Mediterranean thoughts

Mary Yannakoulia,1 PhD, Meropi Kontogianni,1 PhD, Nikolaos Scarmeas,2 MD, PhD

1 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

2 Department of Social Medicine, Psychiatry and Neurology, National & Kapodistrian, University of Athens, Greece

The concept of the Mediterranean diet was originally conceived by Ancel Keys, in the Seven Countries Study [1-2]. However, the core foods of the diet of people living around the Mediterranean basin have been recognized since the BC era: bread, olive oil, and wine were staple foods in the Greek and Roman diets; bread was symbolic of agriculture and human civilization and olive trees were the identity of Mediterranean lands [3].

One of the main conclusions that came up from the Seven Countries Studies was that all-cause and coronary heart disease death rates were lower in cohorts that had olive oil as the main dietary fat compared to northern European ones [4]; thereafter, the notion that the high consumption of olive oil, bread, fruits, vegetables, and cereals may be  responsible for profound health benefits was spread in the scientific community [5]. Nowadays, the term Mediterranean diet is widely used to describe the traditional dietary habits of people leaving around Mediterranean Sea, and it is schematically depicted as a pyramid (Simopoulos, 2001; Willett et al., 1995). This dietary pattern is mainly characterized by the abundance of plant foods: fruits, as the typical after-dinner dessert, vegetables, either as main or side dish, a lot of bread, other forms of cereals, legumes, nuts, and seeds. Olive oil is the principal source of fat. Mediterranean diet also includes moderate amounts of dairy products (mostly cheese and yogurt), low to moderate amounts of fish and poultry, red meat in low amounts and wine, consumed modestly, normally with meals [6-7].

In numerous epidemiological studies, greater adherence to a Mediterranean dietary pattern, as described above, has been associated, with longevity, with lower prevalence and incidence of several chronic diseases (cardiovascular disease, including stroke, type 2 diabetes mellitus, and several cancers), both in Mediterranean and non-Mediterranean populations [8-20]. Mediterranean diet is also protective against mild and advanced cognitive impairment, including Alzheimer’s disease [21-23]. The more prevailing mechanisms underlying the aforementioned health benefits are the anti-inflammatory and anti-oxidative properties of this diet. Much research has been conducted in relation to the potentially beneficial nutrients abundant in the Mediterranean diets. However, the properties of the whole pattern seem to be well beyond the individual effects of nutrients. Furthermore, eating is a complex behavior consisting of several individual behaviors, among others, the choice of specific foods or food groups, the organization of food into meals, and the conditions around or preceding eating. Overall, lifestyle may be as important as food per se.

In fact, in the earlier work by Ancel Keys [2] as well as in the early Mediterranean diet pyramid [6], lifestyle behaviors have been underlined as important component of the Mediterranean way of living: apart from physical activity, lifestyle factors that were extracted as being of particular interest are social support, sharing food, having lengthy meals and post-lunch siestas. The modern Mediterranean diet model re-emphasizes the lifestyle approach [26]. Thus, the concepts of moderation in food consumption and frugality are promoted. The preference for seasonal, fresh and minimally processed foods may, in most cases, maximize the content of protective nutrients and molecules in the diet. Consuming traditional, local, eco-friendly and biodiverse products contributes to the sustainable character of the diet. The conviviality aspect of eating is important, as it contributes to strengthening socialization, communication and social support, whereas devoting enough time and space to culinary activities is also stressed. Finally, regular practice of moderate physical activity (at least 30min throughout the day) and adequate sleep and resting during daytime (naps) serve as basic complements to the dietary pattern.

Can we, thus, attempt to say that foods are the body of our Mediterranean diet, whereas the way of eating and living in community the heart of our cultural intangible heritage? Mediterranean food for thought.

References

1.         Nestle, M., Mediterranean diets: historical and research overview. Am J Clin Nutr, 1995. 61(6 Suppl): p. 1313S-1320S.

2.         Keys, A., Coronary heart disease in seven countries. Circulation, 1970. 41(4 Suppl): p. I1-198.

3.         Ferrari, R. and C. Rapezzi, The Mediterranean diet: a cultural journey. Lancet, 2011. 377(9779): p. 1730-1.

4.         Keys, A., et al., The diet and 15-year death rate in the seven countries study. Am J Epidemiol, 1986. 124(6): p. 903-15.

5.         Sofi, F., et al., Mediterranean diet and health. Biofactors, 2013. 39(4): p. 335-42.

6.         Willett, W.C., et al., Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr, 1995. 61(6 Suppl): p. 1402S-1406S.

7.         Kafatos, A., et al., Mediterranean diet of Crete: foods and nutrient content. J Am Diet Assoc, 2000. 100(12): p. 1487-93.

8.         Trichopoulou, A., et al., Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med, 2003. 348(26): p. 2599-608.

9.         Sofi, F., et al., Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr, 2010. 92(5): p. 1189-96.

10.       Lopez-Garcia, E., et al., The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease. Am J Clin Nutr, 2014. 99(1): p. 172-80.

11.       Couto, E., et al., Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br J Cancer, 2011. 104(9): p. 1493-9.

12.       Estruch, R., et al., Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med, 2013. 368(14): p. 1279-90.

13.       Barzi, F., et al., Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr, 2003. 57(4): p. 604-11.

14.       de Lorgeril, M., et al., Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation, 1999. 99(6): p. 779-85.

15.       Abiemo, E.E., et al., Relationships of the Mediterranean dietary pattern with insulin resistance and diabetes incidence in the Multi-Ethnic Study of Atherosclerosis (MESA). Br J Nutr, 2013. 109(8): p. 1490-7.

16.       Martinez-Gonzalez, M.A., et al., Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ, 2008. 336(7657): p. 1348-51.

17.       Romaguera, D., et al., Mediterranean diet and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study: the InterAct project. Diabetes Care, 2011. 34(9): p. 1913-8.

18.       Esposito, K., et al., Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med, 2009. 151(5): p. 306-14.

19.       Itsiopoulos, C., et al., Can the Mediterranean diet lower HbA1c in type 2 diabetes? Results from a randomized cross-over study. Nutr Metab Cardiovasc Dis, 2011. 21(9): p. 740-7.

20.       Toobert, D.J., et al., Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. Diabetes Care, 2003. 26(8): p. 2288-93.

21.       Psaltopoulou, T., et al., Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann Neurol, 2013. 74(4): p. 580-91.

22.       Singh, B., et al., Association of mediterranean diet with mild cognitive impairment and Alzheimer's disease: a systematic review and meta-analysis. J Alzheimers Dis, 2014. 39(2): p. 271-82.

23.       Scarmeas, N., et al., Mediterranean diet and risk for Alzheimer's disease. Ann Neurol, 2006. 59(6): p. 912-21.

24.       Scarmeas, N., Mediterranean food for thought? J Neurol Neurosurg Psychiatry, 2013. 84(12): p. 1297.

25.       Martinez-Lapiscina, E.H., et al., Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry, 2013. 84(12): p. 1318-25.

26.       Bach-Faig, A., et al., Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr, 2011. 14(12A): p. 2274-84.

 

Google analytics code maybe ?