World Library  
Flag as Inappropriate
Email this Article

Mediterranean diet


Mediterranean diet

The Mediterranean diet is a modern nutritional recommendation originally inspired by the traditional dietary patterns of Greece, Southern Italy, and Spain.[1] The principal aspects of this diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of non-fish meat and non-fish meat products.[2]

In 2013, UNESCO added the Mediterranean diet to the Representative List of the Intangible Cultural Heritage of Humanity of Italy, Spain, Portugal, Morocco, Greece, Cyprus, and Croatia.[3][4]

Despite its name, this diet is not typical of all Mediterranean cuisine. In Northern Italy, for instance, lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables.[6] In both North Africa and the Middle East, sheep's tail fat and rendered butter (samna) are the traditional staple fats, with some exceptions.[7] Indeed, one researcher concludes: "It appears that currently there is insufficient material to give a proper definition of what the Mediterranean diet is or was in terms of well defined chemical compounds or even in terms of foods.... The all embracing term 'Mediterranean diet' should not be used in scientific literature...."[8]

The most commonly understood version of the Mediterranean diet was presented, among others, by Dr Walter Willett of Harvard University's School of Public Health from the mid-1990s on.[9][10][11][12][13][14] Based on "food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s", this diet, in addition to "regular physical activity," emphasizes "abundant plant foods, fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts". Total fat in this diet is 25% to 35% of calories, with saturated fat at 8% or less of calories.[15]

Olive oil is part of the Mediterranean diet, although not of all Mediterranean cuisines: in Egypt, Malta, and Israel, olive oil consumption is negligible,[5] and in other areas, it is not predominant.[6][7] It contains a very high level of monounsaturated fats, most notably oleic acid, which epidemiological studies suggest may be linked to a reduction in coronary heart disease risk.[16] There is also evidence that the antioxidants in olive oil improve cholesterol regulation and LDL cholesterol reduction, and that it has other anti-inflammatory and anti-hypertensive effects.[17]


  • History 1
  • Health effects 2
  • Nutritional evaluation 3
  • Medical research 4
  • Portugal 5
  • See also 6
  • References 7
  • External links 8


Although it was first publicized in 1975 by the American biologist Ancel Keys and chemist Margaret Keys (his wife and collaborator),[18] the Mediterranean diet failed to gain widespread recognition until the 1990s. Objective data showing that Mediterranean diet is healthful originated from results of epidemiological studies in Naples and Madrid [19] confirmed later by the Seven Countries Study, with first publication in 1970,[20] and a book-length report in 1980.[21]

The Mediterranean diet is based on what from the point of view of mainstream nutrition is considered a paradox: that although the people living in Mediterranean countries tend to consume relatively high amounts of fat, they have far lower rates of cardiovascular disease than in countries like the United States, where similar levels of fat consumption are found. A parallel phenomenon is known as the French Paradox.[22]

A diet rich in salads was promoted in England during the early Renaissance period by Giacomo Castelvetro in A Brief Account of the Fruits, Herbs, and Vegetables of Italy.[23]

Health effects

A number of diets have received attention, but the strongest evidence for a beneficial health effect and decreased mortality after switching to a largely plant based diet comes from studies of Mediterranean diet, e.g. from the NIH-AARP Diet and Health Study.[24]

The Mediterranean diet often is cited as beneficial for being low in saturated fat and high in monounsaturated fat and dietary fiber. One of the main explanations is thought to be the health effects of olive oil included in the Mediterranean diet.

Research has shown that people who adopt a strict Mediterranean diet and take regular exercise, often find this helps keep their weight under control. Mediterranean-style meals packed with fruit, vegetables and grains can be quite filling, which reduces any desire to top up with extra calories.[25]

Dietary factors are only part of the reason for the health benefits enjoyed by certain Mediterranean cultures. Physically active lifestyle or labour is also beneficial.[26][27] Environment may also be involved. However, on the population level, i.e. for the population of a whole country or a region, the influence of genetics is rather minimal, because it was shown that the slowly changing habits of Mediterranean populations, from an active lifestyle and Mediterranean diet to a less physically active lifestyle and a diet influenced by the Western pattern diet, significantly increases risk of heart disease.[28][29][30] There is an inverse association between adherence to the Mediterranean diet and the incidence of fatal and non fatal heart disease in initially healthy middle aged adults in the Mediterranean region.[31]

A 2011 systematic review found that a Mediterranean diet appeared to be more effective than a low-fat diet in bringing about long-term changes to cardiovascular risk factors, such as lowering cholesterol level and blood pressure.[32]

