Objective: To characterize patient and provider perceptions of the impact of coronavirus disease 2019 (COVID-19) on weight loss following bariatric surgery.

Background: COVID-19 has disrupted routines and healthcare throughout the United States, but its impact on bariatric surgery patients' postoperative experience is unknown.

Methods: Semistructured interviews with bariatric surgery patients, primary care providers, and health psychologists were conducted from April to November 2020. As part of a secondary analysis, patients and providers described how the COVID-19 pandemic affected the postoperative experience within 3 domains: dietary habits, physical activity, and follow-up care. Interview guides were created from 2 conceptual models: Torain's Surgical Disparities Model and Andersen's Behavioral Model of Health Services Use. Study team members derived codes, which were grouped into themes using conventional content analysis.

Results: Thirty-four participants were interviewed: 24 patients (12 Roux-en-Y gastric bypass and 12 sleeve gastrectomy), 6 primary care providers, and 4 health psychologists. Patients were predominately female (83%) and White (79%). Providers were predominately female (90%) and White (100%). COVID-19 affected the postoperative bariatric surgery patient experience via 3 mechanisms: (1) it disrupted dietary and physical activity routines due to facility closures and fear of COVID-19 exposure; (2) it required patients to transition their follow-up care to telemedicine delivery; and (3) it increased stress due to financial and psychosocial challenges.

Conclusions: COVID-19 has exacerbated patient vulnerability. The pandemic is not over, thus bariatric surgery patients need ongoing support to access mental health professionals, develop new physical activity routines, and counteract increased food insecurity.

Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has affected nearly 600 million people to date across the world. While COVID-19 is primarily a respiratory illness, cardiac injury is also known to occur. Cardiovascular magnetic resonance (CMR) imaging is uniquely capable of characterizing myocardial tissue properties in-vivo, enabling insights into the pattern and degree of cardiac injury. The reported prevalence of myocardial involvement identified by CMR in the context of COVID-19 infection among previously hospitalized patients ranges from 26 to 60%. Variations in the reported prevalence of myocardial involvement may result from differing patient populations (e.g. differences in severity of illness) and the varying intervals between acute infection and CMR evaluation. Standardized methodologies in image acquisition, analysis, interpretation, and reporting of CMR abnormalities across would likely improve concordance between studies. This consensus document by the Society for Cardiovascular Magnetic Resonance (SCMR) provides recommendations on CMR imaging and reporting metrics towards the goal of improved standardization and uniform data acquisition and analytic approaches when performing CMR in patients with COVID-19 infection.

Mental well-being is associated with many mental health symptoms, including depression and health-related quality of life. Digital divide could impact mental health, particularly during the COVID-19 pandemic. Information and communication technology (ICT)-based tools and interventions could effectively provide social support. Intergenerational mentoring between college students and older adults could promote eHealth literacy and self-efficacy, and it is advocated to bridge the digital divide for older adults. However, the effectiveness of an intervention which employs ICT-based tools and intergenerational mentoring strategies (i.e. Digital Buddy) on mental well-being is unclear. This study will employ a multi-centre, cluster-randomized, two-parallel-group, noninferiority, controlled trial design with a 1:1 group allocation ratio. In the intervention group, a Digital Buddy (i.e. a young volunteer) is assigned to a group of older adults in a 1:10 ratio. A series of training sessions for a minimum of 23 h will be provided to the older adults by Digital Buddy, who will also follow through the intervention period with the older participants. The training contents include ICT and mental health care knowledge and skills. The whole intervention period will last for 6 months between 14 sessions. In the control group, participants will receive the usual care. The primary outcome measure is mental well-being. We aim to recruit 292 older participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention. This trial has been registered at ClinicalTrials.gov (NCT05553730) on 23 September 2022, https://clinicaltrials.gov/ct2/show/NCT05553730 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022143). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields.

Objective
The primary objective of this observational study was to analyze the time to the first edge-of-bed (EOB) mobilization in adults who were critically ill with severe versus non-severe COVID-19 pneumonia. Secondary objectives included the description of early rehabilitation interventions and physical therapy delivery.

Methods
All adults with laboratory-confirmed COVID-19 requiring intensive care unit admission for ≥72 hours were included and divided according to their lowest PaO2/FiO2 ratio into severe (≤100 mmHg) or non-severe (>100 mmHg) COVID-19 pneumonia. Early rehabilitation interventions consisted of in-bed activities, EOB or out-of-bed mobilizations, standing, and walking. The Kaplan–Meier estimate and logistic regression were used to investigate the primary outcome time-to-EOB and factors associated with delayed mobilization.

