Olive oil and vegetables
|Criteria||R1, R2, R3, R4, R5|
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. 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.
There is tentative evidence that the Mediterranean diet lowers the risk of heart disease and early death. Olive oil may be the main health-promoting component of the diet. There is preliminary evidence that regular consumption of olive oil may lower all-cause mortality and the risk of cancer, cardiovascular disease, neurodegeneration, and several chronic diseases.
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. It was chosen because "The Mediterranean diet involves 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." 
A 2016 review found similar weight loss as other diets.
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.
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. 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, 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. Newer reviews have reached similar conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors such as high blood pressure.
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.
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 cuisines generally include the same key components, in addition to regular physical activity:
- 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 a diet with roughly this composition is 25% to 35% of calories, with saturated fat at 8% or less of calories.
In Northern 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.
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". 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, with first publication 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 of Harvard University's School of Public Health from the mid-1990s on.
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.
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.
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".
- Cretan diet
- Cuisine of the Mediterranean
- Mediterranean Diet Foundation
- Health effects of wine
- Sustainable diet
- Alberto Capatti et al., Italian Cuisine: A Cultural History, p. 106.; Silvano Serventi and Francoise Sabban, Pasta, p. 162.
- Godman H (6 November 2013). "Adopt a Mediterranean diet now for better health later". Harvard Health Publications, Harvard University, Boston. Retrieved 8 May 2016.
- 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.
- 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 . PMID 18786971.
- Piroddi M, Albini A, Fabiani R, Giovannelli L, Luceri C, Natella F, et al. (2016). "Nutrigenomics of extra-virgin olive oil: A review". BioFactors. doi:10.1002/biof.1318. PMID 27580701.
- 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.
- 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 . PMID 25274026.
- Psaltopoulou T, Kosti RI, Haidopoulos D, Dimopoulos M, Panagiotakos DB (2011). "Olive oil intake is inversely related to cancer prevalence: a systematic review and a meta-analysis of 13,800 patients and 23,340 controls in 19 observational studies.". Lipids Health Dis. 10: 127. doi:10.1186/1476-511X-10-127. PMC . PMID 21801436.
- "UNESCO Culture Sector, Eighth Session of the Intergovernmental Committee (8.COM) – from 2 to 7 December 2013". Retrieved April 3, 2014.
- "UNESCO - Culture - Intangible Heritage - Lists & Register - Inscribed Elements - Mediterranean Diet". Retrieved April 3, 2014.
- "Mediterranean diet - intangible heritage - Culture Sector - UNESCO". www.unesco.org. Retrieved 2016-09-26.
- 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.
- 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.
- 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.
- 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.
- 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. 103 (3): 841–50. doi:10.3945/ajcn.115.112771. PMID 26864357.
- 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.
- 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 August 31, 2016.
- 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.
- 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.
- 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.
- Petersson, SD; Philippou, E (September 2016). "Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence.". Advances in Nutrition (Bethesda, Md.). 7 (5): 889–904. doi:10.3945/an.116.012138. PMC . 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.
- 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 . PMID 24164735.
- 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
- 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 . 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 (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 . PMID 25573005.
- 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 . PMID 26556369.
- 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.
- 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 1-86064-603-4.
- Ancel Keys, Margaret Keys, How to eat well and stay well the Mediterranean way, Doubleday, 1975
- * 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
- 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.
- Ancel Keys (ed), Seven Countries: A multivariate analysis of death and coronary heart disease, 1980. ISBN 0-674-80237-3.
- Burros, Marian (29 March 1995). "Eating Well". The New York Times.Archived by Webcite
- 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.
- 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.
- Willett WC (2006). "The Mediterranean diet: science and practice". Public Health Nutr. 9: 105–10. PMID 16512956.
- Walter C. Willett, Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, Free Press. 2005. ISBN 0-7432-6642-0
- 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
- Castelvetro. G., The Fruits, Herbs, and Vegetables of Italy, London, Viking, 1989, translated from the original published in 1614.
- Moreira, José Augusto (October 10, 2012). "Mediterrânica ou atlântica, eis a questão". Público (in Portuguese).
Media related to Mediterranean Diet at Wikimedia Commons