Mediterranean diet

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This article is about the dietary recommendation that became popular in the 1990s. For food of the areas around the Mediterranean Sea, see Mediterranean cuisine.
Mediterranean diet
Gazpacho ingredients.jpg
Olive oil and vegetables
Criteria R1, R2, R3, R4, R5
Reference 884
Inscription history
Inscription 2013

The Mediterranean diet is a modern nutritional recommendation originally inspired by the dietary patterns of Greece, Southern Italy, and Spain in the 1940s and 1950s.[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 products.[2]

There is tentative evidence that the Mediterranean diet lowers the risk of heart disease and early death.[3][4]

Health effects[edit]

The Mediterranean diet was estimated to decrease the risk of death by 9%.[4] A 2016 review found similar weight loss as other diets.[5]

Dietary factors may be only part of the reason for health benefits gained by certain Mediterranean cultures. Physically active lifestyle, lower body mass index, cessation of smoking and moderate alcohol consumption also may contribute.[6]

Heart disease[edit]

One meta-analysis of prospective cohort studies reported a 9% decreased risk of dying from cardiovascular disease among those who follow the Mediterranean diet.[4]

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.[7] A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors.[3]

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.[8]

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. 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.[9] Olive oil contains monounsaturated fats, most notably oleic acid, which is under clinical research for its potential health benefits.[10] Whereas there is preliminary evidence that regular consumption of olive oil may lower risk of all-cause mortality and several chronic diseases,[9][10] the only approved health claim for olive oil is for protection by its polyphenols against oxidation of blood lipids.[11]

Diabetes[edit]

In 2014, two meta-analyses found that the Mediterranean diet was associated with a decreased risk of type 2 diabetes.[12][13]

Cancer[edit]

A meta-analysis in 2008 found that strictly following the Mediterranean diet reduced the risk of dying from cancer by 6%.[4]

Another 2014 systematic review and meta-analysis found that adherence to the Mediterranean diet was associated with a decreased risk of cancer mortality.[14]

Cognitive ability[edit]

According to a 2013 systematic review, greater adherence to a Mediterranean diet is associated with a lower risk of Alzheimer's disease and slower cognitive decline.[15] 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.[16] The decreased risk has been estimated at 13%.[4] It may also decrease other neurological disorders such as Parkinson's disease.[4]

Gluten[edit]

As the Mediterranean diet usually includes products containing gluten like pasta and bread, increasing use of the diet may have contributed to the growing rate of gluten-related disorders.[17][18]

Dietary components[edit]

Mediterranean roasted vegetables

Although there are many different “Mediterranean diets” among different countries and populations of the Mediterranean basin, because of ethnical, cultural, economical and religious diversities, the distinct Mediterranean diets generally include the same key components, in addition to regular physical activity:[19][20][21]

  • High intakes of extra virgin olive oil (as the principal source of fat), vegetables (including leafy green vegetables), fresh fruits (consumed as desserts or snacks), cereals (mostly wholegrains), nuts and legumes.
  • Moderate intakes of fish (especially marine blue species), seafood, poultry, dairy products (principally cheese and yogurt) and red wine (with the exception of Muslim populations).
  • Low intakes of eggs, red meat, processed meat and sweets.

Total fat in this diet is 25% to 35% of calories, with saturated fat at 8% or less of calories.[21]

In Northern Italy lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables.[22] In both North Africa and the Middle East, sheep's tail fat and rendered butter (samna) are traditional staple fats.[23]

In 2013, UNESCO added the Mediterranean diet to the Representative List of the Intangible Cultural Heritage of Humanity of Italy (promoter), Morocco, Spain, Portugal, Greece, Cyprus, and Croatia.[24][25]

History[edit]

The concept of a Mediterranean diet was developed to reflect "food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s".[21] Although it was first publicized in 1975 by the American biologist Ancel Keys and chemist Margaret Keys (his wife and collaborator),[26] 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 [27] confirmed later by the Seven Countries Study, with first publication in 1970,[28] and a book-length report in 1980.[29] The most commonly understood version of the Mediterranean diet was presented, among others, by Walter Willett of Harvard University's School of Public Health from the mid-1990s on.[30][31][32][33][34]

The Mediterranean diet is based on what from the point of view of mainstream nutrition is considered 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.[35]

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.[36]

Portugal[edit]

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 Keys considered Portugal had the most pure "Mediterranean" diet.[dubious ] However, Salazar, the dictator of Portugal, did not want the name of Portugal included in the diet of the poor.[37]

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".[37] The Southern European Atlantic Diet is the traditional diet of Northern Portugal and Galicia (Spain), and has been associated with a lower risk of non-fatal acute myocardial infarction.[38]

See also[edit]

References[edit]

