Obesity-related diseases account for the majority of morbidity and mortality in U.S. adults. An estimated 4 million women in the United States deliver an infant annually, of which approximately 34% are overweight/obese prior to pregnancy. More than 30% of these women gain weight that exceeds the IOM’s recommendations; increasing their risk of postpartum weight retention and possibly increasing their risk of greater weight gain and retention over time. This research sought to test the efficacy of a traditional MED diet for 4-months on weight loss/control and biomarkers of inflammation in breastfeeding women compared to women randomized to the USDA’s MyPyramid diet for Pregnancy and Breastfeeding (control diet). At baseline, the women (N=129) were 29.7±4.6 years, overweight (BMI: 27.2±4.9 kg/m2), and primarily non-Hispanic white (75.2%). The majority of women were exclusively breastfeeding (73.6%) and a mean 17.5 weeks postpartum. Adherence to the MED diet was evaluated via calculation of the MED diet score from validated FFQs administered pre- and post- the diet intervention. Anthropometric measurements (body weight, body fat, and waist and hip circumference) and biosamples (blood, urine, and breast milk) were collected at baseline and 4-months (diet completion). Biomarkers of inflammation (IL-6 and TNF-α) were assessed via standard ELISA kits. The MED diet score was increased by 0.68±2.74 and 0.27±1.57 for the MED and control group, respectively. Increases in fish and dairy intake and a decrease in meat/poultry intake were significantly different between diet groups (P<0.05). Participants in both diet groups demonstrated significant (P=0.002) reductions in all anthropometric measurements; no significant between group differences were shown. A significant decrease in TNF-α, but not IL-6, was demonstrated in both diet groups. There were no significant between group differences. Both the MED diet and the USDA’s MyPyramid diet were effective in reducing anthropometric measurements and inflammation in postpartum breastfeeding women.

Background: Studies evaluating the possible health-promoting effects of sound nutrition in heart and lung transplant recipients are currently lacking. Despite advances in drug treatment and patient monitoring, lifestyle-associated complications such as obesity, diabetes and cardiovascular disease occur frequently. Following transplantation, a low-fat eating pattern is currently viewed as best standard care. However, a Mediterranean diet based on a varied range of fresh unprocessed foods and supplemented with extra virgin olive oil has demonstrated clinical benefit in various non-transplant populations. The aim of this study was to evaluate the feasibility and acceptability of a Mediterranean vs a low-fat diet intervention in heart and lung transplant recipients, and to assess clinical and biochemical outcomes. Methods: This was a randomised controlled feasibility trial to evaluate a Mediterranean diet supplemented with extra-virgin olive oil, vs a modified low-fat diet in heart and lung transplant recipients at a single centre. In total, 41 clinically stable male and female (median age 55 years) transplant recipients were randomly assigned (1:1) in two separate 12-month waves (n=24 and n=17) to one of these diet interventions. A range of validated food frequency and adherence questionnaires captured changes in participants' reported eating habits to 6 weeks post-study. Clinical and biochemical analysis was conducted at baseline, 25 and 52 weeks. Telephone and outpatient contact provided a support mechanism to reinforce dietary behavioural change. Caloric intake and physical exercise awareness were discussed, but not promoted. Results: Thirty nine participants completed the trial (95%). Adherence to both interventions improved significantly at week 25, and was maintained at 52 and 58 weeks. Compared with baseline, waist circumference decreased in both groups at week 25 (p=0.024). A decrease in blood pressure and heart rate occurred at 52 weeks in the low-fat group only. At 52 weeks, higher adherence resulted in significant improvements in fasting glucose in the Mediterranean (< 4.8%) and low-fat (< 5%) groups. This respective pattern was also observed with total cholesterol (≤ 9% and ≤ 7%), triglycerides (≤ 9% and ≤ 20%) and IGF-1 (≤ 9% and ≤ 15%). A significant decrease in the LDL/HDL ratio (≤ 12%) occurred in the Mediterranean group only. Moreover, clinically relevant lipid and glucose regulation changes were observed in each intervention. Conclusions: The implementation of a prospective 12-month Mediterranean or low-fat diet is feasible and acceptable in a heart and lung transplant outpatient setting. Both interventions were positively associated with improvements in lipid and blood glucose regulation and circulating IGF-1. As part of a multidisciplinary framework, these findings offer an additional therapeutic strategy to optimise outpatient care.

