The Mediterranean diet is a diet inspired by the eating habits of people who live near the Mediterranean Sea. When initially formulated in the 1960s, it drew on cuisines in Greece, Italy, and Spain. In decades since, it has also incorporated other Mediterranean cuisines, such as those in the Levant and North Africa.
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 has been studied as a potential health factor for reducing all-cause mortality and the risk of chronic diseases.
The Mediterranean diet is associated with a reduction in all-cause mortality in observational studies. 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 had low quality and was uncertain. The American Heart Association and American Diabetes Association recommend the Mediterranean diet as a healthy dietary pattern that may reduce the risk of cardiovascular diseases and type 2 diabetes, respectively. The Mediterranean diet may help with weight loss in obese people. The Mediterranean diet is one of three healthy diets recommended in the 2015-2020 Dietary Guidelines for Americans, which also include the DASH diet or a vegetarian diet.
The Mediterranean diet as a nutritional recommendation is different from 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 Croatia, Cyprus, Greece, Italy, Morocco, Spain and Portugal.
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.
The US 2015–2020 national guidelines devised a "Healthy Mediterranean-Style Eating Pattern", assessed against and mirroring the Mediterranean diet patterns and its positive health outcomes. It was designed from the "Healthy U.S.-Style Eating Pattern", but it contains more fruits and seafood, and less dairy. In the 2020s, research on the Mediterranean diet indicates that a Mediterranean diet may contribute to health.
The Mediterranean diet is included among dietary patterns that may reduce the risk of cardiovascular diseases. A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors. A 2013 meta-analysis 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 were raised about the quality of previous systematic reviews examining the impact of a Mediterranean diet on cardiovascular risk factors, further standardized research has been found to be necessary, and the evidence for the possible prevention of vascular disease by the Mediterranean diet was "limited and highly variable". Reviews in 2016-17 reached similar conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors, such as lowering the risk for hypertension and other cardiovascular diseases.
The Mediterranean diet is low in saturated fat with high amounts of monounsaturated fat and dietary fiber. One possible factor is the potential health effects of olive oil 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. The American Heart Association discussed the Mediterranean diet as a healthy dietary pattern that may reduce the risk of cardiovascular diseases.
In 2014, two meta-analyses found that the Mediterranean diet was associated with a decreased risk of type 2 diabetes, findings similar to those of a 2017 review. The American Diabetes Association and a 2019 review indicated that the Mediterranean diet is a healthy dietary pattern that may reduce the risk of diabetes.
A meta-analysis in 2008 found that strictly following the Mediterranean diet was correlated with a decreased risk of dying from cancer by 6%. Another 2014 review found that adherence to the Mediterranean diet was associated with a decreased risk of death from cancer. A 2017 review found a decreased rate of cancer, though evidence was weak. An updated review in 2021 found that the Mediterranean diet is associated with a lower risk of cancer mortality in the general population.
Weight loss in obesity
Overweight adults who adopt Mediterranean diets may lose weight by consuming fewer calories. A 2019 review found that the Mediterranean diet may help obese people lower the quantity and improve the nutritional quality of food intake, with an overall effect of possibly losing body weight.
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 disorder
There is a correlation between adherence to 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 are variations of the "Mediterranean diets" in different countries and among the individual populations of the Mediterranean basin, due to ethnic, cultural, economic and religious diversities. The "Mediterranean diet" as defined by dietitians generally includes the following components, which are not typical of diets in the Mediterranean basin:
- High intakes of olive oil (as the principal source of fat), vegetables (including leafy green vegetables, onions, garlic, tomatoes, and peppers), fresh fruits (consumed as desserts or snacks), cereals (mostly whole grains), nuts, and legumes.
- Moderate intakes of fish and other seafood, poultry, eggs, dairy products (principally cheese and yogurt), and red wine.
