Giuseppina Augimeri

Breast cancer is a heterogeneous disease driven by complex interactions between genetic, hormonal, metabolic, lifestyle, and environmental factors. Among environmental exposures, agricultural pesticides represent potential contributors to breast carcinogenesis through endocrine-disrupting, oxidative, genotoxic, and epigenetic mechanisms. Utilizing a structured search strategy across PubMed, Scopus, and Web of Science, this review provides a critical synthesis of current evidence linking major pesticide classes with breast cancer dynamics, strictly distinguishing preclinical mechanistic findings from human epidemiological data. Special attention is given to endocrine-disrupting pathways involving estrogen receptors and aromatase hyper-induction, alongside oxidative stress, matrix metalloproteinase activation, epithelial–mesenchymal transition, cancer stemness expansion, and therapeutic resistance. We further evaluate the cytoprotective potential and severe bioavailability bottlenecks of dietary phytochemicals in mitigating pesticide-induced damage. Finally, we address critical methodological limitations, such as exposure misclassification, confounding factors, and the gap between micromolar in vitro doses and realistic nanomolar human exposures, stressing that preclinical mechanisms cannot prove direct clinical causality Therefore, integrating prospective multi-omics biomonitoring with cumulative cocktail risk assessments is essential for evidence-based primary prevention.

The Mediterranean Diet pattern is characterized by high intake of plant-based foods rich in bioactive nutrients, including carotenoids. This review examines the major dietary carotenoids and xanthophylls characteristic of the Mediterranean food matrix, focusing on their structural diversity, plant biosynthesis, release from the food matrix, bioavailability, and biological redox-modulating activities. The literature was collected from PubMed, Web of Science, and Scopus to trace the pathway of carotenoids from their accumulation in plant tissues to their potential effects on human health. Culinary processing and the concomitant intake of dietary lipids can enhance carotenoid bioaccessibility by promoting isomerization and facilitating the formation of mixed micelles during digestion. In addition to systemic absorption, noninvasive diagnostic tools, including skin carotenoid measurements by reflectance spectroscopy and macular pigment optical density, provide useful biomarkers of fruit and vegetable intake. Carotenoids may contribute to systemic antioxidant and redox regulation by quenching singlet oxygen, scavenging free radicals, and modulating redox-sensitive signaling pathways. Overall, their structural diversity, food-matrix interactions, bioaccessibility, and biological activities support continued investigation of carotenoid-rich foods within the Mediterranean dietary pattern and their associations with human health outcomes.

Background: Eating behaviors and psychological processes related to food consumption are increasingly recognized as key factors of successful adherence to a healthy dietary pattern. In this context, mindful eating and adherence to the Mediterranean Diet have emerged as models promoting beneficial health outcomes, whereas orthorexia nervosa, characterized by an obsessive focus on eating healthy foods, often leads to dietary inadequacies. Here, we investigated the association among mindful eating, adherence to the Mediterranean Diet, orthorexia nervosa and BMI in a cohort of university students. Methods: A sample of 518 Italian university students completed an online survey assessing general and sociodemographic characteristics, the adherence to the Mediterranean Diet pattern by MEDAS and MEDLIFE, the orthorexia tendency by ORTO-15 test and the degree of mindful eating by the Mind-Eat Scale. Students’ t-test, chi-square test, Pearson’s correlation, and K-means cluster analysis were used for analyses. Results: The participants had a mean BMI of 23.08 ± 3.51, with 69% normal-weight and 25% overweight/obese individuals, showing statistically significant sex differences. Mean Mind-Eat, MEDAS, MEDLIFE and ORTO-15 scores were 3.22 ± 0.46, 8.81 ± 2.35, 3.06 ± 1.14 and 38.31 ± 5.94, respectively. Men scored significantly higher than women in all categories, except for the MEDAS score, where no sex-related differences were observed. Interestingly, the Mind-Eat score was positively associated with ORTO-15 (r = 0.24, p < 0.0001), MEDAS (r = 0.23, p < 0.0001), and MEDLIFE (r = 0.11, p = 0.01) scores. Three clusters were derived, distinguishing optimal (cluster 2), intermediate (cluster 1) and poor (cluster 3) eating profiles, showing sex differences. BMI was significantly lower in cluster 2 than in cluster 3. Conclusions: Our results suggest that integrating psychological and dietary indicators of eating behavior may help identify young adults with less favorable weight-related profiles.

