Definition of the Mediterranean Diet; a Literature Review

Courtney Davis, Janet Bryan, Jonathan Hodgson, Karen Murphy, Courtney Davis, Janet Bryan, Jonathan Hodgson, Karen Murphy

Abstract

Numerous studies over several decades suggest that following the Mediterranean diet (MedDiet) can reduce the risk of cardiovascular disease and cancer, and improve cognitive health. However, there are inconsistencies among methods used for evaluating and defining the MedDiet. Through a review of the literature, we aimed to quantitatively define the MedDiet by food groups and nutrients. Databases PubMed, MEDLINE, Science Direct, Academic Search Premier and the University of South Australia Library Catalogue were searched. Articles were included if they defined the MedDiet in at least two of the following ways: (1) general descriptive definitions; (2) diet pyramids/numbers of servings of key foods; (3) grams of key foods/food groups; and (4) nutrient and flavonoid content. Quantity of key foods and nutrient content was recorded and the mean was calculated. The MedDiet contained three to nine serves of vegetables, half to two serves of fruit, one to 13 serves of cereals and up to eight serves of olive oil daily. It contained approximately 9300 kJ, 37% as total fat, 18% as monounsaturated and 9% as saturated, and 33 g of fibre per day. Our results provide a defined nutrient content and range of servings for the MedDiet based on past and current literature. More detailed reporting amongst studies could refine the definition further.

Keywords: Mediterranean diet; definition; foods and nutrients; quantity.