The putative benefits of the Mediterranean diet for cardiovascular health are primarily correlative in nature; while they reflect a very real disparity in the geographic incidence of heart disease, identifying the causal determinant of this disparity has proven difficult. The most popular dietary candidate, olive oil, has been undermined by a body of experimental evidence that diets enriched in monounsaturated fats such as olive oil are not atheroprotective when compared to diets enriched in either polyunsaturated or even saturated fats.[33][34] A recently emerging alternative hypothesis to the Mediterranean diet is that differential exposure to solar ultraviolet radiation accounts for the disparity in cardiovascular health between residents of Mediterranean and more northerly countries. The proposed mechanism is solar UVB-induced synthesis of Vitamin D in the oils of the skin, which has been observed to reduce the incidence of coronary heart disease, and which rapidly diminishes with increasing latitude.[35] Interestingly, residents of the Mediterranean are also observed to have very low rates of skin cancer (which is widely believed to be caused by over-exposure to solar UV radiation); incidence of melanomas in the Mediterranean countries is lower than in Northern Europe and significantly lower than in other hot countries such as Australia.[36] It has been hypothesized that some components of the Mediterranean diet may provide protection against skin cancer.

A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors.[37]

Nutritional evaluation

Fruits and vegetables: The Mediterranean diet provides 6–12 servings per day. The Canada Food Guide recommends 7–10.[38]

Grain products: The Mediterranean diet provides 4–6 servings per day. The Canada Food Guide recommends 6–8.[38]

Milk and alternatives: The Mediterranean diet provides 1–3 servings of low fat dairy products per day. The Canada Food Guide recommends 2.[38]

Meat and alternatives: The Mediterranean diet provides 1–2 servings of poultry, fish, and shellfish per day. The Canada Food Guide recommends 2–3.[38]

Other: The Mediterranean diet recommends one glass of red wine daily. The Canada Food Guide has no recommendation relevant to this.[38]

Medical research

A meta-analysis published in BMJ in 2008 showed that following strictly the Mediterranean diet reduced the risk of dying from cancer and cardiovascular disease as well as the risk of developing Parkinson's and Alzheimer's disease. The results report 9%, 9%, and 6% reduction in overall, cardiovascular, and cancer mortality respectively. Additionally a 13% reduction in incidence of Parkinson's and Alzheimer's diseases is to be expected provided strict adherence to the diet is observed.[39]

A 2010 meta-analysis published in the The American Journal of Clinical Nutrition found that the Mediterranean diet conferred a significant benefit with regard to the risk of chronic diseases, such as cardiovascular disease and cancer.[40]

A 2011 meta-analysis published in the Journal of the American College of Cardiology analyzed the results of 50 studies (35 clinical trials, 2 prospective and 13 cross-sectional) covering about 535,000 people to examine the effect of a Mediterranean diet on metabolic syndrome. The researchers reported that a Mediterranean diet is associated with lower blood pressure, blood sugar, and triglycerides.[41]

A meta-analysis published in the American Journal of Clinical Nutrition in 2013 compared Mediterranean, vegan, vegetarian, low-glycemic index, low-carbohydrate, high-fiber, and high-protein diets with control diets. The research concluded that Mediterranean, low-carbohydrate, low-glycemic index, and high-protein diets are effective in improving markers of risk for cardiovascular disease and diabetes.[42]

In 2014, two meta-analyses found that adherence to a Mediterranean diet was associated with a decreased risk of type 2 diabetes.[43][44] Another 2014 systematic review and meta-analysis found that adherence to the Mediterranean diet was associated with a decreased risk of cancer mortality.[45]


The name "Mediterranean diet" is not accepted in Portugal. After the Mediterranean diet became well-known, some studies evaluated the health benefits of the so-called "Atlantic diet", which is similar to Keys' "Mediterranean" diet, but with more fish, seafood, and fresh greens. Virgílio Gomes, a Portuguese professor and researcher on food history and gastronomy says, Portuguese cuisine is really an "Atlantic cuisine".[46] The Southern European Atlantic Diet is the traditional diet of Northern Portugal and Galicia (Spain) has been associated with a lower risk of non-fatal acute myocardial infarction.[47]