This thesis consists of three manuscripts, which are presented in chapters 2, 3 and 4. The first manuscript (chapter 2) is a protocol for systematic review which outlines the steps used to systematically analyze the literature with regards to the primary objective of reviewing available evidence. The second manuscript (chapter 3) is the presentation of systematic review and meta-analysis in the form of a manuscript to be submitted for peer-review by fall 2020. The third manuscript (chapter 4) summarizes an analysis of CHILD study data that assesses the association of dietary patterns with infant wheeze and asthma through age 3. In chapter 5, the thesis concludes by summarizing study limitations, epidemiological implications, clinical relevance of these findings and future directions. Appendices are also included to highlight research methodology and describe comprehensively all data analyses. / Thesis / Master of Science (MSc) / This paper-based thesis includes my graduate research work to satisfy the requirements for a masters in science (M.Sc.) degree in the Medical Sciences department. The focus of this thesis is to contribute an important study of the role of maternal and infant nutrition in the development of asthma and wheeze in children. My research findings are presented as original manuscripts of a systematic review protocol, systematic review, and a primary analysis of data collected as part of the CHILD longitudinal birth cohort study. At present, the first 2 manuscripts are under review by scientific journals; and the third will be submitted for peer-review in October 2021.

Η εντερική χλωρίδα θα μπορούσε να περιγραφεί ως ένα μικροβιακό όργανο, μείζονος σημασίας για την ομοιόσταση του οργανισμού, εξαιτίας της συμμετοχής του σε πολλαπλές και διαφορετικές λειτουργιές όπως η πέψη, η απορρόφηση των θρεπτικών συστατικών, η αποβολή των άχρηστων ουσιών και η φυσική ανοσία. Η σύστασή της έχει παρατηρηθεί ότι διαφέρει από άνθρωπο σε άνθρωπο. Ενώ οι κυριότεροι παράγοντες που διαμορφώνουν το τελικό μικροβιακό περιεχόμενο περιλαμβάνουν την ηλικία, το περιβάλλον, τις διαιτητικές συνήθειες, το γενετικό υπόβαθρο, την καταγωγή, την χρήση αντιβιοτικών, πρεβιοτικών ή προβιοτικών, την έκθεση σε ποικιλλία μικροβίων και τις χειρουργικές επεμβάσεις. Η ανθρώπινη εντερική χλωρίδα αποτελείται κατά κύριο λόγο από μόλις τέσσερα φύλα βακτηρίων, τα Bacteroidetes (23%), τα Firmicutes (64%), τα Actinobacteria (3%), και τα Proteobacteria (8%). Τα τελευταία χρόνια αρκετό είναι το ερευνητικό ενδιαφέρον στην μελέτη της σχέσης μεταξύ της σύνθεσης της εντερικής χλωρίδας και της παχυσαρκίας. Η έρευνα των πιθανών μηχανισμών αλληλεπίδρασης του μικροβιακού περιεχομένου και του ξενιστή εκτελείσεται τόσο με την χρήση πειραματοζώων όσο και σε ανθρώπινο επίπεδο. Έχει αποδειχθεί ότι σε παχύσαρκα άτομα υπάρχει χαμηλότερο ποσοστό Bacteroidetes και μεγαλύτερο Firmicutes, σε σύγκριση με άτομα κανονικού βάρους. Αν και έχουν επίσης διατυπωθεί αντίθετα αποτελέσματα. Οι διαιτητικές συνήθεις είναι ένας από τους κύριους παράγοντες που επηρεάζουν την σύσταση της εντερικής χλωρίδας. Παράλληλα, είναι γνωστό ότι το μοντέλο της οικογένειας και το γονεϊκό πρότυπο είναι καθοριστικής σημασίας στην διαμόρφωση διαιτητικών και διατροφικών επιλογών. Στην παρούσα μελέτη στόχος ήταν να ερευνήσουμε την επιρροή του οικογενειακού περιβάλλοντος, της μεσογειακής διατροφής και της παχυσαρκίας στην σύσταση της εντερικής χλωρίδας. Στην έρευνα συμμετείχαν 35 άτομα, από 12 οικογένειες, ηλικίας από 18 ετών έως και 77 ετών. Όλοι είναι μέλη οικογενειών που κατοικούν στην περιοχή της Πάτρας, και αφού πληροφορήθηκαν εκτενώς για τον σκοπό και την μεθεδολογιά της, συνένεσαν εθελοντικά. Μετρήθηκαν τα ανθρωπομετρικά χαρακτηριστικά κάθε εθελοντή, και υπολογίστηκε ο δείκτης μάζας σώματος (ΔΜΣ), καταγράφηκαν, μέσω ερωτηματολογίων, δημογραφικά, κοινωνικο-οικονομικά στοιχεία και οι διαιτητικές-διατροφικές τους συνήθειες. Ακόμα έγινε συλλογή κοπράνων, από όπου απομονώθηκε DNA και αναλύθηκε με την χρήση Real Time PCR. Μετά την στατιστική επεξεργασία, δεν επιβεβαιώθηκε η αρχική εκτίμηση για παρόμοια βακτηριακή κατανομή μεταξύ των μελών