Results
Among the 168 patients included in the study (mean age = 63 y [SD = 12 y]; Sequential Organ Failure Assessment = 11 [interquartile range = 9–14]), 77 (46%) were classified as non-severe, and 91 (54%) were classified as severe COVID-19 pneumonia. Median time-to-EOB was 3.9 days (95% CI = 2.3–5.5) with significant differences between subgroups (non-severe = 2.5 days [95% CI = 1.8–3.5]; severe = 7.2 days [95% CI = 5.7–8.8]). Extracorporeal membrane oxygenation use and high Sequential Organ Failure Assessment scores (adjusted effect = 13.7 days [95% CI = 10.1–17.4] and 0.3 days [95% CI = 0.1–0.6]) were significantly associated with delayed EOB mobilization. Physical therapy started within a median of 1.0 days (95% CI = 0.9–1.2) without subgroup differences.

Conclusion
This study shows that early rehabilitation and physical therapy within the recommended 72 hours during the COVID-19 pandemic could be maintained regardless of disease severity. In this cohort, the median time-to-EOB was fewer than 4 days, with disease severity and advanced organ support significantly delaying the time-to-EOB.

Impact
Early rehabilitation in the intensive care unit could be sustained in adults who are critically ill with COVID-19 pneumonia and can be implemented with existing protocols. Screening based on the PaO2/FiO2 ratio might reveal patients at risk and increased need for physical therapy.

Objectives
The impact of long COVID among persons hospitalized and discharged home is unknown. We aimed to (1) report the prevalence of long COVID in persons hospitalized for COVID-19 and discharged home; (2) estimate the prevalence of physical, sensory, and psychological/mental health impairments; and (3) explore associated factors.

Methods
We conducted a telephone survey of adult residents in Laval, Quebec, who were discharged home ≥ 2 months post-hospitalization for COVID-19. Participants responded to a standard questionnaire regarding persistent symptoms. We calculated the prevalence of long COVID and of persistent types of symptoms and evaluated associated factors using bivariate analysis and multivariable logistic regression.

Results
In our sample (n = 398), 70% reported physical symptoms, 58% psychological problems, and 16% sensory impairments. 31.5% reported being troubled by persistent symptoms (long COVID). Factors associated with long COVID were a greater number of symptoms (odds ratio (OR) = 1.97, 95% confidence interval (CI) = 1.69–2.28) and increased hospital stay (OR = 1.03, 95% CI = 1.01–1.06). Other factors associated with physical and psychological symptoms were female sex (OR = 2.17, 95% CI = 1.27–3.71 and OR = 2.06, 95% CI = 1.25–3.39; respectively), higher education level (OR = 2.10, 95% CI = 1.20–3.68 and OR = 2.43, 95% CI = 1.44–4.14; respectively), and obesity (OR = 1.95, 95% CI = 1.15–3.34 and OR = 1.70, 95% CI = 1.05–2.77; respectively).

Conclusion
In this population-based study of persons hospitalized for COVID-19 and discharged home, nearly one third were troubled by symptoms for 2 months or more post-discharge. There was a high proportion with persistent physical and psychological/mental health symptoms. Further research will assess the specific needs of these patients to inform health policy makers on service requirements for these persons.

Objective
The objective of this systematic review was to identify the health impact of COVID-19 on mortality, morbidity, hospital admission, and hospital readmission rates in the Black population across Canada.

Methods
A comprehensive search strategy consisting of relevant subject headings and keywords was executed in five databases: OVID Medline, OVID Embase, EBSCO CINAHL Plus, Web of Science, and Scopus. Additional searches were conducted for gray literature in ProQuest Dissertations and Theses Global, Google Scholar, and an advanced customized Google search for Canadian government documents. All eligible studies included in this review underwent quality assessment.

Results
Clinical health outcomes identified included mortality, morbidity, and hospital admission rates; none of the studies reported hospital readmission rates. The search identified 616 citations, and following the removal of duplicates and screening according to our inclusion/exclusion criteria, four articles were eligible for inclusion in the review. All of these studies were conducted in Canada. Study dates ranged from 2020 to 2021.

