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Diabetes and obesity and the associated risk of cardiovascular disease and cancer represent a major burden and an enormous societal challenge in all region of the world, including the Mediterranean region. The prevalence of diabetes in the country surrounding the Mediterranean Sea ranges between 6 and 8% to overcome 10% in countries like Egypt, Algeria and Morocco. These findings are particularly striking if one takes into consideration that this is the region where the most celebrated Mediterranean Diet has developed over centuries. This dietary (and lifestyle) pattern, indeed; has been advocated as a very healthy model. A number of epidemiological studies have repeatedly shown that risk of cardiovascular disease, metabolic disorders, and cancer is lower and life expectancy longer within the populations of the Mediterranean regions. This diets characteristically consists of large consumption of complex carbohydrates such as bread and pasta, vegetables, legumes, fresh fruits and nuts with olive oil as a main source of fat. On the contrary, the use of poultry, fish, eggs, and diary products is less common. In some areas, wine is also a component of diet. Many of these aliments have been shown to exert specific biological effects, For instance, vegetables are a significant source of flavonoids exerting an important anti-oxidant effect. Nuts provide compounds that have been associated with a lipid lowering effect. Fresh fruits are rich in fibers, vitamins, oligo-elements, flavonoids and terpenes. Properties of olive oil has been recognized but many other components of the Mediterranean Diet, including flavor enrichers such as garlic, onion, herbs, spices, capers and so on all have shown to provide biologically active compounds that contribute to reduce the risk of metabolic disorders and related cardiovascular/cancer risk. Atypical example is represented by wine, which has lead to phenomenal expectation of the potential beneficial effect of resveratrol. Yet, the wine example also highlights diversities existing within the concept of the “Mediterranean Diet. Dietary patterns, indeed, may differ quite a lot among the countries surrounding the Mediterranean basin. This is not surprising due to influence of dietary habits of religious believes, local economy, and cultural tradition. In summary, while the beneficial effect of the Mediterranean Diet have been attributed to the beneficial effects of body weight, lipid and carbohydrate metabolism, inflammatory processes, and coagulation, multiple factors that may not be common to all Mediterranean countries concur in generating metabolic/cardiovascular beneficial effect. In spite of all the good things the Mediterranean Diet can bring about, people in all countries move away from traditional diet and adopting more and more Western diet patterns. The reason for this shift is likely to recognize multiple reasons including societal changes, increasing costs of some of food that in the past used to be at hand as opposed to cheap industrial food. On the light of the country difference and the temporal change in dietary habits, an International Research Staff Exchange Scheme was planned to allow investigators from different regions of the Mediterranean area to develop skills and exchange research activities with the goal of generating a better understanding of the potential dietary principles with specific health implications, and the biological pathways that may play a role in determining health protection. Therefore, through a “Health and Food” exchange platform different activities were planned toward a common objective, i.e. enhance research capacities for Egypt, Morocco, and Tunisia to promote (or preserve) healthy lifestyles in the Mediterranean basin by 1. Tacking advantage of specific diet habits, 2. Exploiting peculiar diet components that may exert positive health effects, and 3. Preserving organoleptic and biological properties of Mediterranean food even when industrially processed. In order to do that both the medical and agricultural experts were deemed necessary to participate to this action.

To the purpose of these main line of scientific activities two workpackages were designed, identified as “HEALTH” and “FOOD”, respectively.
Workpackage 1 (HEALTH) was built with the idea to generate exchange activities favoring mastering up-to-date laboratory techniques (nutrigenomics, transcriptomics, proteomic and metabolomics) allowing better understanding of the mechanisms through which micro- and macronutrients exert favorable effects in term of cardiovascular protection and prevention of obesity and type 2 diabetes

Workpackage 2 (FOOD) was designed to favor interaction between experts of countries to further improve skills in identifying food composition in the Countries participating in the project and generating sufficient knowledge to stimulate food companies to design and produce healthy food containing the principles of the “Mediterranean diet”.

As already emphasized in the previous report, here too we would like to recall that the main purpose for the IRSES project is to favor exchange of personnel (established investigators, young investigators, and administrative staff) with the final goal to create the environment for scientific collaboration leading to the development of research lines designed to generate more information and potential translation of knowledge related to the Mediterranean Diet and lifestyle. To this extent, personnel so far seconded has had the opportunity to gather skills in methodologies related to identification of nutritional principles, preservation of those principles through modern agricultural procedures, understanding of the biological actions of these principles, implementation of the use of nutrients in human health with specific interest to prevention of obesity and diabetes.

More specifically, within the objective frame of WP1 and WP2 by the end of second period a total of 126 secondments (6 and 120 per WP, respectively) have been accomplished. It must be noted that the vast majority of these secondments followed a south to north gradient and with many more investigators involved in agriculture than in medical sciences. Nonetheless a number of activities have been pursued and continued in the last year of the exchange programme. In particular within the activities of Workpackage 1 (HEALTH) the following topics/techniques have been covered:

- Methods for the assessment of the metabolic implications of obesity and distributiuon of adiposity
- Nutritional approaches in selected patient population;
- Methods for screening of diabetes and implementation of lifestyle modification for prevention of diabetes;
- Development and use of dietary questionnaires
- Genotyping procedures for identification of genetic markers of increased risk of diabetes and potential environmental (including dietary) interaction; Gene sequencing techniques; Microarray procedures;
- Methods for evaluation of anti-oxidant effect on cellular biology;
- Hormonal regulation of energy metabolism;

Similarly, the same areas of interest already promoted in the initial course of Workpackage 2 (FOOD) have been pursued in its second part of the Exchange programme with a number of researchers trained with respect to:

- Nutritional aspects including integration of nutrition components in sustainable agriculture;
- Nutritional impact of organic agriculture;
- Irrigation procedures including trickle irrigation, sprinkler irrigation, water distribution, water use and reuse, water saving, water system management, water scarcity, energy production for water re-use;
- Chemical characterization of natural biomolecules and bio-pesticides;
- Molecular and biological techniques for detection and characterization of plant pathogens;
- Isolation and purification of nutrient components;
- Laboratory techniques in the analysis of soil, water, plants;
- Microbiology and virology applied to plant protection;
- Development of farming techniques (grapes, olives);
- Food processing and preservation;
- Chemical, genetic, and biological characterization of vegetables and fruits (Opuntia Ficus, quinoa, chickpea, dates, Artemisia campestris…)

Moreover, a limited number of secondments also had as goal the elaboration of communication techniques and procedures, coordination of collaborative projects, and student affair structuring.