της κάθε οικογένειας και τελικά δεν σχετίστηκε στατιστικά σημαντικά η υιοθέτηση της Μεσογειακής διατροφής (MedDiet score) με την σύσταση της εντερικής χλωρίδας. / The intestinal flora is a microbial organ of major importance for the homeostasis of human organism, because of its participation in multiple and diverse functions such as digestion, absorption of nutrients, elimination of waste products and immunity. Gut flora is affected by various factors, such as the age, environment, dietary habits, host’s genotype, origin, using of antibiotics, prebiotics or probiotics, exposure to a variety of microbes and surgeries. Human intestinal flora consists primarily of four bacterial genders: the Bacteroidetes (23%), the Firmicutes (64%), the Actinobacteria (3%), and the Proteobacteria (8%). In the last years, many scientists study the correlation between the gut microbiota and obesity. Although, there are conflicting results, there is evidence that obese people have lower percentage of Bacteroides and higher percentage of Firmicutes, when compared with normal weight. It is known that dietary habits affect the composition of gut flora. Furthermore, it has also been proved that type of family and/or parenting model are crucial factors in shaping dietary and nutritional choices. The objective of this study was to investigate the correlation between the Mediterranean diet, obesity and family’s environment with gut microbiota. The survey involved 35 people, from 12 different families, aged from 18 years to 77 years. We measured anthropometric characteristics of each volunteer, calculated body mass index (BMI) and then demographic, socio-economic data and dietary-nutritional habits were recorded through questionnaires. We collected stool sample from every partitipant, DNA was isolated and analyzed using Real-Time PCR. Statistical analysis did not confirm the initial estimate for similar bacterial distribution among the members of each family, and eventually the adherence to Mediterranean Diet (MedDiet score) was not significally related with changes of the intestinal flora.

This paper reviewed the mechanisms of systemic inflammation and the nutritional status of the individuals who suffer from chronic diseases including rheumatoid arthritis, systemic lupus erythematous, chronic obstructive pulmonary disease, irritable bowel diseases include ulcerative colitis and Crohn’s disease, asthma, and atherosclerosis. Treatment modalities such as diet regimens will also be discussed. The Anti-Inflammatory diet, Mediterranean Diet, and the Dash diet will be discussed. Nutritional status and inflammation go hand in hand according to the findings available today. There is still more research required to completely understand the mechanisms that occur in inflammation.

BACKGROUND: The benefits of the Mediterranean-style dietary pattern in mitigating cancer risk among Americans is unclear and its role in obesity-related cancer risk has not been evaluated. OBJECTIVES: This study examines the prospective association between adherence to a Mediterranean style dietary pattern and cancer risk (including total, obesity related, breast and colorectal cancers) among men and women in the Framingham Offspring (FOS) cohort. In secondary analyses for breast cancer, we explore stratifying by hormone receptor status and menopausal status. METHODS: The Mediterranean style dietary pattern (MSDP) score was derived from a semi-quantitative food frequency questionnaire taken at examination visit 5 in the prospective FOS cohort. Subjects included 3199 participants (1703 women and 1496 men), aged 30 years old and older, who were free of prevalent cancer. The MSDP score was classified into tertiles and also dichotomized (MSDP score <19 vs. ≥19) to evaluate the association between the MSDP and cancer risk through the ninth examination cycle (2014). Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all subjects and for men and women separately, adjusting for confounding by age, physical activity, body mass Index, pack-years of cigarette smoking, supplement use, diabetes status and sex (for all subjects models). In the breast cancer model, we adjusted for age, waist-to-height ratio height ratio, pack-years, physical activity, diabetes, supplement use age at menopause. Factors found not to confound the effects of the MSDP on cancer risk were excluded from final models. RESULTS: During a median follow-up of approximately 18 years, 377 and 273 cancer cases were documented among men and women, respectively. Women in the upper two tertiles of the MSDP score had approximately 30% lower lower total cancer risks than women in the lowest tertile (tertile 2: HR, 0.69, 95% CI: 0.50-0.94; tertile 3: HR, 0.73; 95% CI: 0.54-0.99). Effects in men were weaker. Higher adherence to a MSDP was somewhat more strongly protective against total cancer risk among lower-risk individuals such as those who were leaner (BMI <25), drank less alcohol (<14 g/d), and did not currently smoke cigarettes. The association between MSDP adherence and total cancer risk was also modified by waist circumference and WHtR. We also observed a non-statistically significant protective effect of higher MSDP conformity and obesity-related cancer risk (tertile 3: HR, 0.80, 95% CI: 0.60-1.07). The association was present especially among women (tertile 2: HR, 0.76, 95% CI 0.53-1.09; tertile 3: HR, 0.73, 95% CI: 0.51-1.05). In analyses of effect modification by anthropometric measures of body fat, the combined effect estimates for higher adherence to the MSDP in women and body fat were more than additive for BMI and WHtR. The MSDP adherence was also inversely associated with BrCa risk (tertile 3 vs tertile 1: HR: 0.58, 95% CI: 0.34-0.98) especially in post-menopausal women (HR: 0.51, 95% CI: 0.29-0.91) and among those with any positive Estrogen Receptor/Progesterone Receptor BrCa (HR: 0.58, 95% CI: 0.31-1.06). We found no association between MSDP and colorectal cancer in these analyses. CONCLUSIONS: In this large cohort study, higher adherence to MSDP was associated with lower cancer risk (including total, obesity-related and breast cancers), among women aged 30 years old or older in the FOS study.

"Untersuchung kardioprotektiver Wirkungen des Olivenöles und seiner phenolischen Komponenten in einer Gruppe gesunder deutscher Männer" <br><br> EINLEITUNG: Epidemiologische Daten belegen, dass die mediterrane Ernährung mit einer niedrigen Inzidenz an mit oxidativen Stress assoziierten kardiovaskulären Erkrankungen einhergeht. Dabei wird vor allem dem Olivenöl, als Hauptfettlieferant in der mediterranen Ernährung, eine kardioprotektive Wirkung zugesprochen. Olivenöl zeichnet sich neben dem hohen Gehalt an einfach ungesättigten Fettsäuren (MUFA) durch ein reichhaltiges Spektrum an phenolischen Verbindungen aus, deren antioxidative Wirkung bereits zahlreichen in in vitro Studien beschrieben wurde. Demnach könnte der Verzehr von phenolreichem Olivenöl auch in vivo vor oxidativen Schädigungen schützen und somit das Risiko für kardiovaskuläre Erkrankungen senken.<br><br> ZIELSTELLUNG: Untersuchung der kardioprotektiven Wirkung von Olivenöl und seiner phenolischen Komponenten in einer Gruppe gesunder deutscher Männer.<br><br> METHODE: Dazu wurde eine randomisierte cross-over doppelt-verblindete Interventionsstudie an 70 gesunden Männern zwischen 20 - 60 Jahren im Raum Berlin-Brandenburg durchgeführt. In jeweils drei dreiwöchigen Interventionsphasen konsumierten die Probanden täglich 25 ml natives (phenolreich), gemischtes (mittlerer Phenolgehalt) und raffiniertes (annähernd phenolfrei) Olivenöl, was sich ausschließlich im Gehalt an phenolischen Verbindungen unterschied. Das Olivenöl sollte dabei die gewöhnlich verzehrten Fette ersetzen. Die Interventionsphasen waren durch zweiwöchige Wash out-Phasen unterbrochen. Die Erhebung der Blutlipide, Biomarker der Lipidperoxidation und endogene Antioxidantien erfolgte zu Studienbeginn sowie zu Beginn und Ende jeder Verzehrsperiode.