References

    1. Martínez-González M.Á., Sánchez-Villegas A. The emerging role of mediterranean diets in cardiovascular epidemiology: Monounsaturated fats, olive oil, red wine or the whole pattern? Eur. J. Epidemiol. 2004;19:9–13.
    1. Menotti A., Kromhout D., Blackburn H., Fidanza F., Buzina R., Nissinen A. Food intake patterns and 25-year mortality from coronary heart diseas: Cross-cultural correlations in the seven countries study. Eur. J. Epidemiol. 1999;15:507–515. doi: 10.1023/A:1007529206050.
    1. Kromhout D., Menotti A., Bloemberg B., Aravanis C., Blackburn H., Buzina R., Dontas A.S., Fidanza F., Giampaoli S., Jansen A., et al. Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: The seven countries study. Prev. Med. 1995;24:308–315. doi: 10.1006/pmed.1995.1049.
    1. Kafatos A., Verhagen H., Moschandreas J., Apostolaki I., van Westerop J.J.M. Mediterranean diet of crete: Foods and nutrient content. J. Am. Diet. Assoc. 2000;100:1487–1493. doi: 10.1016/S0002-8223(00)00416-8.
    1. Bach-Faig A., Berry E.M., Lairon D., Reguant J., Trichopoulou A., Dernini S., Medina F.X., Battino M., Belahsen R., Miranda G., et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14:2274–2284. doi: 10.1017/S1368980011002515.
    1. Willett W.C., Sacks F., Trichopoulou A., Drescher G., Ferro-Luzzi A., Helsing E., Trichopoulos D. Mediterranean diet pyramid: A cultural model for healthy eating. Am. J. Clin. Nutr. 1995;61:1402S–1406S.
    1. Bamia C., Trichopoulos D., Ferrari P., Overvad K., Bjerregaard L., Tjønneland A., Halkjær J., Clavel-Chapelon F., Kesse E., Boutron-Ruault M.-C., et al. Dietary patterns and survival of older Europeans: The EPIC-Eldely Study (European Prospective Investigation into Cancer and Nutrition) Public Health Nutr. 2007;10:590–598. doi: 10.1017/S1368980007382487.
    1. Trichopoulou A., Kouris-Blazos A., Wahlqvist M.L., Gnardellis C., Lagiou P., Polychronopoulos E., Vassilakou T., Lipworth L., Trichopoulos D. Diet and overall survival in elderly people. BMJ. 1995;311:1457–1460. doi: 10.1136/bmj.311.7018.1457.
    1. Saura-Calixto F., Goñi I. Definition of the mediterranean diet based on bioactive compounds. Crit. Rev. Food Sci. Nutr. 2009;49:145–152. doi: 10.1080/10408390701764732.
    1. Sofi F., Macchi C., Abbate R., Gensini G.F., Casini A. Mediterranean diet and health status: An updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr. 2014;17:2769–2782. doi: 10.1017/S1368980013003169.
    1. Trichopoulou A., Costacou T., Bamia C., Trichopoulos D. Adherence to a Mediterranean diet and survivial in a Greek population. N. Engl. J. Med. 2003;348:2599–2608. doi: 10.1056/NEJMoa025039.
    1. Panagiotakos D.B., Chrysohoou C., Pitsavos C., Stefanadis C. Association between the prevalence of obesity and adherence to the Mediterranean diet: The ATTICA study. Nutrition. 2006;22:449–456. doi: 10.1016/j.nut.2005.11.004.
    1. Gerber M.J., Scali J.D., Michaud A., Durand M.D., Astre C.M., Dallongeville J., Romon M.M. Profiles of a healthful diet and its relationship to biomarkers in a population sample from mediterranean southern France. J. Am. Diet. Assoc. 2000;100:1164–1171. doi: 10.1016/S0002-8223(00)00340-0.
    1. Milá-Villarroel R., Bach-Faig A., Puig J., Puchal A., Farran A., Serra-Majem L., Carrasco J.L. Comparison and evaluation of the reliability of indexes of adherence to the mediterranean diet. Public Health Nutr. 2011;14:2338–2345. doi: 10.1017/S1368980011002606.
    1. Estruch R., Ros E., Salas-Salvadó J., Covas M.-I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., et al. Primary prevention of cardiovascualr disease with a mediterranean diet. N. Engl. J. Med. 2013;368:1279–1290. doi: 10.1056/NEJMoa1200303.
    1. Kromhout D., Keys A., Aravanis C., Buzina R., Fidanza F., Giampaoli S., Jansen A., Menotti A., Nedeljkovic S., Pekkarinen M., et al. Food consumption patterns in the 1960s in seven countries. Am. J. Clin. Nutr. 1989;49:889–894.
