The Mediterranean Diet: from Fiction to Facts

Course Description
The course is intended to teach students about the critical role of nutrition in longevity
and diseases related to aging. The Mediterranean Diet is a type of diet located
geographically in countries bordering the Mediterranean Sea. This diet has unique
characteristics since it combines excellent gastronomic properties with a high and highly
healthy nutritional value. However, false myths or fiction about the Mediterranean diet
devalue its favorable properties. That situation does not help increase the MD's
adherence, which is crucial to improving health in general and promoting longevity. This
course aims to show the composition of the authentic Mediterranean Diet and study from
a biological point of view the components responsible for the positive effects on health.
A critical point: An introductory knowledge of biology, biochemistry, or organic
chemistry is required to follow this course adequately. A placement test will be given on
the first day of class for students to know their level.

Course Goals and Methodology
The course aims to introduce students to the Mediterranean Diet from two points of view:
a) the biological reasons for its positive effects on health and longevity and b) the nature
and properties of specific nutrients in this diet. This study will be complemented by
elaborating dishes containing foods of the MD.

Goals:
• Know what the Mediterranean Diet (MD) is
• Analyze the components of the Mediterranean Diet
• Identify the biological effects of nutrients included in the MD
• Determine how MD nutrients can promote good health
• Evaluate how MD nutrients can retard aging.
• Analyze some Spanish dishes containing components of the MD.
Students will have the syllabus as a starting material at the beginning of the course. No
reference textbook is available since topics included in the course are not included in
only one book. Students can access materials to follow the course at the e-learning
platform Virtual Classroom or Aula Virtual (https://campusvirtual.upo.es/) using the
login/password provided during the course enrollment.
This course uses an inverted class or flipped class methodology. Students should
analyze the class material before the beginning of each lecture. These materials can be
videos, papers, and web pages. Students must answer one exam at the end of every
lecture.

The evaluation in this course is continuous. In each lecture, we will include evaluation
activities accumulated throughout the course. The following list contains mandatory
course activities:
- Video class: Watch a video about the lecture.
- Online exams: One after each lecture, in Blackboard
- Class activities: Individual or group activities performed in the classroom.
- Lab work: Laboratory activities
- Basilippo visit: Group visit to an almazara, a traditional olive oil factory. It is free
for NUTR301E students and is mandatory
- Classbook: To monitor attendance and participation in class
- Kitchen class: To learn how to prepare MD dishes
Learning Objectives
Through this course, students will:
• Describe the origins of the Mediterranean Diet (MD).
• List the essential components of the MD
• Analyze if a diet fits the criteria of MD using MD scores
• Transfer the MD to a different geographical location
• Design dishes adjusted to the MD
• Analyze epidemiological studies about the effects of MD
• Describe the impact of MD on the health
• Describe the diseases on which MD acts positively
• Explain how MD prevents or mitigates the effects of human diseases
• Describe the active ingredients found in MD foods to fight against disease or
aging
• Analyze the molecular function target of the active ingredients of MD foods
Required Texts
Books of General Biochemistry:
• Principles of biochemistry. Lehninger, Albert L. ; Nelson, David L. (David Lee),
1942- ; Cox, Michael M. ; New York : Freeman; 2013
• Biochemistry. Berg, Jeremy M. ; Tymoczko, John L. ; Stryer, Lubert ; New York :
W. H. Freeman and Company; cop. 2002
Books of Nutrition:
• Clinical nutrition Nutrition Society (Great Britain) ; Elia, Marinos ; Chichester,
West Sussex : Wiley-Blackwell; c2013

• Molecular basis of nutrition and aging Malavolta, Marco.; Mocchegiani, Eugenio;
London : Academic Press; 2016
Other sources:
• Olive : a global history. Lanza, Fabrizia. London : Reaktion Books; 2011
• Olive oil and health Quiles, José L.; Ramırez ́ -Tortosa, M. Carmen.; Yaqoob,
Parveen.; Wallingford, UK ; Cambridge, MA : CABI Pub.; c2006
• Cereals and pulses nutraceutical properties and health benefits Yu, Liangli.; Cao,
Rong.; Shahidi, Fereidoon, 1951-; Ames, Iowa : Wiley-Blackwell; 2012
• Phytochemicals of Nutraceutical Importance Prakash, D. ;Sharma, G. ;Prakash,
Dhan ; Sharma, Girish Wallingford: CABI; 2014
• Olives. Ioannis Therios, CABI, 2008. ProQuest Ebook Central
• The Mediterranean diet: culture, health and science. Lorenzo M. Donini, Lluis
Serra-Majem, Monica Bullo, Angel Gil, Jordi Salas-Salvado, British Journal of
Nutrition, https://doi.org/10.1017/S0007114515001087
• The Mediterranean diet: health, science and society. Mariette Gerber and
Richard Hoffman. British Journal of Nutrition (2015), 113, S4–S10
doi:10.1017/S0007114514003912.
The origin of the graphic materials is indicated in the corresponding documents or slides.

