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PurposeTo examine the relationship between psychological distress resulting from the COVID-19 lockdown and dietary changes.MethodsCross-sectional analysis from 2 retrospective Italian cohorts recruited from May to September 2020: (1) The Moli-LOCK cohort consists of 1401 participants from the Moli-sani Study (n = 24,325) who were administered a telephone-based questionnaire to assess lifestyles and psychological factors during confinement; (2) the ALT RISCOVID-19 is a web-based survey of 1340 individuals distributed throughout Italy who self-responded to the same questionnaire using Google® forms.Psychological distress was measured by assessments of depression (PHQ-9 and depressive items from the Screening Questionnaire for Disaster Mental Health- SQD-D), anxiety (GAD-7), stress (PSS-4), and post-traumatic stress disorder (SQD-P). Diet quality was assessed either as changes in consumption of ultra-processed foods (UPF) or adherence to Mediterranean diet (MD).ResultsIn ALT RISCOVID-19, increased UPF intake was directly associated with depression (both PHQ-9 and SQD-D; p < 0.0001), anxiety (p < 0.0001), stress (p = 0.001) and SQD-P (p = 0.001); similar results were obtained in the Moli-LOCK cohort except for perceived stress. When psychometric scales were analysed simultaneously, only depression (SQD-D) remained associated with UPF (both cohorts). In both cohorts, psychological distress poorly influenced changes toward an MD, except for depression (SQD-D) that resulted inversely associated in the ALT RISCOVID-19 participants (β = − 0.16; 95% CI − 0.26, − 0.06).ConclusionsPsychological distress from the COVID-19 confinement is directly associated with unhealthy dietary modifications in two Italian cohorts. In view of possible future restrictive measures to contain pandemic, public health actions are warranted to mitigate the impact of psychological distress on diet quality.

: There is a lack of food frequency questionnaires (FFQs) specifically designed to assess food consumption based on processing levels in younger populations. This study evaluates the validity and the reliability of a 107-item FFQ (NFFQ-Kids) in estimating the intake (g/day) and the weight and energy ratios of Nova groups in Italian children and adolescents aged 2-18 years. : The NFFQ-Kids was administered twice (T0 and T1), with a four-week interval. A total of 73 participants completed the questionnaire at T0, and 53 completed it at T1. Participants were selected from the ICARO Study (December 2023-April 2024), a web-based cohort study in Southern Italy. Questionnaire validity was assessed by comparison with a 3-day food record (two weekdays and one weekend day) collected between the two NFFQ-Kids administrations. Test-retest reliability was evaluated to assess the consistency of the questionnaire over time. : A moderate correlation was found between the NFFQ-Kids and the 3-day food record for the energy ratio of ultra-processed foods (UPFs) (r = 0.48; < 0.001; ICC = 0.46; 95% CI 0.29-0.64) and the weight ratio for both unprocessed or minimally processed foods (r = 0.49; < 0.001; ICC = 0.50; 95%CI 0.33-0.66) and ultra-processed foods (UPFs) (r = 0.58; < 0.001; ICC = 0.58; 95%CI 0.42-0.72). Overall, the NFFQ-Kids showed good test-retest reliability across all Nova group intakes, total food, and relative energy and weight ratios of UPFs (r = 0.71, ICC = 0.67; and r = 0.79, ICC = 0.67, respectively), indicating stable measurements over time. : The NFFQ-Kids demonstrated acceptable validity and good reliability, proving useful for assessing food intake by processing level in Italian youth.

