The optical, seismic, and infrasound signature of the March 5 2022, bolide over Central Italy.

On March 5, 2022, a 12 kg meteoroid crossed the sky above Central Italy and was observed by three different observational systems: the PRISMA all-sky camera network (10 stations), the Italian national seismic network (61 stations), and a 4-element infrasound array. The corresponding datasets, each with its own resolution, provided three independent assessments of the trajectory, size and speed of the meteoroid. The bolide traveled across central Italy with an azimuth of 102 degrees, becoming visible at about 91 km above sea level with a velocity of about 15.4 km/s. Its visible trajectory lasted about 15 s. Reasonably, the residual portion of the ablated bolide terminated its path in the Adriatic Sea and could not be recovered. Seismic and infrasound data well match optical observations detecting the bolide Mach cone at 68 km above sea level with a back azimuth of 25 degrees with respect to the array. By comparing results from the three different systems, discrepancies are within the estimated uncertainties, thus confirming the mutual consistency of the adopted methodologies. Therefore, this study shows that different approaches can be integrated to improve the detection capability for bolide crossing the sky in monitored regions.

Retrospective Recall of Psychological Distress Experienced During the First COVID-19 Lockdown in Italy: Results From the ALT RISCOVID-19 Survey.

Objectives: To estimate psychological distress experienced during the Italian lockdown (March-May 2020) by assessing, in the transition period of the pandemic (June-September 2020), participants' recalling of their psychological state. Methods: Cross-sectional analysis on 1,880 adults (mean age 48.9 ± 14.5 years) from the web-based ALT RISCOVID-19 survey. Participants were asked to retrospectively recall their psychological state during lockdown concerning symptoms of depression (Patients' Health Questionnaire), anxiety (General Anxiety Disorder), stress (Perceived Stress Scale) and post-traumatic stress (Screening Questionnaire for Disaster Mental Health). Results: Experienced symptoms of depression, anxiety and post-traumatic stress was recalled by 15.8, 15.3 and 13.1% of respondents, respectively. These psychometric scales tended to decrease during the 4-month period of assessment (p < 0.05), while perceived stress levels did not (p = 0.13). Men and older individuals reported lower symptoms of depression (ß = -0.42 and ß = -0.42; p < 0.0001, respectively), anxiety (ß = -0.41 and ß = -0.45; p < 0.0001, respectively), stress (ß = -0.36 and ß = 0.50; p < 0.0001, respectively) and post-traumatic stress (ß = -0.42; p < 0.0001, men vs women). Conclusion: Recalled psychological distress experienced during COVID-19 lockdown tended to decrease during the transition period of the pandemic, except for stress. Women and younger people were at higher risk to recall psychological distress.

Psychological distress resulting from the COVID-19 confinement is associated with unhealthy dietary changes in two Italian population-based cohorts.

PURPOSE: To examine the relationship between psychological distress resulting from the COVID-19 lockdown and dietary changes. METHODS: Cross-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). RESULTS: In 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 (ß = - 0.16; 95% CI - 0.26, - 0.06). CONCLUSIONS: Psychological 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.

A Physics-Informed Neural Network Approach for Nearfield Acoustic Holography.

In this manuscript, we describe a novel methodology for nearfield acoustic holography (NAH). The proposed technique is based on convolutional neural networks, with autoencoder architecture, to reconstruct the pressure and velocity fields on the surface of the vibrating structure using the sampled pressure soundfield on the holographic plane as input. The loss function used for training the network is based on a combination of two components. The first component is the error in the reconstructed velocity. The second component is the error between the sound pressure on the holographic plane and its estimate obtained from forward propagating the pressure and velocity fields on the structure through the Kirchhoff-Helmholtz integral; thus, bringing some knowledge about the physics of the process under study into the estimation algorithm. Due to the explicit presence of the Kirchhoff-Helmholtz integral in the loss function, we name the proposed technique the Kirchhoff-Helmholtz-based convolutional neural network, KHCNN. KHCNN has been tested on two large datasets of rectangular plates and violin shells. Results show that it attains very good accuracy, with a gain in the NMSE of the estimated velocity field that can top 10 dB, with respect to state-of-the-art techniques. The same trend is observed if the normalized cross correlation is used as a metric.

