Cilento is a rural and touristic area of Campania region in the Southern Italy, which is considered by scientists as the cradle of the Mediterranean Diet (MD), thanks to the local plantation of a great variety of fruits and vegetables that are at the basis of the traditional cooking, together with locally produced olive oil, wine and fish from the coastal towns. Such territory is characterized by the presence of a high number of long-living individuals (LLI) among the resident population, which often reach the highly desirable goal of the 100 candles. The Italian Institute for Statistics (ISTAT) basing on the data up to January 2016 www.ISTAT.it, leaves no more doubt: there are 183 centenarians in the Cilento and Diano’s Vallo territories, 143 females and 40 males. The question that intrigues scientists from all over the world is: what is the elixir of long-life, that has given precious years to Cilento’s population, allowing them to touch or exceed the century of life? Two main factors seem to play a key role in longevity: the genetic component and a balanced and healthy dietary pattern. In fact, it has been long talked about the health benefits of the MD and its protective effects against cardiovascular diseases, which are the main cause of death in the Western population. The healthy properties of the MD were first described by the American biologist and nutritionist Ancel Keys.1 The MD can certainly extend our life expectancy, put-backing the aging process, thanks to a high daily intake of substances with antioxidant and anti-inflammatory activity present in large quantities in the typical foods of the Mediterranean area. The MD is characterized by an adequately balanced combination of fruit, vegetables, fish, cereals and polyunsaturated fats, with a reduced consumption of meat and dairy products and moderate intake of alcohol, primarily locally produced red wine. The virtue of this diet lies in its ability to preserve the state of health and improve longevity; scientific evidence has shown that the adoption of the MD is a protective factor against the onset of various types of cancer, cardiovascular disease, aging and obesity.2 Numerous scientific studies have been conducted on the Cilento’s populations that has become like a magnet able to attract researchers from all over the world, an outdoor laboratory to study the contribution of diet, environment and genetic to life expectancy. To act as a wakeup call for scientists has been the comparison between the life expectancy of people in the United States, amounting to 78 years, and the average life expectancy in Cilento that is 92 years for women and 85 for men.3 The genomes of Cilento’s LLI have been indeed analyzed and reported at the University of Salerno, in cooperation with the US, where new studies emphasize the role of genes in determining the longevity of LLI. In particular, it has been highlighted the ability of a variant of the protein BPIFB4 (BPI fold containing family B member 4), associated to longevity, to qinduce an improvement of vascular function in aged individuals.4 It is well known that cardiovascular risk is markedly increased in aged individuals. The authors report a dysfunctional endothelial-dependent vasorelaxation, together with reduced eNOS phosphorylation in aged individuals, while BPIFB4 can restore endothelium-dependent vasorelaxation, eNOS phosphorylation, reducing blood pressure levels.5 Among others studies an American research, recently conducted in collaboration with the University of Rome ‘La Sapienza,’ has allowed to monitor several biological parameters of Cilento’s population. This pilot study called CI.A.O (Cilento on Aging Outcomes) showed that the secret of longevity would lie in the microcirculation of the blood vessels, but no data have been published up to now.
In a recent systematic review and meta-analysis Liyanage et al. support the beneficial effects of the MD on cardiovascular outcomes. The American Heart Association/American College of Cardiology, the European Society of Cardiology and the National Heart Foundation of Australia recommend the MD to reduce cardiovascular risk.6 Aging can be regarded as a multifactorial process, which includes genomic instability, epigenetic alterations, telomere shortage, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence and stem cell exhaustion as the main involved factors. The finding of interactions between MD and genetic variants has led to intense research in this field, providing more strong and clinically relevant gene–diet interactions. Many data suggest that the amount and quality of nutrients in the diet influence the longevity by modifying the epigenetic pattern. Regulation of key transcription factors by nutrient availability through direct interaction of these factors with nutrient-sensing factors occurs. Vegetables such as broccoli, cabbage and cauliflower contain sulforaphane, phenethyl isothiocyanate, indole-3-carbinol and diindolymethane that induce cell-cycle arrest and apoptosis.7 Many polyphenols, which not only have antioxidant properties, can interfere with epigenetic patterning.8 The MD encompasses olive oil, which contains many bioactive components including polyphenols that have been reported to fulfill antioxidant and anti-inflammatory activities, and can have a protective effects against cardiovascular diseases.9 Moderate wine drinking is part of the MD. It contains various poliphenolic substances, which may be beneficial for health and in particular flavonols, catechin and epicatechin, various phenolic acids and the resveratrol. It seems have a positive effect on longevity because it increases the expression level of gene Sirt1.10 Age is a risk factor for developing cardiovascular diseases and many studies show that MD is a protection factor against these diseases in the Cilento’s population and this evidence supports the literature data, indicating for centenarians and their descendants less inclination to manifest cardiovascular diseases. A biomarker of aging is the telomere length (TL); shorter telomeres are linked with shorter lifespan and higher risk of variety of age-related disease, contrariwise long TL (LTL) can be associated with longevity. Any studies examined the relationship between dietary patterns and TL, some dietary components and healthy dietary patterns can have an influence on TL. The intake of legumes, seafood and vegetable was positively associated with LTL and longevity.11 The Cilento area has all the features to be referred as a ‘Blue Zone’ (a demographic or geographic area with exceptional high longevity) along with Sardinia in Italy, Okinawa in Japan, Loma Linda in California and Nicoya in Costa Rica.12 All these populations share a healthy dietary pattern, even with distinctive characteristics dependent on the territory and cultural habits, that is generally low in high saturated fat, sugar and refined carbohydrates, and high in vegetables, phytonutrients and fiber together with a healthy lifestyle, characterized by a physical active status and an active social life, associated to lower rates of cardiovascular disease, hypertension, obesity and diabetes. Indeed, Ikaria’s and Sardinia’s populations adheres to a Mediterranean dietary pattern; Okinawa traditional diet is rich in root (sweet potatoes), green and yellow vegetables, legumes (soybean), fish, lean meat and medicinal plants. Loma Linda’s population, for religious reasons, is mainly vegetarian. On the contrary Nicoya’s diet moves away from this pattern, being high in protein and carbohydrates, but still being characterized by a low glycemic index and high fiber consumption.12
