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The Mediterranean Diet: A Healthy Dietary Plan

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Nutrition Guide for Physicians and Related Healthcare Professions

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Abstract

The concept of a Mediterranean diet can be attributed to Ancel Keys. His insights began the study of this dietary pattern and its many variations. Components of the Mediterranean diet have been described and compared to other high-quality diets. The health benefits from the diet have been examined in four separate categories. Central adiposity was significantly less in individuals adhering to a Mediterranean diet than those with poorer adherence scores to a Mediterranean diet. Substituting different types of monounsaturated or polyunsaturated fat for saturated fat, red meat, or carbohydrate significantly reduced body weight. The risk of developing diabetes and the control of the disease are both improved by using a Mediterranean diet plan. In one of the most impressive studies of the Mediterranean diet, the use of extra virgin olive oil (EVOO) or nuts improved major adverse cardiovascular end points. The diet with extra virgin olive oil also reduced the incidence of atrial fibrillation and the detrimental effect of ceramides in individuals with higher baseline values. Finally, the Mediterranean diet improved the features of the metabolic syndrome.

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References

  1. 2019 US News & World Report best diet rankings. https://www.usnews.com/info/blogs/press-room/articles/2019-01-02/us-news-reveals-best-diets-rankings-for-2019.

  2. 2020 US News & World Report best diet rankings. https://www.usnews.com/info/blogs/press-room/articles/2020-01-02/us-news-reveals-best-diets-rankings-for-2020.

  3. Keys A. Mediterranean diet and public health: personal reflections. Am J Clin Nutr. 1995;1(Suppl):1321S–3S.

    Article  Google Scholar 

  4. Keys A, Aravanis C, Blackburn HW, Van Buchem FS, Buzina R, Djordjevi BD, et al. Epidemiological studies related to coronary heart disease: characteristics of men aged 40–59 in seven countries. Acta Med Scand Suppl. 1966;460:1–392.

    CAS  PubMed  Google Scholar 

  5. Dinu M, Pagliai G, Casini A, et al. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72:30–43.

    Article  CAS  PubMed  Google Scholar 

  6. Rees K, Takeda A, Martin N, Ellis L, Wijesekara D, Vepa A, et al. Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2019;3. Art. No.: CD009825 https://doi.org/10.1002/14651858.CD009825.pub3.

  7. Rosato V, Temple NJ, La Vecchia C, Castellan G, Tavani A, Guercio V. Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr. 2019;58:173–91.

    Article  CAS  PubMed  Google Scholar 

  8. Temple NJ, Guercio V, Tavani A. The Mediterranean diet and cardiovascular disease, gaps in the evidence and research challenges. Cardiol Rev. 2019;27:127–30.

    Article  PubMed  Google Scholar 

  9. Panagiotakis DB, Pitsavos C, Arvaniti F, Stefa-nidis C. Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity among healthy adults; the accuracy of the MedDiet score. Prev Med. 2007;44(4):335–40. https://doi.org/10.1016/j.ypmed.2006.12.009. Epub 2006 Dec 30. December 30, 2006

    Article  Google Scholar 

  10. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. PREDIMED study investigators. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. https://doi.org/10.1056/NEJMoa1800389. Epub 2018 Jun 13

    Article  CAS  PubMed  Google Scholar 

  11. Ros E, Martínez-González MA, Estruch R, Salas-Salvadó J, Fitó M, Martínez JA, Corella D. Mediterranean diet and cardiovascular health: teachings of the PREDIMED study. Adv Nutr. 2014;5:330S–6S. https://doi.org/10.3945/an.113.005389.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E, Salas-Salvado J, Buil-Cosiales P, Corella D, et al.; for the PREDIMED Study Investigators. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED. PLoS One. 2012;7(8):e43134. https://doi.org/10.1371/journal.pone.0043134.