Conclusion
A systematic review of studies on the impact of COVID-19 on the Black population in Canada highlights two key points. First, the collection and availability of race-based data are necessary to clarify the impact of COVID-19 and other diseases on Black populations in Canada. Second, with the limited available data, studies suggest that COVID-19 disproportionately impacts Black populations in Canada, making up high shares of cases, deaths, and hospitalizations compared to most of the population.

Objective
Alcohol use is a known risk factor for suicidality, yet this relationship has not been explored during the pandemic in Canada. As a growing body of evidence demonstrates the negative impact of COVID-19 on alcohol consumption and associated harms in Canada, there is a need to examine this more closely.

Methods
Using the Survey on COVID-19 and Mental Health 2020, we compared the prevalence of suicide ideation among: (1) individuals who reported an increase in alcohol consumption vs those who reported a decrease/no change, and (2) individuals who reported past month heavy episodic drinking vs those who did not. We compared overall unadjusted odds ratios and across a number of sociodemographic and mental health variables. All estimates were weighted to ensure they were nationally representative.

Results
The prevalence and likelihood of suicide ideation were significantly higher among people who reported increased alcohol consumption during the pandemic (4.9% vs 2.0%; OR = 2.6, 95% CI: 1.8, 3.7) and people who reported past month heavy episodic drinking (3.4% vs 2.1%; OR = 1.7, 95% CI: 1.2, 2.3). Males and middle-aged and older-aged individuals had the highest odds ratios for increased alcohol consumption and past month heavy episodic drinking with suicide ideation.

Conclusion
In the Canadian general population during the COVID-19 pandemic, there were significant associations between suicide ideation and increased alcohol use as well as past month heavy episodic drinking across specific sociodemographic subgroups. Future research could explore these associations while adjusting for social determinants of health such as income security, employment, education, social support, stress, and mental health.

Open Access

Even though knowledge about the impact of the pandemic on mental health is still very limited in all countries and is largely based on experiences only partially comparable to the current epidemic, such as those of the SARS or Ebola epidemics, it is likely that the need for intervention will increase significantly in the coming months and years. Scientific research in neuroscience is a growing field. It offers a novel perspective on the relationship between mind and brain and provides novel scenarios for understanding the long wave of the current pandemic. Furthermore, the pandemic has also led to the possibility of implementing remote monitoring and management interventions. This volume uses multidisciplinary approaches to physiological and cognitive mechanisms, medical treatment, psychosocial interventions, and self-management to help illustrate the complex association among the COVID-19 pandemic, neurological manifestations, mental health, and society.

Lorsqu’une éclosion de cas de COVID-19 est suspectée ou confirmée dans une installation ou sur une unité de soins, la rapidité d’intervention permet d’évaluer le potentiel de transmission, la gravité de la situation et d’instaurer les mesures requises afin de limiter l’ampleur de la transmission.

Ce document fournit les recommandations et les différentes modalités concernant les dépistages et les mesures de PCI à mettre en place chez les travailleurs de la santé (TdeS) et les usagers lors d’une éclosion de COVID-19 dans tous les milieux de soins visés.

Les milieux de soins visés par ce document sont :

Milieux de soins de courte durée (unités de soins et urgence).
Installations de santé mentale, unités de soins en santé mentale en milieu hospitalier et urgences psychiatriques.
Installations de réadaptation (déficience physique, santé physique et mentale), ainsi que les autres milieux de soins ou de vie en réadaptation physique, déficience intellectuelle et trouble du spectre de l'autisme.
Centres d’hébergement et de soins de longue durée (CHSLD.
Certains autres milieux de vie comportent des unités de soins qui s’apparentent à des soins de longue durée (ex. : RPA, RI, RTF). Il convient alors pour ces unités d’appliquer ces recommandations.
Les dépistages recommandés dans ce document ont pour but de rechercher la source d’une éclosion et de déterminer s’il y a eu transmission dans le milieu de soins. Ce document doit être utilisé en complémentarité avec le document SRAS-CoV-2 : Gestion des travailleurs de la santé en milieux de soins afin de déterminer les mesures à mettre en place pour les TdeS ayant eu un bris dans le port de l’équipement de protection individuelle (ÉPI).

Ce document doit être consulté de façon complémentaire aux autres documents sur la COVID-19 produits par l’Institut national de santé publique du Québec (INSPQ).

Background: Severe acute respiratory syndrome coronavirus 2 is the virus that causes a massive pandemic of the decade and has brought more than 215 million infections and nearly 4.5 million deaths worldwide as of August 2021. In addition, survivors of COVID-19 patients suffer from acute, chronic, and persistent lung problems and pulmonary fibrosis, which is the sequel of future morbidity and mortality.