Course Requirements and Grading
Final exam: At the end of the course. It is an online exam performed in a computer room.
It comprises 30 multiple-choice questions with only one option and six short-answer
questions.
Midterm exam: In the middle of the course. It is an online exam performed in a computer
room. It comprises 30 multiple-choice questions with only one option and four shortanswer questions.
Class activities and lab reports: Each lecture ends with a group or individual activity
that the professor will evaluate. Class and lab activity reports will be hand-delivered
during class on the date indicated in the rules for each activity. Late submission will be
penalized with 10% on the grade obtained for each day late.
Participation: Students must prepare each class in advance with material provided by
the professor. This material has a class video that the students should view.
At the end of the class, students should complete a questionnaire with multiple-choice
questions with a single correct answer and two essay questions. It is recommended that
students check the due dates of the questionnaires as they cannot be completed after
this date.

The final grade will be calculated as follows:
• Participation (20%): Online exams 15% and video watching 5%
• Classbook (5%)
• Midterm exam (20%)
• Class activities and lab reports: Regular classes and lab activities (25%)
• Final exam (30%)

Course contents
Lecture 1: What is the Mediterranean diet?
1. The historical origin of the Mediterranean diet (MD)
2. The traditional Mediterranean diet
3. The seven countries study and MD pattern
4. The pyramid of the Mediterranean diet
5. The food composition of the Mediterranean diet
6. Benefits of MD
7. MD versus Standard Western diet
8. The Mediterranean diet score (MDS)
9. Transferring MD to other countries
10. Ultra-processed foods in MD
Lecture 2: How to analyze MD effects
1. Epidemiological studies classification
a. Case-control
b. Cohort studies
c. Random Controlled Trials (RCT)
2. Cohort studies in MD
3. RCT in MD
4. Survival studies versus epidemiologic studies
5. Components of epidemiological studies
6. Proven effects of MD foods
Lecture 3: Biological mechanisms of MD effects
1. A general view of metabolism
a. Main features of metabolism
b. Functions of metabolism
c. Nutrient's digestion
d. Fuel for organs
2. Nutrient's assimilation
a. Carbohydrates
b. Proteins
c. Fats
3. Effects of MD foods on metabolism
4. Definition of aging
5. Metabolic pathways modified by MD
6. Mitochondrial improvement generated by MD
7. Epigenetics changes of MD
8. Caloric restriction in MD
Lecture 4: Aging-related diseases: targets of MD
a. Metabolic syndrome, diabetes, and obesity
b. Vascular inflammation, dyslipidemia, and CVD
c. Cancer
d. Degenerative diseases
Lecture 5: Olive oil as the best source of MUFA
1. The olive and olive tree
a. Olive tree culture
b. Structure and fruit development
2. Methods to produce olive oil
a. Procedure
b. Types of olive oil
c. The composition of the olive oil
i. Fatty acids
ii. Triacylglycerols (TAGs)
iii. Polyphenols
iv. Sterols
v. Odorant molecules
d. Quality parameters in olive oil
i. Acidity
ii. Peroxidation
3. Epidemiological studies of EVOO effects
4. Biological effects of EVOO
Lecture 6: The role of PUFA in the MD action
1. Nutritional value of fish
a. Sources of PUFA
i. Oily fish and nuts
b. Omega-3 and omega-6 PUFA
c. Effects of PUFA on the health
d. The negative effect of fish consumption
i. Toxic compound accumulation
ii. Peroxidation
e. The ratio ω3/ω6
i. Meaning of the ratio
ii. The anti-inflammatory action of ω3
Lecture 7: How to avoid meat in MD as a source of proteins
1. Protein function and structure
a. Amino acid's structure
b. Type of amino acids
c. Proteogenic and essential amino acids
2. Amino acid requirements in the diet
a. Animal sources in MD
b. Plant sources in MD
3. Legumes in MD as a protein source
a. Nutritional
b. Cost
c. Environmental
4. The savvy combination of legumes and cereals in MD
Lecture 8: The hidden role of fiber in MD goodness
a. Sources of edible fiber in MD
b. Fiber classification
c. Fiber properties
d. Physiological effects of fiber
Lecture 9: MD is an antioxidant diet
1. Antioxidants in fruits, vegetables, and spices
a. Redox reactions and redox stress
b. Free radicals
i. Definition
ii. Formation
c. Effects of oxidative stress
d. Antioxidant's classification
e. The action of antioxidants to block oxidative stress
2. Epidemiologic studies about fruits
3. Examples of antioxidants
a. Carotenoids
b. Vitamin C
c. Resveratrol