<br><br>ERGEBNISSE: Bei den Blutlipiden sowie den Biomarkern der Lipidperoxidation und den endogenen Antioxidantien konnte keine signifikante Veränderung in Abhängigkeit vom Phenolgehalt der applizierten Olivenöle nachgewiesen werden. Einzig die Glutathion-Reduktase-Aktivität stieg mit zunehmendem Gehalt an phenolischen Verbindungen (pTrend = 0,041). Unabhängig von der Konzentration der Phenole im Olivenöl wurde bei den Probanden durch den Olivenölverzehr eine Senkung von Gesamtcholesterol (p = 0,007) und Triglyzeride (p = 0,013) im Serum erzielt. Diese Wirkung geht einher mit einem gestiegenen MUFA-Anteil in der Ernährung aufgrund des Olivenölkonsums (p < 0,001).<br><br> SCHLUSSFOLGERUNG: Die Hypothese, dass die Phenole im Olivenöl aufgrund ihrer in in vitro und Tierstudien beschriebenen antioxidativen Wirkung dem Olivenöl neben dem einzigartigen Fettsäureprofil eine zusätzliche kardioprotektive Wirkung bescheren, konnte in der vorliegenden Studie nicht gezeigt werden. Dennoch konnte durch den Olivenölverzehr und der damit einhergehenden Erhöhung des MUFA-Anteils in der Ernährung eine vorteilhafte Beeinflussung der Blutlipide erzielt werden. Obgleich Olivenöl nicht das vorwiegend verzehrte Fett in Deutschland darstellt, zeigten die befragten Probanden eine hohe Akzeptanz. Folglich könnte die Integration von Olivenöl in die habituelle Ernährung einen Beitrag zur Senkung des kardiovaskulären Erkrankungsrisikos leisten. / "Cardioprotective effects of olive oil and its phenolic compounds in healthy German men" <br><br> BACKGROUND: Epidemiological data show that the Mediterranean diet is related to a low incidence of oxidative stress associated cardiovascular diseases. In particular, olive oil, which is the most consumed alimentary fat in the Mediterranean diet, is discussed to be cardio protective. Besides its high monounsaturated fatty acid content olive oil contains a remarkable amount of phenolic compounds. Results from in vitro and animal studies suggest that these phenols are powerful antioxidants. Thus, consumption of olive oil phenols also could inhibit oxidative damage in vivo and therefore could reduce the risk of cardiovascular diseases. <br><br> OBJECTIVE: To investigate the cardioprotective effect of olive oil and its phenolic compounds in healthy German men. <br><br> METHODS: Therefore, a randomised, cross-over, double-blind intervention trial in 70 healthy men aged 20 - 60 years from the Berlin-Brandenburg area was conducted. Subjects were randomised for three periods of three weeks to replace their usually consumed fat by daily 25 ml of virgin (high-phenolic), common (medium-phenolic) and refined (low-phenolic) olive oil, which vary only in their content of phenolic compounds. Each intervention was separated by a two-week wash-out period. Blood lipids, lipid peroxidation biomarker and endogenous antioxidants were assessed at study baseline and the beginning and end of each intervention period. <br><br> RESULTS: In the total study population, blood lipids, biomarker of lipid peroxidation and endogenous antioxidants were not affected by the phenolic content of the olive oils administered. Solely, a concentration-dependent increase in glutathion-reductase activity could be observed (pTrend = 0.041). A significant reduction in serum total cholesterol (p = 0.007) and triglycerides (p = 0.013) after of olive oil consumption was assessed, which was independent from the content of phenolic compounds in the olive oil. This effect goes along with an increased monounsaturated fatty acids proportion in the habitual diet of the subjects as a result of the olive oil consumption (p < 0.001). <br><br> CONCLUSION: The hypothesis, that phenolic compounds in olive oil due to its antioxidative properties reported in in vitro and animal studies provide additional cardioprotective effects besides those attributed to its unique fatty acids profile could not be supported by this study. However, olive oil consumption exert beneficial effects on blood lipids, which could be ascribed to the increased monounsaturated fatty acid content in the diet. Even though olive oil is not the main source of fat in Germany, the interviewed participants showed a high acceptance. Thus, integration of olive oil into the habitual diet could contribute to a risk reduction in cardiovascular diseases among German men.