- Low intakes of red meat, processed meat, refined carbohydrates, 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 calorie 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 products||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|
|Servings are defined as: 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.|
Consuming a Mediterranean diet or plant-based diet may contribute to improving environmental and agricultural sustainability, possibly due to lower use of dairy products, ruminant meat, and processed foods. The environmental impact and amount of energy needed to feed livestock exceeds its nutritional value. In a 2014 lifecycle analysis of greenhouse gas emissions, researchers found that a Mediterranean-like diet may reduce food production emissions below those of an omnivorous diet for 2050, with a per capita reduction of 30%.
History and reception
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 (a husband and wife team), the Mediterranean diet failed to gain widespread recognition until the 1990s. Objective data showing that the Mediterranean diet is healthy originated from results of epidemiological studies in Calabria, 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.
A secondhand report claims that Portugal was included in Keys' original study, but that the Portuguese prime minister António de Oliveira Salazar did not want Portugal to be associated with the diet of the poor. There is no independent confirmation of this claim.
- Trichopoulou, A; Martínez-González, MA; Tong, TY; Forouhi, NG; Khandelwal, S; Prabhakaran, D; Mozaffarian, D; de Lorgeril, M (24 July 2014). "Definitions and potential health benefits of the Mediterranean diet: views from experts around the world". BMC Medicine. 12: 112. doi:10.1186/1741-7015-12-112. PMC 4222885. PMID 25055810.
- Alberto Capatti; Massimo Montanari (September 2003). Italian Cuisine: A Cultural History. Columbia University Press. p. 106. ISBN 978-0231122320.
- Duarte, A., Fernandes, J., Bernardes, J. & Miguel, G. (2016). "Citrus as a Component of the Mediterranean Diet". Journal of Spatial and Organizational Dynamics - JSOD. 4: 289–304.CS1 maint: multiple names: authors list (link)
- Arnett, Donna K.; Blumenthal, Roger S.; Albert, Michelle A.; Buroker, Andrew B.; Goldberger, Zachary D.; Hahn, Ellen J.; Himmelfarb, Cheryl D.; Khera, Amit; Lloyd-Jones, Donald; McEvoy, J. William; Michos, Erin D.; Miedema, Michael D.; Muñoz, Daniel; Smith, Sidney C.; Virani, Salim S.; Williams, Kim A.; Yeboah, Joseph; Ziaeian, Boback (17 March 2019). "2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease". Circulation. 140 (11): e596–e646. doi:10.1161/CIR.0000000000000678. PMC 7734661. PMID 30879355.
- Rees, K; Takeda, A; Martin, N; Ellis, L; Wijesekara, D; Vepa, A; Das, A; Hartley, L; Stranges, S (13 March 2019). "Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease". The Cochrane Database of Systematic Reviews. 2019 (3): CD009825. doi:10.1002/14651858.CD009825.pub3. ISSN 1469-493X. PMC 6414510. PMID 30864165.
- Dinu, M; Pagliai, G; Casini, A; Sofi, F (10 May 2017). "Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials". European Journal of Clinical Nutrition. 72 (1): 30–43. doi:10.1038/ejcn.2017.58. PMID 28488692. S2CID 7702206.
- Van Horn, L; Carson, JA; Appel, LJ; Burke, LE; Economos, C; Karmally, W; Lancaster, K; Lichtenstein, AH; Johnson, RK; Thomas, RJ; Vos, M; Wylie-Rosett, J; Kris-Etherton, P; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Stroke Council (29 November 2016). "Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association". Circulation. 134 (22): e505–e529. doi:10.1161/CIR.0000000000000462. PMID 27789558. S2CID 37889352.CS1 maint: multiple names: authors list (link)
- Evert, Alison B.; Dennison, Michelle; Gardner, Christopher D.; Garvey, W. Timothy; Lau, Ka Hei Karen; MacLeod, Janice; Mitri, Joanna; Pereira, Raquel F.; Rawlings, Kelly; Robinson, Shamera; Saslow, Laura; Uelmen, Sacha; Urbanski, Patricia B.; Yancy, William S. (May 2019). "Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report". Diabetes Care (Professional society guidelines). 42 (5): 731–754. doi:10.2337/dci19-0014. PMC 7011201. PMID 31000505.
