Adherence to the Mediterranean Diet

  • Maria Daniel Vaz Almeida
  • Salvatore Parisi
  • Amélia Martins Delgado
Chapter
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Abstract

This chapter discusses the desirable features of the Mediterranean diet (MD) and the current evolution of food habits in the countries forming the United Nations Education, Scientific and Cultural Organization MD Representative List. Several dietary indexes that measure adherence to the MD are presented and discussed for the countries of the area, as well as from a global perspective. The concept of ‘dietary pattern’ is used here as an integrated approach enabling the identification and quantification of associations between the ‘overall diet’ and specific health/disease outcomes. Some negative effects of adopting a so-called Western or globalized diet are highlighted, namely the increased proportion of processed energy-dense foods in the daily diet, along with a decreasing trend in the consumption of green vegetables and fresh fruits. These behavioural changes can be the result of a dietary transition, in this case with deleterious consequences. On the other hand, the analysis of nutritional epidemiology studies, complemented with information provided by studies at cellular and/or molecular levels, enables the discussion of the multiple associations between the MD, health, well-being and longevity.

Keywords

Mediterranean Diet Nutrition Transition Food Pattern Mediterranean Diet Score Cooking Skill 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. Alberti-Fidanza A, Fidanza F, Chiuchiù MP, Verducci G, Fruttini D (1999) Dietary studies on two rural Italian population groups of the Seven Countries Study. 3. Trend of food and nutrient intake from 1960 to 1991. Eur J Clin Nutr 53(11):854–860CrossRefGoogle Scholar
  2. Arvaniti F, Priftis KN, Papadimitriou A, Papadopoulos M, Roma E, Kapsokefalou M, Anthracopoulos MB, Panagiotakos DB (2011) Adherence to the Mediterranean type of diet is associated with lower prevalence of asthma symptoms, among 10-12 years old children: the PANACEA study. Pediatr Allergy Immunol 22(3):283–289. doi: 10.1111/j.1399-3038.2010.01113.x CrossRefGoogle Scholar
  3. Bach A, Serra-Majem L, Carrasco JL, Roman B, Ngo J, Bertomeu I, Obrador B (2006) The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review. Public Health Nutr 9(1A):132–146. doi: 10.1079/PHN2005936 CrossRefGoogle Scholar
  4. Barros R, Moreira A, Fonseca J, Ferraz de Oliveira J, Delgado L, Castel-Branco MG, Haahtela T, Lopes C, Moreira P (2008) Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control. Allergy 63(7):917–923. doi: 10.1111/j.1398-9995.2008.01665.x CrossRefGoogle Scholar
  5. Bonaccio M, Di Castelnuovo A, Bonanni A, Costanzo S, De Lucia F, Pounis G, Zito F, Donati MB, de Gaetano G, Iacoviello L (2013) Adherence to a Mediterranean diet is associated with a better health-related quality of life: a possible role of high dietary antioxidant content. BMJ 3(8):e003003. doi: 10.1136/bmjopen-2013-003003 CrossRefGoogle Scholar
  6. Bonaccio M, Di Castelnuovo A, De Curtis A, Costanzo S, Persichillo M, Donati MB, Cerletti C, Iacoviello L, de Gaetano G (2014) Adherence to the Mediterranean diet is associated with lower platelet and leukocyte counts: results from the Moli-sani study. Blood 123(19):3037–3044. doi: 10.1182/blood-2013-12-541672 CrossRefGoogle Scholar
  7. Buckland G, Bach A, Serra-Majem L (2008) Obesity and the Mediterranean diet: a systematic review of observational and intervention studies. Obes Rev 9(6):582–593. doi: 10.1111/j.1467-789X.2008.00503.x CrossRefGoogle Scholar
  8. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C (2004) Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA study. J Am Coll Cardiol 44(1):152–158. doi: 10.1016/j.jacc.2004.03.039 CrossRefGoogle Scholar
  9. Dai J, Jones DP, Goldberg J, Ziegler TR, Bostick RM, Wilson PW, Manatunga AK, Shallenberger L, Jones L, Vaccarino V (2008) Association between adherence to the Mediterranean diet and oxidative stress. Am J Clin Nutr 88(5):1364–1370Google Scholar
  10. da Silva R, Bach-Faig A, Quintana BR, Buckland G, Almeida MDV, Serra-Majem L (2009) Worldwide variation of adherence to the Mediterranean diet, in 1961–1965 and 2000–2003. Public Health Nutr 12(9A):1676–1684. doi: 10.1017/S1368980009990541 CrossRefGoogle Scholar
  11. Fung TT, McCullough ML, Newby PK, Manson JE, Meigs JB, Rifai N, Willett WC, Hu FB (2005) Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 82(1):163–173Google Scholar
  12. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB (2009) Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 119(8):1093–1100. doi: 10.1161/CIRCULATIONAHA.108.816736 CrossRefGoogle Scholar
  13. Garcia-Marcos L, Canflanca IM, Garrido JB, Varela AL-S, Garcia-Hernandez G, Grima FG, Gonzalez-Diaz C, Carvajal-Urueña I, Arnedo-Pena A, Busquets-Monge RM, Suarez Varela MM, Blanco-Quiros A (2007) Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren. Thorax 62(6):503–508. doi: 10.1136/thx.2006.060020 CrossRefGoogle Scholar
  14. Georgoulis M, Kontogianni MD, Yiannakouris N (2014) Mediterranean diet and diabetes: prevention and treatment. Nutrients 6(4):1406–1423. doi: 10.3390/nu6041406 CrossRefGoogle Scholar
  15. Gerber M (2006) Qualitative methods to evaluate Mediterranean diet in adults. Public Health Nutr 9(1A):147–151. doi: 10.1079/PHN2005937 CrossRefGoogle Scholar