Purpose: Evidence suggests that olive oil consumption is associated with a decreased prevalence of cardiovascular disease and certain cancers. The purpose of this study was to assess the intake and knowledge of olive oil and other lipids in a collegiate population. Methods: Using an IRB-approved protocol, volunteered college students (N=56) from the college of Health and Human Sciences at Georgia State University completed a questionnaire on lipid and knowledge and eating behavior. Results were assessed to determine if students were able to accurately answer questions on the contents of different lipids, and also to determine the consumption behaviors of different lipids. Statistical comparisons were made between undergraduate and graduate students, and between students in different academic majors (nutrition, nursing, respiratory therapy, social work, criminal justice, and other). Results: It was hypothesized that eating behaviors would overemphasize unhealthy lipids. Lipids assessed included: olive oil, butter, canola oil, peanut oil, corn oil, margarine, sunflower oil, and soybean oil. There were no statistically significant differences between the ratios of consumed lipids labeled as ‘good’, and lipids labeled as ‘bad’. There were also no statistically significant differences in the presence of ‘good’ to ‘bad’ lipids in the subjects’ kitchens. Therefore, the results of this study were not able to disprove the null hypothesis. Nevertheless, using a Likert scale response scheme, there was a difference (p=0.041) between academic majors in the consumption of canola oil (an oil high in monounsaturated fatty acid), with Nursing majors reporting the highest consumption (X=3.73; SD=1.61) and Respiratory Therapy majors reporting the lowest consumption (X=1.89; SD=1.53). There was no statistically significant difference between graduate and undergraduate students in the presence of lipids in the kitchen. It was hypothesized that subject knowledge of lipid constituents would be poor. The majority of subjects either failed to respond correctly to the constituents of different lipids or reported that they did not know. Based on this result, the study is able to reject the lipid knowledge null hypothesis. There were clear differences in subgroup knowledge of commonly consumed lipids. Most notably, 100% of nutrition students responded correctly to the constituents of olive oil. Conclusions: This study focused on a group of college students in the College of Health and Human Sciences. One might assume that such a population would be sensitive and knowledgeable about key dietary factors that may influence disease risk. Nevertheless, these findings indicate that, except for isolated exceptions, the eating behaviors and lipid knowledge of these students in not at a level that could be considered health promoting. This suggests that, even with students in the health sciences, personal health classes are likely to be beneficial in reducing disease prevalence.

Background: Colon- and rectalcancer is the third most common cancer form worldwide. Previous research shows that unhealthy eating habits has a connection as a causal factor for cancer and that it's possible to prevent a third of all cancer cases with a changed diet. Medeiterranian diet consist of a high intake of seafood and is believed to be a healthpromoting diet. It is also a lower prevalence of cancer among the mediterranian coast. A WHO-report shows that about 1,5 - 2 % of all cancer cases have a connection to environmental pollution and nowadays most waters contains environmental pollution. Aim: The aim of this study was to update the state of knowledge between the mediteranian diet, it's frequency of seafood intake and colon- and rectal cancer in adults.  Method: A literature review was used to answer the aim. The article search was made in PubMed where 12 articles were chosen and passed the quality review. Results: There was an ambiguously connection between mediterranean diet and the incidence of colon- and rectalcancer as research did not agree on whether there was a connection or not and the amount of studies used was limited. Some studies believe that there’s a significant connection while others believe that there isn’t any connection. The study partly confirms the connection between the intake of seafood and the prevalence of colon- and rectalcancer where they who ate according to the WHO-recommendations possibly had a smaller risk of developing colon- and rectalcancer compared to those who ate either more or less seafood than recommended.  Conclusion: More research is needed in the field to ensure possible connection. / Bakgrund: Tjock- och ändtarmscancer är den tredje vanligaste cancerformen världen över. Tidigare forskning visar att ohälsosamma matvanor har en koppling som orsak till cancer och att det genom att förbättra kostvanorna är det möjligt att förebygga en tredjedel av alla cancerfall. Medelhavskost med sitt höga intag av fisk- och skaldjur anses vara en hälsofrämjande kost och kring medelhavskusten är det en minskad förekomst av dödsfall orsakade av cancersjukdom. En rapport av WHO visar att ca 1,5–2 % av alla cancerfall har kopplingar till kemiska föroreningar och de flesta vatten innehåller numera kemiska föroreningar.  Syfte: Syftet med studien var att uppdatera kunskapsläget för samband mellan medelhavskost, dess intag av fisk- och skaldjur och tjock-och ändtarmscancer hos vuxna över 18 år. Metod: En litteraturstudie användes för att besvara syftet. Artikelsökningen skedde i PubMed där 12 artiklar valdes ut och klarade kvalitetsgranskningen.  Resultat: Ett tvetydigt samband fanns mellan medelhavskost och förekomsten av tjock- och ändtarmscancer då forskningen inte var överens om huruvida det finns ett samband eller inte samt att det var en begränsad andel studier. Vissa studier menar att det finns ett signifikant samband medan andra menar att det inte finns något samband.   Studien stärker till viss del sambandet mellan fisk- och skaldjurintag och förekomst av tjock- och ändtarmscancer där de som åt fisk enligt WHO´s nuvarande rekommendationer möjligen hade en minskad risk för tjock- och ändtarmscancer jämfört med de som åt antingen mer eller mindre. Slutsats: Mer forskning behövs inom området för att säkerställa eventuella samband.

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