Changes in ultra-processed food consumption during the first Italian lockdown following the COVID-19 pandemic and major correlates: results from two population-based cohorts.

OBJECTIVE: To evaluate changes in ultra-processed food (UPF) intake and its major correlates during the first Italian lockdown (9 March-3 May 2020). DESIGN: Retrospective observational study. SETTING: Italy. PARTICIPANTS: We analysed 2992 subjects (mean age 57·9 ± 15·3 years, 40·4 % men). Individual participant data were pooled from two retrospective cohorts: (1) The Moli-LOCK cohort consists of 1501 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 and (2) the Analysis of Long Term Risk of Covid-19 Emergency is a web-based survey of 1491 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 nineteen food items, with higher values indicating an increase in UPF during confinement. RESULTS: Overall, 37·5 % of the population reported some increase in UPF (UPF score ≥1). Adults were more likely to decrease UPF (multivariable regression coefficient ß = -1·94; 95 % CI -2·72, -1·17 for individuals aged >75 years as compared with 18-39 years) as did individuals from southern Italian regions as compared with Northern inhabitants (ß = -1·32; 95 % CI -1·80, -0·84), while UPF lowering associated with increased exercise (ß = -0·90; 95 % CI -1·46, -0·35) and weight loss (ß = -1·05; 95 % CI -1·51, -0·59) during confinement. CONCLUSIONS: 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.

The CASSIOPEA Study (Economic Crisis and Adherence to the Mediterranean diet: poSSIble impact on biOmarkers of inflammation and metabolic PhEnotypes in the cohort of the Moli-sAni Study): Rationale, design and characteristics of participants.

BACKGROUND AND AIMS: The CASSIOPEA Study was designed to evaluate whether the economic downturn during the late 2000s was a contributing factor to the observed decrease in adherence to Mediterranean diet (MD). METHODS AND RESULTS: The study protocol consists of two steps: A) recall of 7406 men and women who, between 2005 and 2006, had been randomly recruited in the Moli-sani Study from the general population of Molise, to assess possible economic hardship (EH) related to the economic crisis initiated in 2007; B) re-examination, between 2017 and 2020, of available subjects identified in Step 1 as poorly or harder hit by EH to test the hypothesis that EH is associated with a decrease in MD adherence, possibly resulting in increased inflammation. The results of Step 1 are reported here. From the initial sample of individuals re-examined after 12.6 years (median; IQR = 12.1-13.0 y), 3646 were finally analysed. An Economic Hardship Score (EHS; range 0-14) was obtained by scoring three domains: 1) change in employment status; 2) financial hardship and 3) financial hardship for health expenditures. Overall, 37.8% of the sample reported high EHS (≥3), whilst 32% scored 0 (no EH). Those with high EHS were prevalently women and younger, with low socioeconomic status. CONCLUSIONS: High economic hardship was prevalently reported by weaker socioeconomic groups. Longitudinal analysis (step 2) will examine whether the economic crisis had an effect on adherence to Mediterranean diet with consequent potential impact on inflammation, one of the main biological pathways linking MD to health outcomes. CLINICALTRIALS. GOV IDENTIFIER: NCT03119142.

Determinants of serum uric acid levels in an adult general population: results from the Moli-sani Study.