  1. ^ Alberto Capatti et al., Italian Cuisine: A Cultural History, p. 106.; Silvano Serventi and Francoise Sabban, Pasta, p. 162.
  2. ^ Godman H (6 November 2013). "Adopt a Mediterranean diet now for better health later". Harvard Health Publications, Harvard University, Boston. Retrieved 8 May 2016. 
  3. ^ a b Rees, K; Hartley, L; Flowers, N; Clarke, A; Hooper, L; Thorogood, M; Stranges, S (12 August 2013). "'Mediterranean' dietary pattern for the primary prevention of cardiovascular disease.". The Cochrane database of systematic reviews. 8: CD009825. doi:10.1002/14651858.CD009825.pub2. PMID 23939686. 
  4. ^ a b c d e f 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 2533524free to read. PMID 18786971. 
  5. ^ 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. 
  6. ^ Dahlöf B (2010). "Cardiovascular disease risk factors: epidemiology and risk assessment". Am. J. Cardiol. 105: 3A–9A. doi:10.1016/j.amjcard.2009.10.007. PMID 20102968. 
  7. ^ Nordmann, AJ; Suter-Zimmermann, K; Bucher, HC; Shai, I; Tuttle, KR; Estruch, R; Briel, M (September 2011). "Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors.". The American Journal of Medicine. 124 (9): 841–51.e2. doi:10.1016/j.amjmed.2011.04.024. PMID 21854893. 
  8. ^ 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. 
  9. ^ a b Schwingshackl L, Hoffmann G (Oct 1, 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 4198773free to read. PMID 25274026. 
  10. ^ a b Buckland G, González CA (Apr 2015). "The role of olive oil in disease prevention: a focus on the recent epidemiological evidence from cohort studies and dietary intervention trials" (PDF). Br J Nutr (Review). 113 Suppl 2: S94–101. doi:10.1017/S0007114514003936. 
  11. ^ Sadler MJ (2014). Foods, Nutrients and Food Ingredients with Authorised EU Health Claims; Volume 1 of Woodhead Publishing Series in Food Science, Technology and Nutrition; Section 10.3: Authorised health claim. Elsevier. pp. 214–5. ISBN 9780857098481. 
  12. ^ 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: 1–8. doi:10.1017/S1368980014001542. PMID 25145972. 
  13. ^ 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. 
  14. ^ 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. Journal International Du Cancer. 135 (8): 1884–97. doi:10.1002/ijc.28824. PMID 24599882. 
  15. ^ 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. 
  16. ^ 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 : JAD. 39 (2): 271–82. doi:10.3233/JAD-130830. PMC 3946820free to read. PMID 24164735. 
  17. ^ Guandalini S, Polanco I (Apr 2015). "Nonceliac gluten sensitivity or wheat intolerance syndrome?". J Pediatr. 166 (4): 805–11. doi:10.1016/j.jpeds.2014.12.039. PMID 25662287. The increase in world-wide consumption of a Mediterranean diet, which includes a wide range of wheat-based foods, has possibly contributed to an alarming rise in the incidence of wheat (gluten?)-related disorders.1, 2 
  18. ^ 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 4003198free to read. 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. 
  19. ^ Lin PH, Aronson W, Freedland SJ (Jan 8, 2015). "Nutrition, dietary interventions and prostate cancer: the latest evidence". BMC Med (Review). 13: 3. doi:10.1186/s12916-014-0234-y. PMC 4823849free to read. PMID 25573005. 
  20. ^ Davis C, Bryan J, Hodgson J, Murphy K (Nov 2015). "Definition of the Mediterranean Diet; a Literature Review". Nutrients (Review). 7 (11): 9139–53. doi:10.3390/nu7115459. PMC 4663587free to read. PMID 26556369. 
  21. ^ a b c Willett WC; Sacks, F; Trichopoulou, A; Drescher, G; Ferro-Luzzi, A; Helsing, E; Trichopoulos, D (June 1, 1995). "Mediterranean diet pyramid: a cultural model for healthy eating". American Journal of Clinical Nutrition. 61 (6): 1402S–6S. PMID 7754995. 
  22. ^ Massimo Alberini, Giorgio Mistretta, Guida all'Italia gastronomica, Touring Club Italiano, 1984
  23. ^ Tapper, Richard; Zubaida, Sami (2001). A Taste of Thyme: Culinary Cultures of the Middle East. Tauris Parke Paperbacks. p. 43. ISBN 1-86064-603-4. 
  24. ^ "UNESCO Culture Sector, Eighth Session of the Intergovernmental Committee (8.COM) – from 2 to 7 December 2013". Retrieved April 3, 2014. 
  25. ^ "UNESCO - Culture - Intangible Heritage - Lists & Register - Inscribed Elements - Mediterranean Diet". Retrieved April 3, 2014. 
  26. ^ Ancel Keys, Margaret Keys, How to eat well and stay well the Mediterranean way, Doubleday, 1975
  27. ^ * 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
  28. ^ 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. 
  29. ^ Ancel Keys (ed), Seven Countries: A multivariate analysis of death and coronary heart disease, 1980. ISBN 0-674-80237-3.
  30. ^ Burros, Marian (29 March 1995). "Eating Well". The New York Times. Archived by Webcite
  31. ^ 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: 1407S–1415S. PMID 7754996. 
  32. ^ 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: 1416S–1427S. PMID 7754997. 
  33. ^ Willett WC (2006). "The Mediterranean diet: science and practice". Public Health Nutr. 9: 105–10. PMID 16512956. 
  34. ^ Walter C. Willett, Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, Free Press. 2005. ISBN 0-7432-6642-0
  35. ^ 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
  36. ^ Castelvetro. G., The Fruits, Herbs, and Vegetables of Italy, London, Viking, 1989, translated from the original published in 1614.
  37. ^ a b Moreira, José Augusto (October 10, 2012). "Mediterrânica ou atlântica, eis a questão". Público (in Portuguese). 
  38. ^ Guallar-Castillón P1, Oliveira A, Lopes C, López-García E, Rodríguez-Artalejo F. (February 2013). "The Southern European Atlantic Diet is associated with lower concentrations of markers of coronary risk". Atherosclerosis. 226 (2): 502–9. doi:10.1016/j.atherosclerosis.2012.11.035. PMID 23261168. 

External links[edit]