See also


  1. ^ Alberto Capatti et al., Italian Cuisine: A Cultural History, p. 106.; Silvano Serventi and Francoise Sabban, Pasta, p. 162.
  2. ^ "Get your Meds: the Mediterranean Diet and Health", Ellen Gooch, Epikouria Magazine, Fall 2005
  3. ^
  4. ^
  5. ^ a b A. Noah, A. S. Truswell, "There are many Mediterranean diets", Asia Pacific Journal of Clinical Nutrition 10:1:2-9 (2001) doi:10.1046/j.1440-6047.2001.00198.x
  6. ^ a b Massimo Alberini, Giorgio Mistretta, Guida all'Italia gastronomica, Touring Club Italiano, 1984
  7. ^ a b
  8. ^ A. Ferro-Luzzi, "The Mediterranean Diet: an attempt to define its present and past composition", European Journal of Clinical Nutrition 43:13-29 (1989) as quoted in Noah, op.cit.
  9. ^ Archived by Webcite
  10. ^ "Health implications of Mediterranean diets in light of contemporary knowledge. 1. Plant foods and dairy products." Kushi LH, Lenart EB, Willett WC Am J Clin Nutr 1995 Jun;61(6 Suppl):1407S-1415S.
  11. ^ "Health implications of Mediterranean diets in light of contemporary knowledge. 2. Meat, wine, fats, and oils." Kushi LH, Lenart EB, Willett WC" Am J Clin Nutr 1995 Jun;61(6 Suppl):1416S-1427S.
  12. ^ "The Mediterranean diet: science and practice". Willett WC. Public Health Nutr. 2006 Feb;9(1A):105-10.
  13. ^ "Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women". Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Circulation. 2009 Mar 3;119(8) 1093-100.
  14. ^ Walter C. Willett, Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, Free Press. 2005. ISBN 0-7432-6642-0
  15. ^
  16. ^
  17. ^
  18. ^ Ancel Keys, Margaret Keys, How to eat well and stay well the Mediterranean way, Doubleday, 1975
  19. ^ * António José Marques da Silva, La diète méditerranéenne. Discours et pratiques alimentaires en Méditerranée (vol. 2), L'Harmattan, Paris, 2015 ISBN 978-2-343-06151-1, pp. 52-54
  20. ^
  21. ^ Ancel Keys (ed), Seven Countries: A multivariate analysis of death and coronary heart disease, 1980. ISBN 0-674-80237-3.
  22. ^ Bruno Simini (1 January 2000) "Serge Renaud: from French paradox to Cretan miracle" The Lancet 355:9197:48 doi:10.1016/S0140-6736(05)71990-5
  23. ^ Castelvetro. G., The Fruits, Herbs, and Vegetables of Italy, London, Viking, 1989, translated from the original published in 1614.
  24. ^
  25. ^
  26. ^ Cardiovascular disease risk factors: epidemiology and risk assessment. Dahlöf B. Am J Cardiol. 2010 Jan 4;105(1 Suppl):3A-9A.
  27. ^ "Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism". Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, Stewart KJ; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Nutrition, Physical Activity, and Metabolism. "Circulation". 2007 Jul 31;116(5) 572-84.
  28. ^ "Cardiovascular disease risk factors and dietary habits of farmers from Crete 45 years after the first description of the Mediterranean diet". Vardavas CI, Linardakis MK, Hatzis CM, Saris WH, Kafatos AG. Eur J Cardiovasc Prev Rehabil. 2010 Aug;17(4) 440-6.
  29. ^ "Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study". Kafatos A, Diacatou A, Voukiklaris G, Nikolakakis N, Vlachonikolis J, Kounali D, Mamalakis G, Dontas AS" Am J Clin Nutr 1997 Jun;65(6) 1882-6.
  30. ^ "Inter-cohort differences in coronary heart disease mortality in the 25-year follow-up of the seven countries study". Menotti A, Keys A, Kromhout D, Blackburn H, Aravanis C, Bloemberg B, Buzina R, Dontas A, Fidanza F, Giampaoli S, et al. Eur J Epidemiol. 1993 Sep;9(5) 527-36.
  31. ^ "Mediterranean diet and the incidence of cardiovascular disease: A Spanish cohort". Martínez-González MA, García-López M, Bes-Rastrollo M, Toledo E, Martínez-Lapiscina EH, Delgado-Rodriguez M, Vazquez Z, Benito S, Beunza JJ. Nutr Metab Cardiovasc Dis. 2010 Jan 20.
  32. ^
  33. ^
  34. ^
  35. ^
  36. ^ Global Perspectives of Contemporary Epidemiological Trends of Cutaneous Malignant Melanoma
  37. ^
  38. ^ a b c d e
  39. ^
  40. ^
  41. ^
  42. ^
  43. ^
  44. ^
  45. ^
  46. ^
  47. ^
  • Martin Bruegel, "Alimentary identities, nutritional advice, and the uses of history"
  • Government. "Eating Well with Canada's Food Guide." Health Canada. N.p., 1 Sept. 2011. Web. 25 Feb. 2014.

External links

  • Secrets of the Mediterranean Diet, European Food Information Council
  • American Heart Association recommendations for the Mediterranean diet
  • An Italian Project for the promotion and dissemination of Mediterranean Diet (Federsanità-ANCI – 2010-2012 - Italy).
  • The Mediterranean Diet Pyramid, Oldways

  • António José Marques da Silva, La diète méditerranéenne. Discours et pratiques alimentaires en Méditerranée (vol. 2), L'Harmattan, Paris, 2015 ISBN 978-2-343-06151-1. see extract
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from World eBook Library are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.