OBJECTIVES: High levels of serum uric acid (UA) are associated with cerebro-cardiovascular disease risk factors. This study aimed at evaluating the main determinants of serum UA levels in relation to biochemical, lifestyle, and clinical variables. METHODS: The study population included 15,594 participants (48% men, age ≥ 35 years) to the Moli-sani Study, for whom data on serum UA levels were available. Association of UA with dependent variables was investigated by multivariable linear regression analysis separately for men and women. RESULTS: Average serum UA levels were higher in men than in women (6.1 ± 1.3 vs 4.6 ± 1.2 mg/dL, respectively). Cystatin C, creatinine, albumin, triglycerides, body mass index (BMI), and diuretic therapy were the major determinants of the heterogeneity of UA levels. In women, the final model, resulting from the stepwise analysis, explained 41.6% of the UA variability. In particular, cystatin C explained 22.5% of UA variance, followed by BMI (7.2%), albumin (4.0%), and creatinine (1.9%). The final model in men fitted the data less than in women (total R2 = 29.1%), and creatinine was found to be the main determinant of UA levels (10.1%), followed by triglycerides (7.6%), BMI (3.7%), and albumin (2.0%). CONCLUSIONS: In a general adult population, the major determinants of serum UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics. Knowledge of its main determinants will be useful to better evaluate the relationship between UA levels and detrimental health outcomes and to clarify if an increase in uricemia is a marker or an independent risk factor. Key Points • Increased serum uric acid (UA) levels are reportedly associated with cardiovascular disease risk factors. • The major determinants of heterogeneity of UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics, in a general adult population. • Studying the main determinants associated with high levels of serum uric acid would help better understanding if uric acid is a marker or an independent cardiovascular risk factor.

COVID-19 lockdown and its latency in Northern Italy: seismic evidence and socio-economic interpretation.

The Italian Government has decreed a series of progressive restrictions to delay the COVID-19 pandemic diffusion in Italy since March 10, 2020, including limitation in individual mobility and the closure of social, cultural, economic and industrial activities. Here we show the lockdown effect in Northern Italy, the COVID-19 most affected area, as revealed by noise variation at seismic stations. The reaction to lockdown was slow and not homogeneous with spots of negligible noise reduction, especially in the first week. A fresh interpretation of seismic noise variations in terms of socio-economic indicators sheds new light on the lockdown efficacy pointing to the causes of such delay: the noise reduction is significant where non strategic activities prevails, while it is small or negligible where dense population and strategic activities are present. These results are crucial for the a posteriori interpretation of the pandemic diffusion and the efficacy of differently targeted political actions.

Site-selection criteria for the Einstein Telescope.

The Einstein Telescope (ET) is a proposed next-generation, underground gravitational-wave detector to be based in Europe. It will provide about an order of magnitude sensitivity increase with respect to the currently operating detectors and, also extend the observation band targeting frequencies as low as 3 Hz. One of the first decisions that needs to be made is about the future ET site following an in-depth site characterization. Site evaluation and selection is a complicated process, which takes into account science, financial, political, and socio-economic criteria. In this paper, we provide an overview of the site-selection criteria for ET, provide a formalism to evaluate the direct impact of environmental noise on ET sensitivity, and outline the necessary elements of a site-characterization campaign.

Alcohol consumption and hospitalization burden in an adult Italian population: prospective results from the Moli-sani study.

BACKGROUND AND AIMS: Epidemiological evidence on the impact of different alcohol drinking patterns on health-care systems or hospitalizations is sparse. We investigated how the different average volumes of alcohol consumed relate to all-cause and cause-specific hospitalizations. DESIGN: Prospective cohort study (baseline 2005-10) linked to a registry of hospital discharge records to identify hospitalizations at follow-up (December 2013). SETTING: Molise region, Italy. PARTICIPANTS: A total of 20 682 individuals (48% men, age ≥ 35 years) who participated in the Moli-sani Study and were free from cardiovascular disease or cancer at baseline. MEASUREMENTS: The alcohol volume consumed in the year before enrolment was classified as: life-time abstainers, former drinkers, occasional drinkers and current drinkers who drank 1-12 (referent), 12.1-24, 24.1-48 and > 48 g/day of alcohol. Cause-specific hospitalizations were assigned by Italian Diagnosis Related Groups classification or by ICD-9 code of main admission diagnoses. Incidence rate ratios (IRR) of hospitalization were estimated by Poisson regression, taking into account the total number of admissions that occurred during the follow-up per person. FINDINGS: During a median follow-up of 6.3 years, 12 996 multiple hospital admissions occurred. In multivariable analyses, life-time abstainers and former drinkers had higher rates of all-cause [IRR = 1.11, 95% confidence interval (CI) = 1.05-1.17 and IRR = 1.19, 95% CI = 1.02-1.31, respectively] and vascular (IRR = 1.14, 95% CI = 1.02-1.27 and IRR = 1.48, 95% CI = 1.24-1.76, respectively) hospitalizations compared with light alcohol consumers. Alcohol consumption > 48 g/day was associated with a higher rate of hospitalization for both alcohol-related diseases (IRR = 1.74, 95% CI = 1.32-2.29) and cancer (IRR = 1.36, 95% CI = 1.12-1.65). The magnitude of the association between heavier alcohol intake and hospitalization tended to be greater in smokers than non-smokers. No associations were observed with hospitalization for trauma or neurodegenerative diseases. CONCLUSIONS: Moderate alcohol consumption appears to have a modest but complex impact on global hospitalization burden. Heavier drinkers have a higher rate of hospitalization for all causes, including alcohol-related diseases and cancer, a risk that appears to be further magnified by concurrent smoking.