Background/Objectives: The increasing prevalence of overweight and obesity in adolescents represents a major global health concern. Adolescent weight gain frequently shows additional metabolic risk factors, including insulin resistance, hypertension, and dyslipidemia, whose co-occurrence defines the metabolic syndrome (MetS). Adherence to a healthy dietary pattern, such as the Mediterranean Diet (MD), has been shown to reduce the metabolic risk among adolescents. Skin carotenoid score has emerged as an objective and non-invasive indicator of MD adherence; however, its relationship with a cluster of metabolic parameters which characterize the MetS, including the triglyceride levels, diastolic blood pressure, and waist circumference, remains poorly explored. Here, we investigated the role of skin carotenoid score as an early biomarker of metabolic syndrome risk in adolescents. Methods: A sample of 634 healthy adolescents underwent anthropometric and clinical measurements, blood sample collection, and evaluation of the MD adherence by the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) questionnaire and the skin carotenoid levels by the Veggie Meter^®. Student’s t-test, chi-square test, Pearson correlation, and the multivariable linear regression model were used for analyses. Results: Participants had a mean BMI Z-score of 0.02 ± 1.01; the metabolic serum profile and the cardiovascular parameters were within the normal range. Mean KIDMED and skin carotenoid scores were 5.21 ± 2.56 and 357 ± 96.58, respectively. Skin carotenoids were positively associated with height (p = 0.02), while they were inversely associated with weight (p = 0.008), BMI Z-score (p < 0.0001), diastolic blood pressure (p = 0.013), and triglycerides (p = 0.003). Moreover, the carotenoid score was positively associated with male gender and KIDMED score and negatively associated with waist circumference and triglyceride levels in multivariable regression analyses. Conclusions: Our results suggested the potential application of skin carotenoid score as a complementary biomarker for the early identification of adolescents at increased metabolic risk.

Childhood obesity represents a public concern worldwide. Evidence indicates that fruits and vegetables (FV) consumed as part of the daily diet reduce the global burden of obesity. Indeed, FV are rich in bioactive compounds, including carotenoids, which exert health benefits as very potent natural antioxidants. Here, we compared the anthropometric characteristics and the skin carotenoid content between two schoolchildren populations from Southern and Central Italy to evaluate their dietary habits. A sample of 121 and 124 schoolchildren from primary schools in Central and Southern Italy, respectively, was recruited. All participants underwent anthropometric measurements and assessment of the adherence to the Mediterranean Diet (MD) by the KIDMED questionnaire and the skin carotenoid score by Veggie Meter^®. The mean body mass index (BMI) was significantly lower in participants from Central Italy than in those from Southern Italy. A significantly higher percentage of overweight and obesity was found in the overall sample from Southern than in Central Italy. The adherence to the MD was in the average range for both populations, with no gender-related differences. The carotenoid score was higher and negatively correlated with BMI in the schoolchildren from Central Italy. In multiple regression analyses, skin carotenoids were positively associated with the consumption of fruit in the entire sample. This study suggests the importance of increasing FV intake, particularly in Southern Italy, as a strategy for preventingof obesity during the whole lifespan. Further studies are essential to better understand the influence of skin carotenoids on different variables and their potential role as indicators of health status in children.