Background: Although national surveys report increasing ultra-processed foods (UPFs) consumption, updated estimates for Italy are lacking. Given the central role of the Mediterranean Diet (MD), understanding how UPFs contribute to the contemporary Italian diet is essential. This study quantified UPF intake in a convenience sample of Italian adults and examined its main sociodemographic correlates, including MD adherence. Methods: A web-based cross-sectional survey was conducted among Italian adults (≥18 years). Dietary intake was assessed using the validated 94-item NOVA Food Frequency Questionnaire (NFFQ). Associations between sociodemographic factors and NOVA food groups were evaluated using multivariable-adjusted linear regression, expressed as beta coefficients (β) and 95% confidence intervals (95% CI). MD adherence was assessed using the Medi-Lite score. Results: Data from 1629 participants (79.8% women; mean age 42.1 years, range 18–85) recruited between September 2021 and April 2025 were analyzed. Participants resided in Northern (23.4%), Central (40.4%), and Southern Italy (36.2%). UPFs contributed 20.0% (95% CI: 19.5–20.6) of total energy intake, while unprocessed/minimally processed foods, processed culinary ingredients, and processed foods accounted for 39.2%, 9.0%, and 31.8%, respectively. UPF consumption decreased with age (β = −3.34; 95% CI: −5.96 to −0.72 for >64 vs. ≤40 years) and was lower in Central (β = −2.92; 95% CI: −4.31 to −1.53) and Southern Italy (β = −1.51; 95% CI: −3.01 to −0.01) compared to the North. UPF intake showed an inverse linear association with MD adherence. Conclusions: UPFs contribute a modest share of total energy intake among Italian adults, consistent with other Mediterranean populations. Although based on a convenience sample, these findings highlight the relevance of the MD as a dietary model naturally limiting UPF consumption and provide updated evidence on UPF intake and its correlates in Italy.

Background Breakfast quality, together with regularity of breakfast, has been suggested to be associated with cardiometabolic health advantages. We aimed to evaluate the quality of breakfast and its socioeconomic and psychosocial correlates in a large sample of the Italian population. Methods Cross-sectional analyses on 7,673 adult and 505 children/adolescent regular breakfast eaters from the Italian Nutrition & Health Survey (INHES; 2010-2013). Dietary data were collected through a single 24-h dietary recall. Breakfast quality was assessed through the Breakfast Quality Index (BQI) combining intake of ten food groups, energy, and nutrients of public health concern, and potentially ranging from 0 to 10. The association of sociodemographic and psychosocial factors with BQI were analyzed by multivariable-adjusted linear regression models. Results The average BQI was 4.65 (SD ± 1.13) and 4.97 (SD ± 1.00) in adults and children/adolescents, respectively. Amongst adults, older age (β = 0.19; 95%CI 0.06 to 0.31 for > 65 vs. 20–40 years) and having a high educational level (β = 0.13; 0.03 to 0.23; for postsecondary vs. up to elementary) were independent predictors of better breakfast quality, while men reported lower BQI (β = -0.08; -0.14 to -0.02 vs. women). Perceived stress levels at home and work and financial stress were inversely associated with BQI. Children/adolescents living in Central and Southern Italian regions had lower BQI compared to residents in Northern Italy (β = -0.55; -0.91 to -0.19 and β = -0.24; -0.47 to -0.01, respectively). Conclusions In adults, breakfast quality was associated with age, sex, and educational level. Perceived stress levels were inversely associated with the quality of breakfast. In children/adolescents, a north-south gradient in breakfast quality was observed.

PurposeTo evaluate in an Italian general population, the association with mortality of a traditional Mediterranean diet (MD) and non-Mediterranean dietary (non-MD) patterns, and their combined effect, and to test some biomarkers of cardiovascular (CVD) risk as potential mediators of such associations.MethodsLongitudinal analysis on 22,849 men and women aged ≥ 35 years, recruited in the Moli-sani Study (2005–2010), followed up for 8.2 years (median). The MD was assessed by the Mediterranean diet score (MDS). The Dietary Approaches to Stop Hypertension (DASH), the Palaeolithic diet, and the Nordic diet were chosen as reportedly healthy non-MD patterns. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by multivariable Cox regression.ResultsParticipants reaching higher MDS or DASH diet score experienced lower risk of both all-cause (HR 0.77; 95% CI 0.66–0.90 and 0.81; 0.69–0.96, respectively, highest vs lowest quartile) and CVD (0.77; 0.59–1.00 and 0.81; 0.69–0.96, respectively) death risk; risk reduction associated with the Palaeolithic diet was limited to total and other cause death, whereas the Nordic diet did not alter risk of mortality. Increasing adherence to MD was associated with higher survival in each stratum of non-MD diets. Biomarkers of glucose metabolism accounted for 7% and 21.6% of the association between either MDS or DASH diet, respectively, with total mortality risk.ConclusionsBoth the traditional MD and DASH diet may reduce risk of all-cause mortality among Italians, as well as risk of dying from cardiovascular causes. The Palaeolithic diet did not appear to reduce cardiovascular risk, while the Nordic eating pattern was unlikely to be associated with any substantial health advantage.

