Mediterranean Diet
Mediterranean diet
Gazpacho ingredients.jpg
Olive oil and vegetables
Criteria R1, R2, R3, R4, R5 [1]
Reference 884
Inscription history
Inscription 2013

The Mediterranean diet is a diet based on the patterns of Greece, Southern Italy, France and Spain in the 1940s and 1950s.[2] 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.[3]

There is some evidence that the Mediterranean diet lowers the risk of heart disease and early death.[4][5] Olive oil may be the main health-promoting component of the diet.[6] 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.[6][7][8][9]

In 2013, UNESCO added the Mediterranean diet to the Representative List of the Intangible Cultural Heritage of Humanity of Italy (promoter), France, Morocco, Spain, Portugal, Greece, Cyprus, and Croatia.[10][11] 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." [12]

Health effects

A 2016 review found similar weight loss as other diets.[13] A 2017 found evidence of a decreased risk of early death.[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.[14]

Heart disease

A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors.[4] 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.[15] 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.[16] Newer reviews have reached similar conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors such as high blood pressure.[17]

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.[7] 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[18] and for the contribution to the maintenance of normal blood LDL-cholesterol levels by replacing saturated fats in the diet with oleic acid[19] (Commission Regulation (EU) 432/2012 of 16 May 2012).[20] 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.[8]

Diabetes

In 2014, two meta-analyses found that the Mediterranean diet was associated with a decreased risk of type 2 diabetes.[21][22]

Cancer

A meta-analysis in 2008 found that strictly following the Mediterranean diet reduced the risk of dying from cancer by 6%.[23] A 2017 review found a decreased rate of cancer.[5]

Another 2014 systematic review and meta-analysis found that adherence to the Mediterranean diet was associated with a decreased risk of death from cancer.[24] There is preliminary evidence that regular consumption of olive oil may lower the risk of developing cancer.[9]

Cognitive ability

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.[25]

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.[26] 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.[27]

Gluten

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.[28]

Dietary components

Mediterranean roasted vegetables
Harvard food pyramid.png

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:[29][30][31]

  • 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 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. Total fat in a diet with roughly this composition is 25% to 35% of calories, with saturated fat at 8% or less of calories.[31]

In Northern Italy lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables.[32] In both North Africa and the Middle East, sheep's tail fat and rendered butter (samna) are traditional staple fats.[33]

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 southern Italy in the early 1960s".[31] Although it was first publicized in 1975 by the American biologist Ancel Keys and chemist Margaret Keys (his wife and collaborator),[34] 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 [35] confirmed later by the Seven Countries Study, with first publication in 1970,[36] and a book-length report in 1980.[37] 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.[38][39][40][41][42]

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.[43]

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.[44]

The diet is today classified as a fad diet.[45]

Portugal

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.[46]

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".[46]

See also

References

  1. ^ Decision
  2. ^ Alberto Capatti et al., Italian Cuisine: A Cultural History, p. 106.; Silvano Serventi and Francoise Sabban, Pasta, p. 162.
  3. ^ Godman H (6 November 2013). "Adopt a Mediterranean diet now for better health later". Harvard Health Publications, Harvard University, Boston. Retrieved 2016. 
  4. ^ 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. PMID 23939686. doi:10.1002/14651858.CD009825.pub2. 
  5. ^ a b c 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. PMID 28488692. doi:10.1038/ejcn.2017.58. 
  6. ^ a b Piroddi M, Albini A, Fabiani R, Giovannelli L, Luceri C, Natella F, et al. (2016). "Nutrigenomics of extra-virgin olive oil: A review". BioFactors. PMID 27580701. doi:10.1002/biof.1318. 
  7. ^ 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. 
  8. ^ 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. PMC 4198773 Freely accessible. PMID 25274026. doi:10.1186/1476-511X-13-154. 
  9. ^ a b 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. PMC 3199852 Freely accessible. PMID 21801436. doi:10.1186/1476-511X-10-127. 
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  12. ^ "Mediterranean diet - intangible heritage - Culture Sector - UNESCO". www.unesco.org. Retrieved . 
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  17. ^ 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. PMID 26902492. doi:10.1161/HYPERTENSIONAHA.115.06853. 
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  19. ^ 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. 
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  21. ^ 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. PMID 25145972. doi:10.1017/S1368980014001542. 
  22. ^ 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. PMID 24931280. doi:10.1016/j.metabol.2014.04.010. 
  23. ^ 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. PMC 2533524 Freely accessible. PMID 18786971. doi:10.1136/bmj.a1344. 
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  35. ^ * 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
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  46. ^ a b Moreira, José Augusto (October 10, 2012). "Mediterrânica ou atlântica, eis a questão". Público (in Portuguese). 

External links

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