Moderate Alcohol Consumption Is Associated With Lower Risk for Heart Failure But Not Atrial Fibrillation.

OBJECTIVES: The aim of this study was to assess the hypothesis that alcohol consumption is associated with onset of atrial fibrillation (AF) and/or heart failure (HF). BACKGROUND: The connection between ethanol intake and AF or HF remains controversial. METHODS: The study population was 22,824 AF- or HF-free subjects (48% men, age ≥35 years) randomly recruited from the general population included in the Moli-sani study, for whom complete data on HF, AF, and alcohol consumption were available. The cohort was followed up to December 31, 2015, for a median of 8.2 years (183,912 person-years). Incident cases were identified through linkage to the Molise regional archive of hospital discharges. Hazard ratios were calculated using Cox proportional hazard models and cubic spline regression. RESULTS: A total of 943 incident cases of HF and 554 of AF were identified. In comparison with never drinkers, both former and occasional drinkers showed comparable risk for developing HF. Drinking alcohol in the range of 1 to 4 drinks/day was associated with a lower risk for HF, with a 22% maximum risk reduction at 20 g/day, independent of common confounders. In contrast, no association of alcohol consumption with onset of AF was observed. Very similar results were obtained after restriction of the analyses to regular or only wine drinkers or according to sex, age, social status, or adherence to the Mediterranean diet. CONCLUSIONS: Consumption of alcohol in moderation was associated with a lower incidence of HF but not with development of AF.

Postoperative atrial fibrillation and total dietary antioxidant capacity in patients undergoing cardiac surgery: The Polyphemus Observational Study.

OBJECTIVE: Postoperative atrial fibrillation is a major cause of morbidity and mortality for stroke after cardiac surgery. Both systemic inflammation and oxidative stress play a role in the initiation of postoperative atrial fibrillation after cardiac surgery. The possible association between long-term intake of antioxidant-rich foods and postoperative atrial fibrillation incidence was examined in patients undergoing cardiac surgery. METHODS: A total of 217 consecutive patients (74% were men; median age, 68.4 years) undergoing cardiac surgery, mainly coronary artery bypass grafting and valve replacement or repair, were recruited from January 2010 to September 2012. Total antioxidant capacity was measured in foods by the Trolox equivalent antioxidant capacity assay. The European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary total antioxidant capacity assessment. The association among tertiles of dietary total antioxidant capacity and postoperative atrial fibrillation incidence was assessed using multivariable logistic analysis. RESULTS: The overall incidence of total arrhythmias and postoperative atrial fibrillation was 42.4% and 38.2%, respectively. In multivariable analysis, after adjustment for age, gender, use of hypoglycemic drugs, physical activity, education, previous diagnosis of atrial fibrillation, and total energy intake, patients in the highest tertile of dietary total antioxidant capacity had a lower risk of postoperative atrial fibrillation than patients in the 2 lowest tertiles (odds ratio, 0.46; 95% confidence interval, 0.22-0.95; P = .048). A restricted cubic spline transformation confirmed the nonlinear relationship between total antioxidant capacity (in continuous scale) and postoperative atrial fibrillation (P = .023). When considering only coronary artery bypass grafting, valve replacement/repair, and combined surgeries, the protective effect on postoperative atrial fibrillation of a diet rich in antioxidants was confirmed. CONCLUSIONS: Long-term consumption of antioxidant-rich foods is associated with a reduced incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery.

