The Mediterranean diet: health, science and society.

The Mediterranean diet (MD) emerged as a healthy food regimen long before it could be recognised which nutrients or foods were responsible for its observed benefits, and it was only in the middle of the last century that the first scientific approach 'The Seven Countries Study' appeared. Epidemiological and anthropological studies of the MD converged, first by investigating at single nutrients or foods, then by adopting the more holistic approach of dietary patterns (DP), and now with a molecular approach. These studies resulted in convincing evidence that a MD decreases the risk of all-cause mortality and cardiovascular mortality and incidence. A risk reduction of developing type 2 diabetes is probable. Evidence is less stringent for other metabolic diseases and all cancers but from possible to probable for some cancer sites. Although DP showed that the MD has to be considered in its totality, olive oil could have a specific role. Lifestyle factors such as physical activity for energy balance, outdoor life for vitamin D synthesis and conviviality are also probably partly responsible for the health benefits. The MD is a lifestyle well suited for coping not only with personal health but also with wider societal concerns in relation to environment, public health and economy.

Design and development of an instrument to measure overall lifestyle habits for epidemiological research: the Mediterranean Lifestyle (MEDLIFE) index.

OBJECTIVE: To design and develop a questionnaire that can account for an individual's adherence to a Mediterranean lifestyle including the assessment of diet and physical activity patterns, as well as social interaction. DESIGN: The Mediterranean Lifestyle (MEDLIFE) index was created based on the current Spanish Mediterranean food guide pyramid. MEDLIFE is a twenty-eight-item derived index consisting of questions about food consumption (fifteen items), traditional Mediterranean dietary habits (seven items) and physical activity, rest and social interaction habits (six items). Linear regression models and Spearman rank correlation were fitted to assess content validity and internal consistency. SETTING: A subset of participants in the Aragon Workers' Health Study cohort (Zaragoza, Spain) provided the data for development of MEDLIFE. SUBJECTS: Participants (n 988) of the Aragon Workers' Health Study cohort in Spain. RESULTS: Mean MEDLIFE score was 11·3 (sd 2·6; range: 0-28), and the quintile distribution of MEDLIFE score showed a significant association with each of the individual items as well as with specific nutrients and lifestyle indicators (intra-validity). We also quantified MEDLIFE correspondence with previously reported diet quality indices and found significant correlations (ρ range: 0·44-0·53; P<0·001) for the Alternate Healthy Eating Index, the Alternate Mediterranean Diet Index and Mediterranean Diet Adherence Screener. CONCLUSIONS: MEDLIFE is the first index to include an overall assessment of lifestyle habits. It is expected to be a more holistic tool to measure adherence to the Mediterranean lifestyle in epidemiological studies.

Mediterranean diet and longevity: an example of nutraceuticals?

The Mediterranean diet (Mediet) is an eating pattern characterizing a lifestyle and culture that has been reported to contribute to better health and quality of life. The Mediet reflects food patterns typical of Mediterranean regions, where olive oil plays an essential role in the food pyramid. Olive oil is located in the middle and it is considered the principal source of dietary fat because of its high nutritional quality (particularly extra virgin olive oil). Several studies have shown the effect of the Mediet on healthy status by lowering the rates of coronary heart disease, certain cancers, and some other age-related chronic diseases. Although the scientific literature regarding diet and life span is complex and with different opinions, there are studies that demonstrate the beneficial effects of the Mediet on longevity. Therefore, the Mediet may be considered as including several nutraceuticals that favourably influence health. In the present review we discuss two Mediterranean populations from the island of Ikaria (Greece) and the Sicani Mounts (Sicily, Italy) whose longevity is attributed to a close adherence to the Mediet.

Dietary intake and major food sources of polyphenols in a Spanish population at high cardiovascular risk: the PREDIMED study.