Method: Electronic databases searched were PubMed, Cochrane Library, Google Scholar, HINARI, Web of Science, and direct Google search. For publication bias, a funnel plot and the Egger regression test were used. The I2 statistic was used to check the heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. Subgroup analysis was done by using publication year and mean sample size. For the effect of a single study on the overall estimation, sensitivity analysis was deployed. STATA version 14 software using the random-effects model was used to conduct all statistical analyses.

Result: The study included 9 studies with a total sample size of 1241. The overall pooled prevalence of pulmonary fibrosis among post-COVID follow-up patients was found to be 54.04% (95% confidence interval, 40.54%-67.54%).

Conclusions: The overall pooled prevalence of pulmonary fibrosis among post-COVID-19 follow-up patients was higher in magnitude and recognized as a potential sequela among survivors. Because of exaggerated viral and immune response, further searching for better diagnostic and efficacious treatment strategies is recommended.

Background
Enteral nutrition is essential to improve outcomes in patients who are critically ill. Patients in the prone position, including those diagnosed with coronavirus disease 2019 (COVID-19) present additional challenges for enteral nutrition initiation.

Methods
A novel technique for placing feeding tubes while in the prone position was developed using an electromagnetic placement device and specialty trained clinical nurse specialists. Data were assessed retrospectively to determine effectiveness of this new practice.

Results
Sixty-eight patients had feeding tubes placed while in the prone position; 75% were able to be placed through the postpyloric route, 22% were placed through the gastric route, and 3% unable to be placed. Use of this technique facilitated earlier initiation of feedings by 2 days from time of admission and almost half a day from intubation to feeding. There was no additional radiation exposure from using this technique.

Conclusion
Ability to place feeding tubes early while patients were prone reduced delays for starting enteral nutrition. Patients with COVID-19 in the prone position were able to receive effective nutrition support earlier with no additional complications.

Ce document présente les recommandations de prévention et contrôle des infections (PCI) particulières à appliquer pour l’évaluation et la prise en charge des usagers dialysés spécifiquement dans les unités ambulatoires d’hémodialyse (cliniques ambulatoires en milieu de soins de courte durée ou autres, cliniques mobiles ou autres unités de dialyse non traditionnelles) et ce, peu importe leur provenance. Une évaluation des risques et des bénéfices devra être réalisée par le service d’hémodialyse et le service de PCI pour déterminer les mesures à instaurer. Ces mesures peuvent être ajustées à l’aide des autres documents disponibles, tels que SRAS-CoV-2 : Mesures de prévention et contrôle des infections en milieux en présence d’un cas suspecté ou un cas de COVID-19 de courte durée, de longue durée, de réadaptation et de santé mentale et SRAS-CoV-2 : Principes généraux de prévention et contrôle des infections en période de circulation du SRAS-CoV-2.

Ces recommandations sont basées sur les connaissances scientifiques actuelles, les recommandations de nombreuses organisations (voir section Méthodologie) et sont révisées de façon continue. Certaines recommandations découlent également d’un consensus des experts du CINQ. Plus globalement, la démarche s'inscrit dans un processus de gestion de risque visant à optimiser l'utilisation des ressources disponibles, et ce, tout en assurant la sécurité de la population.

La prévention de l’introduction du virus SRAS-CoV-2, l’identification rapide d’un usager ou d’un travailleur de la santé (TdeS) pouvant être infecté et l’application de mesures de prévention et de contrôle des infections appropriées sont essentielles pour diminuer la transmission possible du microorganisme dans l’installation.

Ce document doit être consulté de façon complémentaire aux autres documents sur la COVID-19 produits par l’Institut national de santé publique du Québec (INSPQ).

Demandé l'article à bibliotheques.cissslan@ssss.gouv.qc.ca

BACKGROUND
Nirmatrelvir–ritonavir has been authorized for emergency use by many countries for the treatment of coronavirus disease 2019 (Covid-19). However, the supply falls short of the global demand, which creates a need for more options. VV116 is an oral antiviral agent with potent activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS
We conducted a phase 3, noninferiority, observer-blinded, randomized trial during the outbreak caused by the B.1.1.529 (omicron) variant of SARS-CoV-2. Symptomatic adults with mild-to-moderate Covid-19 with a high risk of progression were assigned to receive a 5-day course of either VV116 or nirmatrelvir–ritonavir. The primary end point was the time to sustained clinical recovery through day 28. Sustained clinical recovery was defined as the alleviation of all Covid-19–related target symptoms to a total score of 0 or 1 for the sum of each symptom (on a scale from 0 to 3, with higher scores indicating greater severity; total scores on the 11-item scale range from 0 to 33) for 2 consecutive days. A lower boundary of the two-sided 95% confidence interval for the hazard ratio of more than 0.8 was considered to indicate noninferiority (with a hazard ratio of >1 indicating a shorter time to sustained clinical recovery with VV116 than with nirmatrelvir–ritonavir).