- American Diabetes Association (January 2019). "5. Lifestyle Management: Standards of Medical Care in Diabetes-2019". Diabetes Care. 42 (Suppl 1): S46–S60. doi:10.2337/dc19-S005. PMID 30559231.
- Pallazola, Vincent A.; Davis, Dorothy M.; Whelton, Seamus P.; Cardoso, Rhanderson; Latina, Jacqueline M.; Michos, Erin D.; Sarkar, Sudipa; Blumenthal, Roger S.; Arnett, Donna K.; Stone, Neil J.; Welty, Francine K. (2019). "A Clinician's Guide to Healthy Eating for Cardiovascular Disease Prevention". Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 3 (3): 251–267. doi:10.1016/j.mayocpiqo.2019.05.001. ISSN 2542-4548. PMC 6713921. PMID 31485563.
- "2015–2020 Dietary Guidelines for Americans" (National guidelines). Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. 7 November 2019. Retrieved 7 November 2019.
- "Decision of the Intergovernmental Committee: 5.COM 6.41, Spain, Greece, Italy and Morocco have nominated the Mediterranean diet for inscription on the Representative List of the Intangible Cultural Heritage of Humanity". United Nations (UNESCO), Section of Intangible Cultural Heritage. 2010.
- "UNESCO - Culture - Intangible Heritage - Lists & Register - Inscribed Elements - Mediterranean Diet". Retrieved 3 April 2014.
- Martinez-Lacoba, R; Pardo-Garcia, I; Amo-Saus, E; Escribano-Sotos, F (2018). "Mediterranean diet and health outcomes: a systematic meta-review". European Journal of Public Health. Advance articles (5): 955–961. doi:10.1093/eurpub/cky113. PMID 29992229.
- Mancini, JG; Filion, KB; Atallah, R; Eisenberg, MJ (April 2016). "Systematic Review of the Mediterranean Diet for Long-Term Weight Loss". American J Med. 129 (4): 407–415.e4. doi:10.1016/j.amjmed.2015.11.028. PMID 26721635.
- O'Keefe, James H.; Torres-Acosta, Noel; O'Keefe, Evan L.; Saeed, Ibrahim M.; Lavie, Carl J.; Smith, Sarah E.; Ros, Emilio (22 September 2020). "A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week". Journal of the American College of Cardiology. 76 (12): 1484–1493. doi:10.1016/j.jacc.2020.07.049. ISSN 1558-3597. PMID 32943166.
- Ajala O.; English P.; Pinkney J. (2013). "Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes". The American Journal of Clinical Nutrition. 97 (3): 505–516. doi:10.3945/ajcn.112.042457. PMID 23364002.
- Huedo-Medina, TB; Garcia, M; Bihuniak, JD; Kenny, A; Kerstetter, J (March 2016). "Methodologic quality of meta-analyses and systematic reviews on the Mediterranean diet and cardiovascular disease outcomes: a review". American Journal of Clinical Nutrition (Review). 103 (3): 841–50. doi:10.3945/ajcn.115.112771. PMID 26864357.
- Nissensohn M, Román-Viñas B, Sánchez-Villegas A, Piscopo S, Serra-Majem L (January 2016). "The Effect of the Mediterranean Diet on Hypertension: A Systematic Review and Meta-Analysis". Journal of Nutrition Education and Behavior (Review). 48 (1): 42–53.e1. doi:10.1016/j.jneb.2015.08.023. PMID 26483006.
- Liyanage T, Ninomiya T, Wang A, Neal B, Jun M, Wong MG, Jardine M, Hillis GS, Perkovic V (2016). "Effects of the Mediterranean Diet on Cardiovascular Outcomes-A Systematic Review and Meta-Analysis". PLOS ONE (Review). 11 (8): e0159252. Bibcode:2016PLoSO..1159252L. doi:10.1371/journal.pone.0159252. PMC 4980102. PMID 27509006.
- Gay, HC; Rao, SG; Vaccarino, V; Ali, MK (April 2016). "Effects of Different Dietary Interventions on Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials". Hypertension. 67 (4): 733–9. doi:10.1161/HYPERTENSIONAHA.115.06853. PMID 26902492. S2CID 24011456.