Nutrition knowledge is associated with higher adherence to Mediterranean diet and lower prevalence of obesity. Results from the Moli-sani study.

A Mediterranean dietary pattern has been associated with reducing the risk of cardiovascular and chronic disease. The aim of this study was to evaluate the role of nutrition knowledge in determining possible differences among dietary patterns in a general population from a Mediterranean region. We conducted a cross-sectional study on a subsample of 744 subjects enrolled in the population-based cohort of the Moli-sani Project. A 92-item questionnaire on nutrition knowledge was elaborated, validated and administered. Dietary information were obtained from the EPIC food frequency questionnaire and adherence to a Mediterranean dietary pattern was evaluated both by the a priori Greek Mediterranean diet score and the a posteriori approach obtained by principal component analysis. Nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern. The odds of having higher adherence to a Mediterranean dietary pattern increased with greater nutrition knowledge. The odds ratio of being obese significantly decreased with increasing nutrition knowledge levels. The results showed that nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern and with lower prevalence of obesity in a Southern Italian region with Mediterranean diet tradition independently from education and other socioeconomic factors.

Association of D-dimer levels with all-cause mortality in a healthy adult population: findings from the MOLI-SANI study.

Elevated D-dimer levels are reportedly associated with higher risk of total mortality in patients with different diseases. We investigated whether a similar association could be found in a large, apparently healthy population. A large sample of individuals (N=17,359, 47% men, age ≥ 35 years) free of clinically recognized cardiovascular and cancer disease, for whom baseline D-dimer level was available, were studied within the MOLI-SANI cohort, randomly recruited from the general adult population of Southern Italy. The cohort was followed for a median of 4.2 years (73,807 person-years). D-dimer was measured in fresh citrated plasma by an automated latex-enhanced immunoassay. Hazard ratios were calculated using three Cox-proportional hazard models. Two hundred and eighty deaths were recorded. When modeled as a continuous variable, D-dimer level at baseline showed a non-linear association with mortality, whose incidence increased only in the upper quartile of the distribution (D-dimer ≥ 221 ng/mL). Thus, the group of individuals with D-dimer <221 ng/mL (75% of the population) acted as the reference group, while the remaining individuals were subdivided in tertiles and compared with the former group. Multivariable hazard ratios for mortality were 1.06, 1.45 and 1.97, respectively (P for trend <0.0001) across the three categories of increasing D-dimer concentration. The association was slightly attenuated, but still highly significant (P for trend 0.0002), after further adjustment for white blood cell count and C-reactive protein. In conclusion, Elevated D-dimer levels were independently associated with increased risk of death from any cause in an apparently healthy adult population.

Pandemic and seasonal vaccine coverage and effectiveness during the 2009-2010 pandemic influenza in an Italian adult population.

OBJECTIVES: To evaluate the response to pandemic vaccination and seasonal and pandemic vaccine effectiveness (VE) in an Italian adult population, during the 2009-2010 influenza season. METHODS: Data were recorded by interviewing 19,275 subjects (≥35 years), randomly recruited from the general population of the Moli-sani project. Events [influenza-like illness (ILI), hospitalization and death], which had occurred between 1 November 2009 and 31 January 2010 were considered. VE was analyzed by multivariable Poisson regression analysis. RESULTS: Pandemic vaccine coverage was very low (2.4%) in subjects at high-flu risk, aged 35-65 years (N = 8,048); there was no significant preventive effect of vaccine against ILI. Seasonal vaccine coverage was 26.6% in the whole population (63% in elderly and 21.9% in middle-aged subjects at high-flu risk). There was a higher risk to develop ILI in middle-age [VE: -17% (95% CI: -35,-1)] or at high flu-risk [VE: -17% (95% CI: -39, 2)] vaccinated groups. CONCLUSIONS: Coverage of pandemic vaccine was very low in a Southern Italy population, with no protective effect against ILI.

Distribution of short and lifetime risks for cardiovascular disease in Italians.