RESULTS
A total of 822 participants underwent randomization, and 771 received VV116 (384 participants) or nirmatrelvir–ritonavir (387 participants). The noninferiority of VV116 to nirmatrelvir–ritonavir with respect to the time to sustained clinical recovery was established in the primary analysis (hazard ratio, 1.17; 95% confidence interval [CI], 1.01 to 1.35) and was maintained in the final analysis (median, 4 days with VV116 and 5 days with nirmatrelvir–ritonavir; hazard ratio, 1.17; 95% CI, 1.02 to 1.36). In the final analysis, the time to sustained symptom resolution (score of 0 for each of the 11 Covid-19–related target symptoms for 2 consecutive days) and to a first negative SARS-CoV-2 test did not differ substantially between the two groups. No participants in either group had died or had had progression to severe Covid-19 by day 28. The incidence of adverse events was lower in the VV116 group than in the nirmatrelvir–ritonavir group (67.4% vs. 77.3%).

CONCLUSIONS
Among adults with mild-to-moderate Covid-19 who were at risk for progression, VV116 was noninferior to nirmatrelvir–ritonavir with respect to the time to sustained clinical recovery, with fewer safety concerns. (Funded by Vigonvita Life Sciences and others; ClinicalTrials.gov number, NCT05341609. opens in new tab; Chinese Clinical Trial Registry number, ChiCTR2200057856.)

Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are closely monitored in people with cystic fibrosis (pwCF), especially severe cases. Previous studies used hospitalization rates as proxy for severity.

Methods
We evaluated data from coronavirus disease 2019 (COVID-19) cases diagnosed in French pwCF over the first pandemic year. Objective criteria were applied for defining severity (eg, respiratory failure and/or death). Data were compared to all French pwCF using the National Registry.

Results
As of 30 April 2021, 223 pwCF were diagnosed with COVID-19, with higher risks in adults (odds ratio [OR], 2.52 [95% confidence interval {CI}, 1.82−3.48]) and transplant recipients (OR, 2.68 [95% CI, 1.98–3.63]). Sixty (26.9%) patients were hospitalized, with increased risk in transplant recipients (OR, 4.74 [95% CI, 2.49–9.02]). In 34 (15%) cases, COVID-19 was considered severe; 28 (46.7%) hospitalizations occurred without objective criteria of severity. Severe cases occurred mostly in adult (85.3%) and posttransplant pwCF (61.8%; OR, 6.02 [95% CI, 2.77–13.06]). In nontransplanted pwCF, risk factors for severity included low lung function (median percentage of predicted forced expiratory volume in 1 second, 54.6% vs 75.1%; OR, 1.04 [95% CI, 1.01–1.08]) and CF-related diabetes (OR, 3.26 [95% CI, 1.02–10.4]). While 204 cases fully recovered, 16 were followed for possible sequelae, and 3 posttransplant females died.

Conclusions
Severe COVID-19 occurred infrequently during the first pandemic year in French pwCF. Nontransplanted adults with severe respiratory disease or diabetes and posttransplant individuals were at risk for severe COVID-19. Thus, specific preventive measures should be proposed.

Care of the newborn infant is a critical skill for general pediatricians and other providers in the practice of pediatric medicine. Optimal care relies on a thorough understanding of risk factors that may be present during the pregnancy and delivery, as well as the ability to recognize and address unanticipated problems in the postnatal period. This article focuses on antenatal care of the newborn, issues that present in the immediate postdelivery period, and care of the newborn after discharge. It also includes updated information on current topics in pediatric practice, such as the importance of vaccination, parental hesitancy in accepting common medical interventions, and updated guidelines related to the coronavirus disease 2019 pandemic. At the conclusion of the article, the reader should have a general understanding of antenatal risk factors that could affect the transition from the intrauterine environment and have the knowledge to address common issues that arise in the care of newborn infants.

