Mediterranean diet, physical activity and subcutaneous advanced glycation end-products' accumulation: a cross-sectional analysis in the ILERVAS project

Eur J Nutr. 2020 Apr;59(3):1233-1242. doi: 10.1007/s00394-019-01983-w. Epub 2019 May 7.


Purpose: Adherence to Mediterranean diet (MedDiet) and physical activity have been associated to lower cardiovascular risk and mortality. Our purpose was to test the modification of advanced glycation end-products (AGEs) as one of the underlying mechanisms explaining this relationship.

Methods: Cross-sectional study assessing the adherence to MedDiet (14-item Mediterranean Diet Adherence Screener) and physical activity (International Physical Activity Questionnaire short form) in 2646 middle-aged subjects without known cardiovascular disease and type 2 diabetes from the ILERVAS study. Skin autofluorescence (SAF), a non-invasive assessment of subcutaneous AGEs, was measured. Multivariable logistic regression models were done to study interactions and independent associations with a likelihood ratio test.

Results: Participants with a high adherence to MedDiet had lower SAF than those with low adherence (1.8 [IR 1.6; 2.1] vs. 2.0 [IR 1.7; 2.3] arbitrary units, p < 0.001), without differences according to categories of physical activity. There was an independent association between high adherence to MedDiet and the SAF values [OR 0.59 (0.37-0.94), p = 0.026]. When adherence to MedDiet was substituted by its individual food components, high intake of vegetables, fruits and nuts, and low intake of sugar-sweetened soft beverages were independently associated with a decreased SAF (p ≤ 0.045). No interaction between MedDiet and physical activity on SAF values was observed except for nuts consumption (p = 0.047).

Conclusions: Adherence to the MedDiet, but not physical activity, was negatively associated to SAF measurements. This association can be explained by some typical food components of the MedDiet. The present study offers a better understanding of the plausible biological conditions underlying the prevention of cardiovascular disease with MedDiet. identifier: NCT03228459.

Keywords: Advanced glycation end-products; Mediterranean diet; Physical activity; Questionnaire; Skin autofluorescence.

MeSH terms

  • Cardiovascular Diseases / prevention & control*
  • Cross-Sectional Studies
  • Diet, Mediterranean / statistics & numerical data*
  • Exercise*
  • Female
  • Glycation End Products, Advanced / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Optical Imaging / methods
  • Patient Compliance / statistics & numerical data*
  • Skin / diagnostic imaging


  • Glycation End Products, Advanced

Associated data