  16. Goulet J, Lamarche B, Nadeau G, Lemieux S (2003) Effect of a nutritional intervention promoting the Mediterranean food pattern on plasma lipids, lipoproteins and body weight in healthy French-Canadian women. Atherosclerosis 170(1):115–124. doi: 10.1016/S0021-9150(03)00243-0 CrossRefGoogle Scholar
  17. Huijbregts P, Feskens E, Räsänen L, Fidanza F, Nissinen A, Menotti A, Kromhout D (1997) Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ 315(7099):13–17. doi: 10.1136/bmj.315.7099.13 CrossRefGoogle Scholar
  18. Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB (2011) The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 57(11):1299–1313. doi: 10.1016/j.jacc.2010.09.073 CrossRefGoogle Scholar
  19. Keys A (1995) Mediterranean diet and public health: personal reflections. Am J Clin Nutr 61(6 suppl):1321s–1333sGoogle Scholar
  20. Leal F, Oliveira B, Rodrigues S (2011) Relation between cooking habits and skills and Mediterranean diet in a sample of Portuguese adolescents. Perspect Public Health 131(6):283–287. doi: 10.1177/1757913911419909 CrossRefGoogle Scholar
  21. Mariscal-Arcas M, Rivas A, Velasco J, Ortega M, Caballero AM, Olea-Serrano F (2008) Evaluation of the Mediterranean Diet Quality Index (KIDMED) in children and adolescents in Southern Spain. Public Health Nutr 12(9):1408–1412. doi: 10.1017/S1368980008004126 CrossRefGoogle Scholar
  22. Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, Covas MI, Schröder H, Arós F, Gómez-Gracia E, Fiol M, Ruiz-Gutiérrez V, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Muñoz MA, Wärnberg J, Ros E, Estruch R (2012) A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One 7(8):e43134. doi: 10.1371/journal.pone.0043134 CrossRefGoogle Scholar
  23. Mena MP, Sacanella E, Vazquez-Agell M, Morales M, Fitó M, Escoda R, Serrano-Martínez M, Salas-Salvadó J, Benages N, Casas R, Lamuela-Raventós RM, Masanes F, Ros E, Estruch R (2009) Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the Mediterranean diet. Am J Clin Nutr 89(1):248–256. doi: 10.3945/ajcn.2008.26094 CrossRefGoogle Scholar
  24. Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, Briel M (2011) Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 124(9):841–851. doi: 10.1016/j.amjmed.2011.04.024 CrossRefGoogle Scholar
  25. Peres E (1997) Bem comidos e Bem Bebidos. Editorial Caminho, LisboaGoogle Scholar
  26. Popkin BM (2006) Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 84(2):289–298Google Scholar
  27. Rodrigues SSP, Caraher M, Trichopoulou A, Almeida MDV (2008) Portuguese households’ diet quality (adherence to Mediterranean food pattern and compliance with WHO population dietary goals): trends, regional disparities and socioeconomic determinants. Eur J Clin Nutr 62(11):1263–1272. doi: 10.1038/sj.ejcn.1602852 CrossRefGoogle Scholar
  28. Santos D, Rodrigues S, Trichopoulou A, Almeida MDV (2009) Adherence to the Mediterranean diet by Portuguese elderly. J Nutr Health Aging 13:S21–S22CrossRefGoogle Scholar
  29. Satalic Z, Baric IC, Keser I, Maric B (2004) Evaluation of diet quality with the Mediterranean dietary quality index in university students. Int J Food Sci Nutr 55(8):589–595. doi: 10.1080/09637480500086141 CrossRefGoogle Scholar
  30. Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Lamuela-Raventós R, Ros E, Salaverría I, Fiol M, Lapetra J, Vinyoles E, Gómez-Gracia E, Lahoz C, Serra-Majem L, Pintó X, Ruiz-Gutierrez V, Covas MI (2011) A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 141(6):1140–1145. doi: 10.3945/jn.110.135566 CrossRefGoogle Scholar
  31. Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, Aranceta J (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 7(7):931–935. doi: 10.1079/PHN2004556 Google Scholar
  32. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337:a1344. doi: 10.1136/bmj.a1344 CrossRefGoogle Scholar
  33. Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92(5):1189–1196. doi: 10.3945/ajcn.2010.29673 CrossRefGoogle Scholar
  34. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D (1995) Diet and overall survival in elderly people. BMJ 311(7018):1457–1460. doi: 10.1136/bmj.311.7018.1457 CrossRefGoogle Scholar
  35. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348(26):2599–2608. doi: 10.1056/NEJMoa025039 CrossRefGoogle Scholar
  36. Vareiro D, Faig AB, Quintana B, Bertomeu I, Buckland G, Almeida MDV, Majem LS (2009) Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas. Public Health Nutr 12(9A):936–941. doi: 10.1017/S136898000999053X CrossRefGoogle Scholar
  37. WHO (2015) Programmes and projects. Nutrition. Nutrition health topics. 3. Global and regional food consumption patterns and trends. Available at http://www.who.int/nutrition/topics/3_foodconsumption/en/. Accessed 30 Oct 2015
  38. Yang J, Farioli A, Korre M, Kales SN (2014) Modified Mediterranean diet score and cardiovascular risk in a North American working population. PLoS One 9(2):e87539. doi: 10.1371/journal.pone.0087539 CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Maria Daniel Vaz Almeida
    • 1
  • Salvatore Parisi
    • 2
  • Amélia Martins Delgado
    • 3
  1. 1.Faculty of Nutrition and Food SciencesUniversity of PortoOportoPortugal
  2. 2.Associazione ‘Componiamo il Futuro’ (CO.I.F.)PalermoItaly
  3. 3.Consultant for Food Safety and NutritionLisbonPortugal

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