- Buckland G, González CA (April 2015). "The role of olive oil in disease prevention: a focus on the recent epidemiological evidence from cohort studies and dietary intervention trials". Br J Nutr (Review). 113 Suppl 2: S94–101. doi:10.1017/S0007114514003936. PMID 26148926.
- European Food Safety Authority (2011). "Scientific Opinion on the substantiation of health claims related to polyphenols in olive". EFSA Journal. 9 (4): 2033. doi:10.2903/j.efsa.2011.2033.
- European Food Safety Authority (2011). "Scientific Opinion on the substantiation of health claims related to oleic acid intended to replace saturated fatty acids (SFAs) in foods or diets". EFSA Journal. 9 (4): 2043. doi:10.2903/j.efsa.2011.2043.
- "COMMISSION REGULATION (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children's development and health. Text with EEA relevance". Official Journal of the European Union. Retrieved 31 August 2016.
- Schwingshackl L, Hoffmann G (1 October 2014). "Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies". Lipids Health Dis (Review). 13: 154. doi:10.1186/1476-511X-13-154. PMC 4198773. PMID 25274026.
- Schwingshackl, L; Missbach, B; König, J; Hoffmann, G (22 August 2014). "Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis". Public Health Nutrition. 18 (7): 1292–9. doi:10.1017/S1368980014001542. PMID 25145972.
- Koloverou, E; Esposito, K; Giugliano, D; Panagiotakos, D (July 2014). "The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants". Metabolism: Clinical and Experimental. 63 (7): 903–11. doi:10.1016/j.metabol.2014.04.010. PMID 24931280.
- "8 eating plans for patients with prediabetes". American Medical Association. Retrieved 4 October 2020.
- Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008). "Adherence to Mediterranean diet and health status: meta-analysis". BMJ (Clinical Research Ed.). 337 (sep11 2): a1344. doi:10.1136/bmj.a1344. PMC 2533524. PMID 18786971.
- Schwingshackl, L; Hoffmann, G (15 October 2014). "Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies". International Journal of Cancer. 135 (8): 1884–97. doi:10.1002/ijc.28824. PMID 24599882. S2CID 10389033.
- Morze, J., Danielewicz, A., Przybyłowicz, K. (2021). "An updated systematic review and meta-analysis on adherence to mediterranean diet and risk of cancer". European Journal of Nutrition. 60 (3): 1561–1586. doi:10.1007/s00394-020-02346-6. PMC 7987633. PMID 32770356.CS1 maint: uses authors parameter (link)
- Estruch, Ramon; Ros, Emilio (1 September 2020). "The role of the Mediterranean diet on weight loss and obesity-related diseases". Reviews in Endocrine and Metabolic Disorders. 21 (3): 315–327. doi:10.1007/s11154-020-09579-0. ISSN 1573-2606. PMID 32829455. S2CID 221235205. Retrieved 23 March 2021.
- Esposito, Katherine; Kastorini, Christina-Maria; Panagiotakos, Demosthenes B.; Giugliano, Dario (February 2011). "Mediterranean diet and weight loss: meta-analysis of randomized controlled trials". Metabolic Syndrome and Related Disorders. 9 (1): 1–12. doi:10.1089/met.2010.0031. ISSN 1557-8518. PMID 20973675. Retrieved 23 March 2021.
- Mancini, Joseph G.; Filion, Kristian B.; Atallah, Renée; Eisenberg, Mark J. (April 2016). "Systematic Review of the Mediterranean Diet for Long-Term Weight Loss". The American Journal of Medicine. 129 (4): 407–415.e4. doi:10.1016/j.amjmed.2015.11.028. PMID 26721635.
- Petersson, SD; Philippou, E (September 2016). "Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence". Advances in Nutrition. 7 (5): 889–904. doi:10.3945/an.116.012138. PMC 5015034. PMID 27633105.
- Lourida, Ilianna; Soni, Maya; Thompson-Coon, Joanna; Purandare, Nitin; Lang, Iain A.; Ukoumunne, Obioha C.; Llewellyn, David J. (July 2013). "Mediterranean Diet, Cognitive Function, and Dementia". Epidemiology. 24 (4): 479–489. doi:10.1097/EDE.0b013e3182944410. PMID 23680940. S2CID 19602773.