Objective: During the COVID-19 pandemic, caregivers who are facing high stress levels and decreased emotional well-being may parent their children differently. Certain children are experiencing greater fear in response to COVID-19, and research is needed to identify parenting behaviors significantly linked with children's COVID-19 fear. The purpose of this article was to evaluate whether the association between parenting stress and children's COVID-19 fear could be explained by parents' COVID-19 information management and emotional well-being.

Methods: Participants were recruited through Amazon Mechanical Turk. The sample consisted of 595 caregivers of children during the COVID-19 pandemic; 40.0% men, 69.2% non-Latinx White, 12.1% Black, 10.1% Latinx, 6.6% Asian, and <2% others. Children had an average age of 11.3 years. Parents completed self-report measures.

Results: The bootstrapped confidence interval (0.040, 0.148) for the indirect effect (0.090) revealed that parent emotional well-being significantly mediated the relation between parenting stress and children's COVID-19 fear. In addition, parent management of children's COVID-19 knowledge significantly mediated the relation between parenting stress and children's COVID-19 fear.

Conclusion: We found that the combined effect of parents' emotional well-being and parents' management of children's COVID-19 knowledge significantly mediated the positive relation between parenting stress and children's COVID-19 fear. Based on our findings, once parents' parenting stress is decreased and their well-being increases, parents may be more likely to provide children with developmentally appropriate and accurate COVID-19 information.

Une étude de la portée a été menée pour recenser les modèles, les effets et les interventions visant à lutter contre l’isolement social et la solitude de personnes âgées vivant dans la communauté pendant la pandémie de COVID-19. Cette étude a aussi intégré : 1) les données de l’Étude longitudinale canadienne sur le vieillissement (ÉLCV) et 2) une analyse de la littérature grise canadienne sur des interventions réalisées au cours de la pandémie. Les données de l’ÉLCV ont permis de mettre en évidence des augmentations relatives estimées de la solitude allant de 33 % à 67 % selon le groupe d’âge ou le sexe. Des études internationales ont également rapporté un accroissement des niveaux de solitude pendant la pandémie, ainsi que de fortes associations entre la solitude et la dépression. Les études recensées ont principalement mis l’accent sur l’utilisation d’interventions basées sur la technologie pour réduire l’isolement social et la solitude. L’application de modèles socioécologiques et de résilience suggère que les chercheurs auraient avantage à explorer un éventail plus large d’interventions potentielles adaptées aux personnes âgées (p. ex. activités de plein air, programmes intergénérationnels et autres interventions de proximité) et d’approches fondées sur les forces (p. ex. renforcement des capacités de la communauté et du système) qui pourraient contribuer à la réduction de l’isolement social et de la solitude.

Purpose of review: Chronic noncommunicable diseases remain the leading cause of morbidity and mortality worldwide and the majority are preventable with a healthy diet and lifestyle, but controversy remains as to the best approach. Greater adherence to a traditional Mediterranean diet has consistently been associated with lower morbidity and mortality from cardiovascular disease, diabetes and many cancers, and lower all-cause mortality. Despite the well known benefits on chronic disease risk there remains some scepticism as to the effects of this dietary pattern across populations outside the Mediterranean and the mechanisms of action of this traditional plant-based dietary pattern.

This narrative review aims to summarize the latest evidence on the health protective effects of a traditional Mediterranean diet on chronic noncommunicable diseases, specifically focussing on the anti-inflammatory effects of this highly published dietary pattern.

Recent findings: Recent high-quality evidence now supports a Mediterranean diet in secondary prevention of cardiovascular disease with impacts on atherosclerosis progression, likely through reduction of systemic inflammation and irrespective of changes in cholesterol or weight. The Mediterranean diet has a low Dietary Inflammatory Index illustrating its anti-inflammatory potential. This dietary pattern beneficially modulates the gut microbiota and immune system, including emerging evidence for efficacy against severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019). Emerging evidence shows clinicians are not routinely recommending a Mediterranean diet despite well known evidence due to barriers such as lack of training, patient materials and concerns about potential patient adherence.

Summary: The physiological mechanisms of action of this healthy diet pattern are becoming better understood to be multisystem and involving the gut. Larger controlled trials investigating mechanistic effects in broader non-Mediterranean populations are warranted. Although reflected in therapeutic guidelines for chronic disease management worldwide there are individual, clinical practice and health system barriers to its implementation that need a multisectoral approach to address.