BACKGROUND: Guidelines for primary prevention recommend calculation of lifetime risk for cardiovascular disease (CVD) in addition to short-time risk. We aimed at evaluating the distribution of CVD lifetime risk and the percentage of Italians having low short-term, but high lifetime, risk. DESIGN: Cross-sectional general population-based cohort study. METHODS: We included 8,403 (46% men) cardiovascular disease-free individuals aged 35-50 years, among those randomly recruited in the framework of the MOLI-SANI cohort. Participants were stratified into three groups: low short-time (10-year) (≤3% and non diabetic)/low lifetime, low short-time/high lifetime, and high short-time risk. Short-time risk was evaluated by the equation provided by the Italian CUORE project. Lifetime risk was evaluated using the algorithm derived from the Framingham cohort. RESULTS: High short-time risk was prevalent in 16% population (32% of men and 2% of women). Among individuals with low short-time risk, 80% had high lifetime risk (82% men and 78% women). The proportion of individuals with very low lifetime risk due to all optimal risk factors was 4.1% only (1.5% men and 6.3% women). CONCLUSIONS: A large proportion of Italian adults not qualified for CVD primary prevention because of their very low short-time predicted CVD risk, are in fact at high risk to develop a CVD event in their lifetime; therefore population-based approaches should be sought to modify the overall distribution of individual risk factors. These findings offer helpful information for policy makers involved in contrasting the burden of CVD, especially in women and young men.

Mass media information and adherence to Mediterranean diet: results from the Moli-sani study.

OBJECTIVE: To investigate the association between mass media information, dietary habits and risk factors for cardiovascular disease in an Italian adult population. METHODS: Subsample of 1,132 subjects (mean age 53 ± 10, 50% men) enrolled in the Moli-sani Project, a population-based cohort study. A specific questionnaire on exposure to information from various media sources was elaborated, validated, and administered. A mass media exposure score was obtained from principal component analysis of ten items of media exposure. Dietary habits were assessed based on eating patterns obtained from principal component analysis of 45 food groups derived from the EPIC food frequency questionnaire and by the Mediterranean score. RESULTS: In a multivariable general linear regression analysis including age, sex, social status, physical activity, C-reactive protein, total calories intake, three dietary patterns or Mediterranean score, higher media exposure was positively associated with adherence to a Mediterranean-like eating pattern (P = 0.0018) as well as to the Mediterranean score (P = 0.0005). CONCLUSIONS: Exposure to mass media information is significantly associated with greater adherence to both Mediterranean diet and Mediterranean-like eating pattern, an association that public health strategies should take into account.

Adherence to Mediterranean diet and anthropometric and metabolic parameters in an observational study in the 'Alto Molise' region: the MOLI-SAL project.

BACKGROUND AND AIMS: The Mediterranean diet is reportedly a healthy eating pattern with protective effects on chronic diseases. The aim of this study was to assess the relationship between adherence to the Mediterranean diet and anthropometric and metabolic variables in a rural setting in southern Italy, in the context of a health screening initiative. METHODS AND RESULTS: Five hundred and twenty-two healthy participants from the "Alto Molise" region in southern Italy were studied. Blood pressure, glucose, and total cholesterol were measured using automatic devices. Food intake was evaluated with a semi-quantitative food-frequency questionnaire, and the Mediterranean adequacy index (MAI) was calculated. The median value of MAI in the population studied was 3.0 (1.5-5.4) in men and 2.4 (1.2-5.1) in women. In women, the stronger contributors to MAI were dairy products (42.5%), sweets (29.3%) and meat (19.4%), while in men they were cereals (39.1%), meat (18.6%), dairy products (16.9%) and sweets (16.1%). In multiple linear regression analysis MAI was positively associated with age in both sexes (P=0.0044 in men and P=0.0054 in women) and with systolic blood pressure in women (P=0.012). After stratification of women by age, systolic blood pressure was significantly associated with MAI only in older persons (P=0.040) but not at younger ages (interaction effect P<0.0001). CONCLUSIONS: Adherence to the Mediterranean diet depends on age, possibly because in younger people the traditional Mediterranean style diet is decreasing, even in rural areas of southern Italy. Age also influences the association between MAI and metabolic variables such as systolic blood pressure in women.