Background/Objectives: Orthorexia nervosa (ON) is characterized by an obsession with rigid dietary rules, which leads to an emphasis being placed on food purity and health. Exploring the prevalence rates and understanding the potential risk factors associated with ON is essential for developing effective prevention and intervention strategies. This study investigated the prevalence of ON and examined different variables in associations to enhance our knowledge of their impact on ON tendency. Methods: A sample of 500 participants, including 357 women and 143 men, aged between 20 and 60, from an Italian university community was recruited to complete an online survey assessing ON, using the 15-item self-report measure ORTO-15, and Mediterranean diet adherence and lifestyle habits using the Mediterranean Diet Adherence Screener (MEDAS) and the Mediterranean Lifestyle Index (MEDLIFE) questionnaires, respectively. Student’s t-test, ANOVA, chi-squared test, and multiple linear regressions were used for analyses. Results: We found that MEDAS and MEDLIFE scores were statistically higher in males than in females, while the ORTO-15 score was significantly lower in females than in males. In the total, ON prevalence was 19.8% (women = 16.08% and men = 21.28%). Multiple regression analyses on the ORTO-15 score and different variables showed that in our population sample, ON was associated with female sex (β = −2.98; p = 4 × 10⁻⁶) and the body mass index (BMI) (β = −0.41; p = 6.71 × 10⁻⁷). When adjusting for sex and the BMI, the resulting ORTO-15 score was associated with health science faculty attendance (β = 1.26, p = 0.003), following a food plan (β = −3.14; p = 1 × 10⁻⁷) and carrying out physical activity (β = −1.20; p = 0.03). Conclusions: This study identified the importance of several factors for ON focusing on lifestyle habits that clinicians should consider when assessing patients at risk for eating disorders. Further studies are warranted to better define the diagnostic criteria of ON and develop effective prevention and intervention strategies to promote a healthy relationship with food.

The Mediterranean Diet (MD) is characterized by a high intake of fruits and vegetables (FVs), which is considered as an important contributor to the beneficial effects of the MD pattern. In this cross-sectional study, we compared the food choices, evaluated by dietary habit questionnaires, of a sample of 995 adults, including 601 and 394 participants from Southern Italy and the Dominican Republic, respectively. In addition, we focused on their FV consumption, assessed by the Mediterranean Diet Adherence Screener (MEDAS) questionnaire, and on its association with skin carotenoid levels as measured by the Veggie Meter^®. We found that a significantly higher percentage of Italians had five meals/day and breakfast compared to Dominicans (five meals/day: 43 vs. 25, p < 0.05; breakfast: 89 vs. 79, p < 0.05), whereas a lower percentage of participants from Italy consumed snacks between the two meals compared to the Dominican Republic population (47 vs. 70, p < 0.005). Most of the participants from both populations had breakfast at home. However, 59.3% of Italians and 27.5% of Dominicans (p = 0.005) had breakfast between 7:00 and 9:00 a.m., whereas 5.8% and 27.5% (p = 0.001) had breakfast after 9:00 a.m., respectively. Milk/yogurt and eggs were the most consumed foods for breakfast in Italy and the Dominican Republic, respectively. Regarding the main meals, most of the Italians and Dominicans had a first course for lunch and a second course for dinner. Of note, we observed that approximately half of the Italians ate FVs in their main meals and had a higher carotenoid score than the Dominicans. Interestingly, in the multiple linear regression analysis, we found that the carotenoid score was positively associated with sex (β = 0.078; p = 0.009), age (β = 0.008; p = 0.001), vegetable consumption (β = 0.12; p = 0.041) and the perception of a healthy diet (β = 0.12; p = 0.001) in the Dominic Republic population, while the carotenoid score was directly associated with sex (β = 54.97; p < 0.0001) and both vegetable (β = 25.42; p = 0.0008) and fruit (β = 38.61; p < 0.0001) consumption in the Italian sample. Our findings confirm the need to promote nutrition-based interventions to encourage FV intake, particularly in non-Mediterranean countries.