Bread is one of the most common staple foods, despite the increasing consumption of the so-called “bread substitutes”. The aim of the present work is to survey the nutritional quality intended as a nutrition declaration of 339 pre-packed bread products and 1020 bread substitutes sold in the major retailers present on the Italian market. Comparisons of energy, macronutrient, and salt content within product types, and between regular and gluten-free (GF) products and products with or without nutrition claim (NC) and health claim (HC) declarations, were performed. A high inter-product variability was detected. The median energy contents were 274 (interquartile range 255–289) and 412 (380–437) kcal/100 for bread products and substitutes, respectively. Irrespective of the category, GF products had lower amounts of energy than their gluten-containing counterpart (p < 0.001), whereas products carrying NC had lower energy, sugar and salt amounts than the products without these declarations on the pack (p < 0.001 for all). A strong positive correlation was observed between energy and carbohydrate in bread (rho = 0.73, p < 0.001), but not in substitutes (rho = 0.033, p = 0.29). The present work highlighted a high variability in the apparent nutritional quality of bread products and substitutes sold on the Italian market, and suggested that bread alternatives should not be considered tout court as substitutes from a nutritional point of view.

To assess ultra-processed food (UPF) consumption and its socio-demographic, psychosocial and behavioural correlates in a general population of Italian children, adolescents and adults. Cross-sectional telephone-based survey. Italy, 2010-2013. In total, 9078 participants (5-97 years) from the Italian Nutrition & Health Survey. Dietary intakes were collected by a 1-d 24-h dietary recall. UPF was defined by the NOVA classification and expressed as percentage of total energies. Average energy intake from UPF (95 % CI) was 17·3 % (17·1 %, 17·6 %) among adults and 25·9 % (24·8 %, 27·0 %) in children/adolescents. Top sources of UPF were processed meats (32·5 %) and bread substitutes (16·7 %). Among adults, age (β = -3·10; 95 % CI (-4·40, -1·80) for >65 years v. 20-40 years; βs are dimensionless) and residing in Southern Italy (β = -0·73; 95 % CI (-1·32, -0·14) v. Northern) inversely associated with UPF. Screen view during meals was directly linked to UPF, as well as poor self-rated health (β = 5·32; 95 % CI (2·66, 7·99)), adverse life events (β = 2·33; 95 % CI (1·48, 3·18)) and low sleep quality (β = 2·34; 95 % CI (1·45, 3·23)). Boys consumed two-point percent more UPF of the total energy than girls (β = 2·01; 95 % CI (0·20, 3·82)). For all ages, a Mediterranean diet was inversely associated with UPF (β = -4·86; 95 % CI (-5·53, -4·20) for good v. poor adherence in adults and (β = -5·08; 95 % CI (-8·38, -1·77) for kids). UPF contributes a modest proportion of energy to the diets of Italian adults while being one-quarter of the total energies in children/adolescents. UPF was associated with several psychosocial factors and eating behaviours. Increased adherence to Mediterranean diet would possibly result in lower UPF consumption.