    1. Serra-Majem L., Roman B., Estruch R. Scientific evidence of interventions using the mediterranean diet: A systematic review. Nutr. Rev. 2006;64:S27–S47. doi: 10.1111/j.1753-4887.2006.tb00232.x.
    1. Hu F.B., Manson J.E., Willett W.C. Types of dietary fat and risk of coronary heart disease: A critical review. J. Am. Coll. Nutr. 2001;20:5–19. doi: 10.1080/07315724.2001.10719008.
    1. Panagiotakos D.B., Pitsavos C., Stefanadis C. Dietary patterns: A mediterranean diet score and its relation to clinical and biological markers of cardiovacsular disease risk. Nutr. Metab. Cardiovasc. Dis. 2006;16:559–568. doi: 10.1016/j.numecd.2005.08.006.
    1. Dilis V., Vasilopoulou E., Trichopoulou A. The flavone, flavonol and flavan-3-ol content of the greek traditional diet. Food Chem. 2007;105:812–821. doi: 10.1016/j.foodchem.2007.01.069.
    1. Mediterranean Diet Pyramid. [(accessed on 27 February 2013)]. Available online: .
    1. Ministry of health and welfare, supreme scientific health council: Dietary guidelines for adults in greece. Arch. Hell. Med. 1999;16:516–524.
    1. Varela-Moreiras G., Ávila J., Cuadrado C., del Pozo S., Ruiz E., Moreiras O. Evaluation of food consumption and dietary patterns in spain by the food consumption survey: Updated information. Eur. J. Clin. Nutr. 2010;64:S37–S43. doi: 10.1038/ejcn.2010.208.
    1. de Lorgeril M., Renaud S., Mamelle N., Salen P., Martin J.-L., Monjaud I., Guidollet J., Touboul P., Delaye J. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454–1459. doi: 10.1016/S0140-6736(94)92580-1.
    1. Kouris-Blazos A., Gnardellis C., Wahlqvist M.L., Trichopoulos D., Lukito W., Trichopoulou A. Are the advantages of the mediterranean diet transferable to other populations? A cohort study in melbourne, australia. Br. J. Nutr. 1999;82:57–61.
    1. Guallar-Castillon P., Rodriguez-Artalejo F., Tormo M., Sanchez M., Rodriguez L., Quiros J.R., Navarro C., Molina E., Martinez C., Marin P., et al. Major dietary patterns and risk of coronary heart disease in middle-aged persons from a mediterranean country: The epic-spain cohort study. Nutr. Metab. Cardiovasc. Dis. 2012;22:192–199. doi: 10.1016/j.numecd.2010.06.004.
    1. Buckland G., González C.A., Agudo A., Vilardell M., Berenguer A., Amiano P., Ardanaz E., Arriola L., Barricarte A., Basterretxea M., et al. Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am. J. Epidemiol. 2009;170:1518–1529. doi: 10.1093/aje/kwp282.
    1. Itsiopoulos C., Brazionis L., Kaimakamis M., Cameron M., Best J., O’Dea K., Rowley K. Can the mediterranean diet lower hba1c in type 2 diabetes? Results from a randomized cross-over study. Nutr. Metab. Cardiovasc. Dis. 2011;21:740–747. doi: 10.1016/j.numecd.2010.03.005.
    1. Vincent-Baudry S., Defoort C., Gerber M., Bernard M.-C., Verger P., Helal O., Portugal H., Planells R., Grolier P., Amiot-Carlin M.-J., et al. The medi-rivage study: Reduction of cardiovascular disease risk factors after a 3-mo intervention with a mediterranean-type diet or a low-fat diet. Am. J. Clin. Nutr. 2005;82:964–971.
    1. Australian Dietary Guidelines: Summary. [(accessed on 23 February 2015)]; Available online: .
    1. De Lorgeril M., Salen P., Martin J.-L., Monjaud I., Delaye J., Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the lyon diet heart study. Circulation. 1999;99:779–785. doi: 10.1161/01.CIR.99.6.779.
    1. Trichopoulou A., Vasilopoulou E., Georga K., Soukara S., Dilis V. Traditional foods: Why and how to sustain them. Trends Food Sci. Technol. 2006;17:498–504. doi: 10.1016/j.tifs.2006.03.005.
    1. Ambring A., Friberg P., Axelsen M., Laffrenzen M., Taskinen M.-R., Basus S., Johansson M. Effects of a mediterranean-inspired diet on blood lipids, vascular function and oxidative stress in healthy subjects. Clin. Sci. 2004;106:519–525. doi: 10.1042/CS20030315.
    1. Zamora-Ros R., Andres-Lacueva C., Lameula-Raventós R.M., Berenguer T., Jakszyne P., Barricarte A., Ardanaz E., Amiano P., Dorronsoro M., Larranaga N., et al. Estimation of dietary sources and flavonoid intake in a spanish adult population (Epic-Spain) J. Am. Diet. Assoc. 2010;110:390–398. doi: 10.1016/j.jada.2009.11.024.
