The Mediterranean diet is a diet inspired by the eating habits of Greece and Italy in the 1960s. 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 products.
Olive oil and vegetables
|Criteria||R1, R2, R3, R4, R5 |
There is some evidence that the Mediterranean diet lowers the risk of heart disease and early death, although a 2019 review determined that the evidence remains of low quality and uncertain. Olive oil may be the main health-promoting part of the diet. There is preliminary evidence that regular consumption of olive oil may also reduce all-cause mortality and the risk of cancer, cardiovascular disease, neurodegeneration, and several chronic diseases.
The Mediterranean diet, as defined by nutritionists, is loosely connected to the cultural practices that UNESCO listed in 2010 under the heading "Mediterranean diet" on the Representative List of the Intangible Cultural Heritage of Humanity: "a set of skills, knowledge, rituals, symbols and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking, and particularly the sharing and consumption of food", not as a particular set of foods. Its sponsors include Italy, Spain, Portugal, Morocco, Greece, Cyprus, and Croatia.
A 2017 review found evidence that practice of a Mediterranean diet could lead to a decreased risk of cardiovascular diseases, overall cancer incidence, neurodegenerative diseases, diabetes, and early death. A 2018 review showed that practice of the Mediterranean diet may improve overall health status, such as reduced risk of non-communicable diseases, reduced total costs of living, and reduced costs for national healthcare. A 2016 review found similar weight loss as other diets.
A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors. A meta-analysis 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, while there was limited evidence for an effect of vegetarian diets on glycemic control and lipid levels unrelated to weight loss. However, reviews of early 2016 have been more cautious: Concerns have been raised about the quality of previously performed systematic reviews and meta-analyses examining the impact of a Mediterranean diet on cardiovascular risk factors, further standardized research has been found to be necessary, and the evidence as to the prevention of vascular disease by the Mediterranean diet has been found to be "limited and highly variable". Newer reviews have reached similar conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors such as high blood pressure and other cardiovascular diseases.
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. Olive oil contains monounsaturated fats, most notably oleic acid, which is under clinical research for its potential health benefits. The European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies approved health claims on olive oil, for protection by its polyphenols against oxidation of blood lipids and for the contribution to the maintenance of normal blood LDL-cholesterol levels by replacing saturated fats in the diet with oleic acid (Commission Regulation (EU) 432/2012 of 16 May 2012). A 2014 meta-analysis concluded that an elevated consumption of olive oil is associated with reduced risk of all-cause mortality, cardiovascular events and stroke, while monounsaturated fatty acids of mixed animal and plant origin showed no significant effects.
Another 2014 systematic review and meta-analysis found that adherence to the Mediterranean diet was associated with a decreased risk of death from cancer. There is preliminary evidence that regular consumption of olive oil may lower the risk of developing cancer.
A 2016 systematic review found a relation between greater adherence to a Mediterranean diet and better cognitive performance; it is unclear if the relationship is causal.
According to a 2013 systematic review, greater adherence to a Mediterranean diet is correlated with a lower risk of Alzheimer's disease and slower cognitive decline. Another 2013 systematic review reached similar conclusions, and also found a negative association with the risk of progressing from mild cognitive impairment to Alzheimer's, but acknowledged that only a small number of studies had been done on the topic.
Major depressive disorderEdit
There is a correlation between adherence to a healthy diet, like the Mediterranean diet, and a lower risk of depression. Studies on which these correlations are made, are observational and do not prove cause and effect.
There is a huge variety of "Mediterranean diets" in the different countries and among the individual populations of the Mediterranean basin, due to ethnical, cultural, economic and religious diversities.
- High intakes of olive oil (as the principal source of fat), vegetables (including leafy green vegetables), fresh fruits (consumed as desserts or snacks), cereals (mostly whole grains), nuts and legumes.
- Moderate intakes of fish and other seafood, poultry, dairy products (principally cheese and yogurt) and red wine.
- Low intakes of eggs, red meat, processed meat and sweets.
These proportions are sometimes represented in the Mediterranean Diet Pyramid. In a diet with roughly this composition, the fat content accounts for 25% to 35% of the total intake of calories, while the amount of saturated fat is, at most, 8% of the calorific content.
In contrast to the dietary recommendation, olive oil is not the staple fat in much of the Mediterranean basin: in northern and central Italy, lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables; in both North Africa and the Middle East, sheep's tail fat and rendered butter (samna) are traditional staple fats.
and Trust (2009)
|Olive oil||Every meal||Every meal||Main added lipid|
|Vegetables||Every meal||≥2 servings every meal||6 serv./day|
|Fruits||Every meal||1–2 serv. every meal||3 serv./day|
|Bread/cereals||Every meal||1–2 serv. every meal||8 serv./day|
|Legumes||Every meal||≥2 serv./week||3–4 serv./week|
|Nuts||Every meal||1–2 serv./day||3–4 serv./week|
|Fish/seafood||≥2 serv./week||≥2 serv./week||5–6 serv./week|
|Eggs||Moderate portions, daily to weekly||2–4 serv./week||3 serv./week|
|Poultry||Moderate portions, daily to weekly||2 serv./week||4 serv./week|
|Dairy foods||Moderate portions, daily to weekly||2 serv./day||2 serv./day|
|Red meat||Less often||<2 serv./week||4 serv./month|
|Sweets||Less often||<2 serv./week||3 serv./week|
|Red wine||In moderation||In moderation and respecting social beliefs||Daily, in moderation|
|Each serving is: bread 25 g., potato 100 g., cooked pasta 50–60 g., vegetables 100 g., apple 80 g., banana 60 g., orange 100 g., melon 200 g., grapes 30 g., milk or yogurt 1 cup, 1 egg, meat 60 g., cooked dry beans 100 g.|
History and receptionEdit
The concept of a Mediterranean diet was developed to reflect "food patterns typical of Crete, much of the rest of Greece, and Italy in the early 1960s". Although it was first publicized in 1975 by the American biologist Ancel Keys and chemist Margaret Keys (his wife and collaborator), 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, confirmed later by the Seven Countries Study first published in 1970, and a book-length report in 1980.
The most commonly understood version of the Mediterranean diet was presented, among others, by Walter Willett and colleagues of Harvard University's School of Public Health since the mid-1990s. The Mediterranean diet is based on a paradox: 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. By 2011, the Mediterranean diet was included by some authors as a fad diet promoted for losing weight. As of 2018, the value of the traditional Mediterranean diet was questioned due to homogenization of dietary choices and food products in the global economy, yet clinical research activity remained high, with favorable outcomes reported for various disease conditions, such as metabolic syndrome.
When Ancel Keys and his team of researchers studied and characterized the Mediterranean diet and compared it with the eating habits of the US and the most developed countries during that period, some identified it as the "Diet of the Poor". According to the famed Portuguese gastronomist Maria de Lourdes Modesto who met with Keys, Portugal was included in their observations and studies, and according to their conversation, Keys considered Portugal had the most pure "Mediterranean" diet. However, Salazar, the dictator of Portugal, did not want the name of Portugal included in what he understood as the diet of the poor.
Still today the name of the diet is not consensual among Portuguese gastronomists. 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".
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