AbstractObjectiveTo jointly analyse two food dimensions, the Food Standards Agency Nutrient Profiling System (FSAm-NPS), used to derive the Nutri-Score front-of-pack label, and the NOVA classification in relation to mortality.DesignProspective cohort study.SettingMoli-sani Study, Italy 2005-10.Participants22 895 participants (mean age 55 (SD 12) years; 48% men).Main outcomes measuresAssociations between dietary exposures and mortality risk, assessed using multivariable cause specific Cox proportional hazard models controlled for known risk factors.ResultsA total of 2205 deaths occurred during 272 960 person years of follow-up. In the highest quarter of the FSAm-NPS index compared with the lowest quarter, multivariable adjusted hazard ratios for all cause and cardiovascular mortality were 1.19 (95% confidence interval 1.04 to 1.35; absolute risk difference 4.3%, 95% confidence interval 1.4% to 7.2%) and 1.32 (1.06 to 1.64; 2.6%, 0.3% to 4.9%), respectively. The hazard ratios were 1.19 (1.05 to 1.36; absolute risk difference 9.7%, 5.0% to 14.3%) and 1.27 (1.02 to 1.58; 5.0%, 1.2% to 8.8%), respectively, for all cause and cardiovascular mortality when the two extreme categories of ultra-processed food intake were compared. When these two indices were analysed jointly, the magnitude of the association of the FSAm-NPS dietary index with all cause and cardiovascular mortality was attenuated by 22.3% and 15.4%, respectively, whereas mortality risks associated with high ultra-processed food intake were not altered.ConclusionsAdults with the lowest quality diet, as measured using the FSAm-NPS dietary index (underpinning the Nutri-Score), and the highest ultra-processed food consumption (NOVA classification) were at the highest risk for all cause and cardiovascular mortality. A significant proportion of the higher mortality risk associated with an elevated intake of nutrient poor foods was explained by a high degree of food processing. In contrast, the relation between a high ultra-processed food intake and mortality was not explained by the poor quality of these foods.

BackgroundOlive oil consumption has been reportedly associated with lower mortality rates, mostly from cardiovascular diseases, but its potential impact on cancer death remains controversial. Moreover, biological mechanisms possibly linking olive oil consumption to mortality outcomes remain unexplored.MethodsWe longitudinally analysed data on 22,892 men and women from the Moli-sani Study in Italy (follow-up 13.1 y), to examine the association of olive oil consumption with mortality. Dietary data were collected at baseline (2005–2010) through a 188-item FFQ, and olive oil consumption was standardised to a 10 g tablespoon (tbsp) size. Diet quality was assessed through a Mediterranean diet score. Multivariable-adjusted Cox proportional hazard models, also including diet quality, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The potential mediating role of inflammatory, metabolic, cardiovascular and renal biomarkers on the association between olive oil intake and mortality was evaluated on the basis of change-in-estimate and associated p values.ResultsMultivariable HRs for all-cause, cancer, cardiovascular and other cause mortality associated with high (>3 tbsp/d) versus low (≤1.5 tbsp/d) olive oil consumption were 0.80 (0.69–0.94), 0.77 (0.59–0.99), 0.75 (0.58–0.97) and 0.97 (0.73–1.29), respectively. Taken together, the investigated biomarkers attenuated the association of olive oil consumption with all-cause and cancer mortality by 21.2% and 13.7%, respectively.ConclusionsHigher olive oil consumption was associated with lower cancer, cardiovascular and all-cause mortality rates, independent of overall diet quality. Known risk factors for chronic diseases only in part mediated such associations suggesting that other biological pathways are potentially involved in this relationship.

To evaluate changes in ultra-processed food (UPF) intake and its major correlates during the first Italian lockdown (March 9 -May 3 2020). Retrospective observational study. Italy. We analysed 2,992 subjects (mean age 57.9±15.3 y, 40.4% men). Individual participant data were pooled from 2 retrospective cohorts: 1) The Moli-LOCK cohort consists of 1,501 adults, a portion of the larger Moli-sani Study (n=24,325; 2005-2010) who were administered a phone-based questionnaire to assess lifestyles and psychological factors during confinement; 2) the ALT RISCOVID-19 is a web-based survey of 1,491 individuals distributed throughout Italy who self-responded to the same questionnaire by using Google forms.UPF was defined according to NOVA classification based on degree of food processing. An UPF score was created by assigning 1 point to increased consumption, -1 to decreased and 0 point for unchanged intakes of 19 food items, with higher values indicating an increase in UPF during confinement. Overall, 37.5% of the population reported some increase in UPF (UPF score ≥1). Adults were more likely to decrease UPF (multivariable regression coefficient β=-1.94; 95%CI: -2.72,-1.17 for individuals aged >75 y as compared to 18-39 y) as did individuals from southern Italian regions as compared to Northern inhabitants (β=-1.32; -1.80,-0.84), while UPF lowering associated with increased exercise (β=-0.90; -1.46,-0.35) and weight loss (β=-1.05; -1.51, -0.59) during confinement. During the first Italian lockdown, about 40% of our population switched to unfavourable eating as reflected by increased UPF intake and this may have long-term effects for health.