
7.04
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Physical Sciences › Chemistry › Organic Chemistry › Edible Oils Quality and Analysis
  • Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
Keywords
Mediterranean diet, antioxidants, anti-inflammatory agents, metabolic health, non-communicable diseases, obesity, diabetes mellitus, metabolic syndrome, cardiovascular disease, reproductive health, neurodegenerative diseases, depression, gut microbiota, offspring health, physical activity, healthy lifestyle, dietary habits
MeSH terms
Diet, Healthy, Antioxidants, Female, Humans, Male, Mental Health, Nutritional Physiological Phenomena, Diet, Mediterranean, Reproductive Health

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

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