BACKGROUND AND AIMS: Epidemiological data have shown an inverse association between the consumption of polyphenol-rich foods and the risk of cardiovascular disease or overall mortality. A comprehensive estimation of individual polyphenol intake in nutritional cohorts is needed to gain a better understanding of this association. The aim of this study was to estimate the quantitative intake of polyphenols and the major dietary sources in the PREDIMED (PREvención con DIeta MEDiterránea) cohort using individual food consumption records. METHODS AND RESULTS: The PREDIMED study is a large, parallel-group, multicentre, randomised, controlled 5-year feeding trial aimed at assessing the effects of the Mediterranean diet on the primary prevention of cardiovascular disease. A total of 7200 participants, aged 55-80 years, completed a validated 1-year food frequency questionnaire (FFQ) at baseline. Polyphenol consumption was calculated by matching food consumption data from the FFQ with the recently developed Phenol-Explorer database on polyphenol content in foods. The mean total polyphenol intake was 820 ± 323 mg day⁻¹ (443 ± 218 mg day⁻¹ of flavonoids and 304 ± 156 mg day⁻¹ of phenolic acids). Hydroxycinnamic acids were the phenolic group with the highest consumption and 5-caffeoylquinic acid was the most abundantly ingested individual polyphenol. The consumption of olives and olive oil was a differentiating factor in the phenolic profile of this Spanish population compared with other countries. CONCLUSION: In Mediterranean countries, such as Spain, the main dietary source of polyphenols is coffee and fruits, but the most important differentiating factor with respect to other countries is the consumption of polyphenols from olives and olive oil.

Breast milk fat concentration and fatty acid pattern during the first six months in exclusively breastfeeding Greek women.

PURPOSE: To determine fat and fatty acid (FA) profile of Greek mother's milk during the first 6 months of exclusive breastfeeding and to examine their correlation with dietary and other maternal characteristics. METHODS: Milk samples and dietary records were obtained by mothers at 1st (n = 64), 3rd (n = 39), and 6th (n = 24) month postpartum. Fatty acid methylesters were separated and quantified by gas chromatography (GC/FID) and fat concentration by the creamatocrit method. RESULTS: At the 3 time points, milk fat concentration ranged between 26.3 and 30.2 g/l (p > 0.05). Milk's FA composition was expressed as weight percentage (% wt/wt of all FAs detected with a C6 to C22 chain length). Maternal macronutrient and FA dietary intake, as well as the FAs' profile in maternal milk, remained constant over the 6 months. Saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) represented approx. 46, 35, and 18 % of all FAs, while ω6 and ω3 PUFA were 17.4 and 0.8 %, respectively. Body weight gain during pregnancy was positively related to breast milk's concentration in SFA (p < 0.01) and negatively to milk's concentration in MUFA (p < 0.01). Age and parity were also independent factors affecting the FA profile in maternal milk. A strong positive effect was found during the first month postpartum, between mother's PUFA intake and the concentration of PUFA, ω3 fatty acids, docosahexaenoic and linoleic acid (LA) in the milk, while MUFA intake was strongly correlated with the concentration of PUFA, ω6 fatty acids, and LA. CONCLUSION: This study is among few in literature to determine FA profile of breast milk in European populations and verified certain dietary factors that influence this profile. Maternal PUFA and MUFA intake were found to be important factors affecting breast milk's FA profile.

Olive oil intake and mortality within the Spanish population (EPIC-Spain).

BACKGROUND: Olive oil consumption is associated with a decreased risk of several chronic diseases, in particular cardiovascular disease (CVD). However, data on the effects of olive oil on overall mortality are scarce. OBJECTIVE: We evaluated the association between olive oil and overall and cause-specific mortality in the Spanish population in the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). DESIGN: A total of 40,622 participants (62% female) aged 29-69 y were recruited from 5 Spanish regions in 1992-1996. The association between olive oil (analyzed as a categorical and continuous variable) and overall and cause-specific mortality (CVD, cancer, and other causes) was analyzed by using Cox proportional hazards regression models adjusted for potential confounders. RESULTS: A total of 1915 deaths were reported during 13.4 y of follow-up: 416 CVD deaths, 956 cancer deaths, and 417 deaths from other causes (for 126 deaths the cause was not available). In comparison with nonconsumers, the highest quartile of olive oil consumption was associated with a 26% (95% CI: 13%, 36%) reduction in risk of overall mortality and a 44% (95% CI: 21%, 60%) reduction in CVD mortality. For each increase in olive oil of 10 g · 2000 kcal⁻¹ · d⁻¹, there was a 7% (95% CI: 3%, 10%) decreased risk of overall mortality and a 13% (95% CI: 6%, 20%) decreased risk of CVD mortality. No significant association was observed between olive oil and cancer mortality. CONCLUSIONS: Olive oil was associated with a decreased risk of overall mortality and an important reduction in CVD mortality in this large Mediterranean cohort. This provides further evidence on the beneficial effects of one of the key Mediterranean dietary components.

Olive oil, Mediterranean diet and health

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Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas.