- Singh, B; Parsaik, AK; Mielke, MM; Erwin, PJ; Knopman, DS; Petersen, RC; Roberts, RO (2014). "Association of mediterranean diet with mild cognitive impairment and Alzheimer's disease: a systematic review and meta-analysis". Journal of Alzheimer's Disease. 39 (2): 271–82. doi:10.3233/JAD-130830. PMC 3946820. PMID 24164735.
- Lassale, C; Batty, GD; Baghdadli, A; Jacka, F; Sánchez-Villegas, A; Kivimäki, M; Akbaraly, T (July 2019). "Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies". Molecular Psychiatry. 24 (7): 965–986. doi:10.1038/s41380-018-0237-8. PMC 6755986. PMID 30254236.
- Psaltopoulou, T; Sergentanis, TN; Panagiotakos, DB; Sergentanis, IN; Kosti, R; Scarmeas, N (October 2013). "Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis". Annals of Neurology. 74 (4): 580–91. doi:10.1002/ana.23944. PMID 23720230. S2CID 5995461.
- Volta U, Caio G, Tovoli F, De Giorgio R (2013). "Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness". Cellular and Molecular Immunology (Review). 10 (5): 383–392. doi:10.1038/cmi.2013.28. ISSN 1672-7681. PMC 4003198. PMID 23934026.
Many factors have contributed to the development of gluten-related pathology, starting with the worldwide spread of the Mediterranean diet, which is based on a high intake of gluten-containing foods.
- Lin PH, Aronson W, Freedland SJ (8 January 2015). "Nutrition, dietary interventions and prostate cancer: the latest evidence". BMC Medicine (Review). 13: 3. doi:10.1186/s12916-014-0234-y. PMC 4823849. PMID 25573005.
- Willett WC; Sacks, F; Trichopoulou, A; Drescher, G; Ferro-Luzzi, A; Helsing, E; Trichopoulos, D (1 June 1995). "Mediterranean diet pyramid: a cultural model for healthy eating". American Journal of Clinical Nutrition. 61 (6): 1402S–6S. doi:10.1093/ajcn/61.6.1402s. PMID 7754995.
- Massimo Alberini, Giorgio Mistretta, Guida all'Italia gastronomica, Touring Club Italiano, 1984
- Tapper, Richard; Zubaida, Sami (2001). A Taste of Thyme: Culinary Cultures of the Middle East. Tauris Parke Paperbacks. p. 43. ISBN 978-1-86064-603-4.
- This article incorporates text by Courtney Davis, Janet Bryan, Jonathan Hodgson, and Karen Murphy available under the CC BY 4.0 license. Davis, Courtney; Bryan, Janet; Hodgson, Jonathan; Murphy, Karen (2015). "Definition of the Mediterranean Diet; A Literature Review". Nutrients. 7 (11): 9139–9153. doi:10.3390/nu7115459. PMC 4663587. PMID 26556369.
- "Mediterranean Diet Pyramid". Retrieved 27 February 2013.
- Bach-Faig, A.; Berry, E. M.; Lairon, D.; Reguant, J.; Trichopoulou, A.; Dernini, S.; Medina, F. X.; Battino, M.; Belahsen, R.; Miranda, G.; Serra-Majem, L.; Mediterranean Diet Foundation Expert Group (2011). "Mediterranean diet pyramid today. Science and cultural updates". Public Health Nutrition. 14 (12A): 2274–84. doi:10.1017/S1368980011002515. PMID 22166184.
- Food and Agriculture Organization of the United Nations, "Food-based dietary guidelines—Greece" 
- Martínez-González, M. A.; Sánchez-Villegas, A. (2004). "The emerging role of Mediterranean diets in cardiovascular epidemiology: Monounsaturated fats, olive oil, red wine or the whole pattern?". European Journal of Epidemiology. 19 (1): 9–13. doi:10.1023/b:ejep.0000013351.60227.7b. PMID 15012018. S2CID 8863511.