    1. Tresserra-Rimbau A., Rimm E.B., Medina-Remón A., Martínez-González M.Á., López-Sabater C.M., Arós F., Fiol M., Ros E., Serra-Majem L., Pintó X., et al. Polyphenol intake and mortality risk: A re-analysis of the predimed trial. BMC Med. 2014;12:77.
    1. Vasilopoulou E., Georga K., Joergensen B.M., Naska A., Trichopoulou A. The antioxidant properties of greek foods and the flavonoid content of the mediterranean menu. Curr. Med. Chem. 2005;5:33–45.
    1. Sofi F., Abbate R., Gensini G.F., Casini A., Trichopoulou A., Bamia C. Identification of change-points in the relationship between food groups in the mediterranean diet and overall mortality: An “a posteriori” approach. Eur. J. Nutr. 2012;51:167–172. doi: 10.1007/s00394-011-0202-7.
    1. Buckland G., Mayén A.L., Agudo A., Travier N., Navarro C., Huerta J.M., Chirlaque M.D., Barricarte A., Ardanaz E., Moreno-Iribas C., et al. Olive oil intake and mortality within the spanish population (Epic-Spain) Am. J. Clin. Nutr. 2012;96:142–149. doi: 10.3945/ajcn.111.024216.
    1. Alberti-Fidanza A., Fidanza F. Mediterranean adequacy index of italian diets. Public Health Nutr. 2004;7:937–941. doi: 10.1079/PHN2004557.
    1. Urpi-Sarda M., Casas R., Chiva-Blanch G., Romero-Mamani E.S., Valderas-Martínez P., Arranza S., Andres-Lacueva C., Llorach R., Medina-Remón A., Lamuela-Raventos R.M., et al. Virgin olive oil and nuts as key foods of the mediterranean diet effects on inflammatory biomarkers related to atherosclerosis. Pharmacol. Res. 2012;65:577–583. doi: 10.1016/j.phrs.2012.03.006.
    1. Urpi-Sarda M., Casas R., Chiva-Blanch G., Romero-Mamani E.S., Valderas-Martínez P., Salas-Salvadó J., Covas M.I., Toledo E., Andres-Lacueva C., Llorach R., et al. The mediterranean diet pattern and its main components are associated with lower plasma concentrations of tumor necrosis factor receptor 60 in patients at high risk for cardiovascular disease. J. Nutr. 2012;142:1019–1025. doi: 10.3945/jn.111.148726.
    1. Sofi F., Abbate R., Gensini G.F., Casini A. Accruing evidence on benefits of adherence to the mediterranean diet on health: An updated systematic review and meta-analysis. Am. J. Clin. Nutr. 2010;92:1189–1196. doi: 10.3945/ajcn.2010.29673.
    1. Fung T.T., Rexrode K.M., Mantzoros C.S., Manson J.E., Willett W.C., Hu F.B. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119:1093–1100. doi: 10.1161/CIRCULATIONAHA.108.816736.
    1. Breslow J.L. N-3 fatty acids and cardiovascular disease. Am. J. Clin. Nutr. 2006;83:1477S–1482S.
    1. Rafnsson S.B., Dilis V., Trichopoulou A. Antioxidant nutrients and age-related cognitive decline: A systematic review of population-based cohort studies. Eur. J. Nutr. 2013;52:1553–1567. doi: 10.1007/s00394-013-0541-7.
    1. Pérez-López F.R., Fernández-Alonso A., Chedraui P., Simoncini T. Mediterranean lifestyle and diet: Deconstructing mechanisms of health benefits. In: Watson R., Preedy V.R., editors. Bioactive Food as Dietary Intervention for the Aging Population. 1st ed. Academic Press; Waltham, MA, USA: 2013. pp. 129–138.
    1. Willett W.C., Howe G.R., Kushi L.H. Adjustment for total energy intake in epidemiologic studies. Am. J. Clin. Nutr. 1997;65:1220S–1228S.
    1. Souza R.G., Gomes A.C., Naves M.M., Mota J.F. Nuts and legume seeds for cardiovascular risk reduction: Scientific evidence and mechanisms of action. Nutr. Rev. 2015;73:335–347. doi: 10.1093/nutrit/nuu008.
    1. PubMed. [(accessed on 19 March 2013)]; Available online: .
    1. Ovid: Search. [(accessed on 20 March 2013)]. Available online:
    1. Science Direct. [(accessed on 21 March 2013)]. Available online:
    1. Academic Search Premier. [(accessed on 22 March 2013)]. Available online: .
    1. UniSA Library. [(accessed on 18 March 2013)]. Available online:

Source: PubMed

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