OBJECTIVE: The purpose of the present study was to evaluate the changes in the availability of the most important food components of the traditional Mediterranean diet and other food groups in five geographical areas during a 43-year period. DESIGN: Ecological study with food availability data obtained from FAO food balance sheets in forty-one countries for the period 1961-1965 and 2000-2004. SETTING: Mediterranean, Northern and Central Europe, Other Mediterranean countries and Other Countries of the World were the studied areas. RESULTS: The main changes since the 1960s, at an availability level, were found in European areas and in Other Mediterranean countries. The greatest changes were found in Mediterranean Europe, recording high availability of non-Mediterranean food groups (animal fats, vegetable oils, sugar and meat), whereas the availability of alcoholic beverages, including wine, and legumes decreased. Despite having lost some of its typical characteristics, Mediterranean Europe has more olive oil, vegetables, fruits and fish available than other areas. Although Northern Europe has a greater availability of non-Mediterranean foods, there has been a tendency towards a decrease in availability of some of these foods and to increase Mediterranean food such as olive oil and fruits. CONCLUSIONS: The present study suggests that European countries, especially those in the Mediterranean area, have experienced a 'westernisation' process of food habits, and have increasingly similar patterns of food availability (mainly non-Mediterranean food groups) among them. Measures must be taken to counteract these tendencies and to avoid their possible negative consequences. It is also crucial to find ways to promote and preserve the Mediterranean diet and its lifestyle in modern societies.

Worldwide variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003.

OBJECTIVE: The present study aimed to analyse the worldwide trends of adherence to the Mediterranean diet (MD), in 1961-1965 and 2000-2003. DESIGN: Data were obtained from the FAO food balance sheets in two periods: 1961-1965 and 2000-2003. In order to have a sample from across the world, forty-one countries were selected. The average of available energy for different food groups was calculated for all selected countries. These values were used to evaluate the adherence to the MD through a variation of Mediterranean Adequacy Index (MAI). RESULTS: The majority of the forty-one countries in this study have tended to drift away from a Mediterranean-like dietary pattern. Mediterranean Europe and the Other Mediterranean country groups suffered a significant decrease in their MAI values. The Mediterranean European group, especially Greece, experienced the greatest decrease in MAI value. In both periods, the Other Mediterranean countries showed the highest MAI values. In an analysis by countries, Iran had the highest increase in MAI across the time periods, and Egypt occupied the first place in the ranking in 2000-2003. The Northern European group was the only one that registered an increase in MAI, although this was not statistically significant. CONCLUSIONS: Many countries in the Mediterranean basin are drifting away from the Mediterranean dietary pattern (MDP). However, countries in Northern Europe and some other countries around the world are taking on a Mediterranean-like dietary pattern. The Other Mediterranean countries have the closest adherence to the MDP, currently and in the 1960s. Nutrition policy actions to tackle dietary westernisation and preserve the healthy prudent MDP are required.

The ethnobotanical study of local Mediterranean food plants as medicinal resources in Southern Spain.

We studied medicinal and food plant species, recording an extraordinary number of species and uses in Castilla-La Mancha, Murcia and Valencia in Spain. Focusing on two demographically distinct regions - Castilla-La Mancha and Lower Segura Valley. A high proportion of the flora (20 to 30 %) is known for its medicinal properties, and, interestingly, a high number of medicinal-food plants (5 to 7 %) is recorded. The concept of "Local Food" involves the whole repertory of species that characterises the local diet (incl. local cultivars and non-cultivated gathered food plants). The number of food plant species varies between 15 and 25 % of the vascular flora, and for the gathered food plants (GFP) this decreases to a 3 to 8 %. Those GFP that are also used for medicinal purposes are only 2 to 4 % of the total vascular flora. The relevant plant families are very similar in relative numbers along the different areas: Compositae, Rosaceae and Umbelliferae, followed of Boraginaceae, Liliaceae, Cruciferae, and Caryophyllaceae. Chenopodiaceae, Polygonaceae and Gramineae are less uniformly represented or in lesser numbers. The high species diversity does not imply a general dietary relevance of this particular plant family. For instance Caryophyllaceae with a relatively low number of species comprises the "collejas" (Silene vulgaris) that have shown to be the more widely consumed species. Information regarding 145 species has been recorded. Among the Gathered Food Plant Species 81 are used in medicine, in double proportion than the cultivated food plants. 61 are orally administered, in the same form as food.