- "How our diets impact climate change — and what we can do about it". NBC News. Retrieved 23 March 2021.
- "U.S. could feed 800 million people with grain that livestock eat, Cornell ecologist advises animal scientists". Cornell Chronicle. 7 August 1997. Retrieved 26 April 2019.
- "Tackling climate change through livestock". United Nations. 21 October 2014.
- Magkos, Faidon; Tetens, Inge; Bügel, Susanne Gjedsted; Felby, Claus; Schacht, Simon Rønnow; Hill, James O; Ravussin, Eric; Astrup, Arne (1 January 2020). "A Perspective on the Transition to Plant-Based Diets: a Diet Change May Attenuate Climate Change, but Can It Also Attenuate Obesity and Chronic Disease Risk?". Advances in Nutrition. 11 (1): 1–9. doi:10.1093/advances/nmz090. ISSN 2161-8313. PMC 7442415. PMID 31504086.
- Tilman, David; Clark, Michael (1 November 2014). "Global diets link environmental sustainability and human health". Nature. 515 (7528): 518–522. Bibcode:2014Natur.515..518T. doi:10.1038/nature13959. ISSN 1476-4687. PMID 25383533. S2CID 4453972.
- Ancel Keys; Margaret Keys (December 1975). How to eat well and stay well the Mediterranean way. Doubleday. ISBN 978-0385009065.
- Sarah Boseley (2 September 2016). "What actually is the Mediterranean diet – and does it work?". The Guardian. Retrieved 14 September 2021.
- António José Marques da Silva (2015). The Mediterranean Diet: Discussions and Eating Practices in the Mediterranean (translated) (vol. 2) pp. 52-54. L'Harmattan, Paris. ISBN 978-2-343-06151-1.
- Ancel Keys, ed. (April 1970). "Coronary heart disease in seven countries". Circulation. 41 (4 Suppl): I1–211. doi:10.1161/01.CIR.41.4S1.I-1. PMID 5442782. S2CID 80146863.
- Ancel Keys (February 1980). Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Harvard University Press. ISBN 978-0674802377.
- Burros, Marian (29 March 1995). "Eating Well". The New York Times. Archived from the original on 28 October 2008.
- Kushi LH, Lenart EB, Willett WC (1995). "Health implications of Mediterranean diets in light of contemporary knowledge. 1. Plant foods and dairy products". Am. J. Clin. Nutr. 61 (6 Suppl): 1407S–1415S. doi:10.1093/ajcn/61.6.1407S. PMID 7754996.
- Kushi LH, Lenart EB, Willett WC (1995). "Health implications of Mediterranean diets in light of contemporary knowledge. 2. Meat, wine, fats, and oils". Am. J. Clin. Nutr. 61 (6 Suppl): 1416S–1427S. doi:10.1093/ajcn/61.6.1407S. PMID 7754997.
- Willett WC (2006). "The Mediterranean diet: science and practice". Public Health Nutr. 9 (1A): 105–10. doi:10.1079/phn2005931. PMID 16512956.
- Simini Bruno (2000). "Serge Renaud: from French paradox to Cretan miracle". The Lancet. 355 (9197): 48. doi:10.1016/S0140-6736(05)71990-5. PMID 10615898. S2CID 8142036.
- Brown JE, Isaacs J, Krinke B, Lechtenberg E, Murtaugh M (2011). Nutrition Through the Life Cycle (4th ed.). Cengage Learning. p. 410. ISBN 978-1-133-00816-3.
- Villani A, Sultana J, Doecke J, Mantzioris E (2018). "Differences in the interpretation of a modernized Mediterranean diet prescribed in intervention studies for the management of type 2 diabetes: how closely does this align with a traditional Mediterranean diet?". European Journal of Nutrition. 58 (4): 1369–1380. doi:10.1007/s00394-018-1757-3. PMID 29943276. S2CID 49420773.
- Moreira, José Augusto (10 October 2012). "Mediterrânica ou atlântica, eis a questão". Público (in Portuguese).
- Media related to Mediterranean diet at Wikimedia Commons