  13. Beulen Y, Martínez-González MA, van de Rest O, Salas-Salvadó J, Sorlí JV, Gómez-Gracia E, et al. Quality of dietary fat intake and body weight and obesity in a Mediterranean population: secondary analyses within the PREDIMED trial. Nutrients. 2018 Dec 19;10(12):2011. https://doi.org/10.3390/nu10122011.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean diet and diabetes: prevention and treatment. A review. Nutrients. 2014;6:1406–23. https://doi.org/10.3390/nu6041406.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Mozaffarian D, Marfisi R, Levantesi G, Silletta MG, Tavazzi L, Tognoni G, et al. Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors. Lancet. 2007;370:667–75. https://doi.org/10.1016/S0140-6736(07)61343-9.

    Article  CAS  PubMed  Google Scholar 

  16. Martinez-Gonzalez MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008;336:1348–51. https://doi.org/10.1136/bmj.39561.501007.BE.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. De Koning L, Chiuve SE, Fung TT, Willett WC, Rimm EB, Hu FB. Diet-quality scores and the risk of type 2 diabetes in men. Diabetes Care. 2011;34:1150–6. https://doi.org/10.2337/dc10-2352.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Romaguera D, Guevara M, Norat T, Langenberg C, Forouhi NG, Sharp S, 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;34:1913–8. https://doi.org/10.2337/dc11-0891.

    Article  CAS  PubMed  Google Scholar 

  19. Tobias DK, Zhang C, Chavarro J, Bowers K, Rich-Edwards J, Rosner B, et al. Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus. Am J Clin Nutr. 2012;96:289–95. https://doi.org/10.3945/ajcn.111.028266.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Tobias DK, Hu FB, Chavarro J, Rosner B, Mozaffarian D, Zhang C. Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med. 2012;172:1566–72. https://doi.org/10.1001/archinternmed.2012.3747.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Abiemo EE, Alonso A, Nettleton JA, Steffen LM, Bertoni AG, Jain A, Lutsey PL. Relationships of the Mediterranean dietary pattern with insulin resistance and diabetes incidence in the multi-ethnic study of atherosclerosis (MESA). Br J Nutr. 2013;109:1490–7. https://doi.org/10.1017/S0007114512003339.

    Article  CAS  PubMed  Google Scholar 

  22. Rossi M, Turati F, Lagiou P, Trichopoulos D, Augustin LS, La Vecchia C, Trichopoulou A. Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the greek cohort of the population-based european prospective investigation into cancer and nutrition (EPIC). Diabetologia. 2013;56:2405–13. https://doi.org/10.1007/s00125-013-3013-y.

    Article  CAS  PubMed  Google Scholar 

  23. Esposito K, Maiorino MI, Bellastella G, Chiodini P, Panagiotakos D, Giugliano D. A journey into a Mediterranean diet and type 2 diabetes: as systematic review with meta-analyses. BMJ Open. 2015;5:e008222. https://doi.org/10.1136/bmjopen-2015-008222.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ruiz-Canela M, Guasch-Ferré M, Toledo E, Clish CB, Razquin C, Liang L, et al. Plasma branched chain/aromatic amino acids, enriched Mediterranean diet and risk of type 2 diabetes: case-cohort study within the PREDIMED trial. Diabetologia 2018;61(7):1560–1571. doi: https://doi.org/10.1007/s00125-018-4611-5. Epub 2018 Apr 16.

  25. Martínez-González MÁ, Toledo E, Arós F, Fiol M, Corella D, Salas-Salvadó J, et al.; PREDIMED Investigators. Extra virgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevención con Dieta Mediterránea) trial. Circulation 2014;130(1):18–26. https://doi.org/10.1161/CIRCULATIONAHA.113.006921. Epub 2014 Apr 30. PMID: 24787471.

  26. Liyanage T, Ninomiya T, Wang A, Neal B, Jun M, Wong MG, et al. Effects of the Mediterranean diet on cardiovascular outcomes-a systematic review and meta-analysis. PLoS One. 2016;11(8):e0159252. https://doi.org/10.1371/journal.pone.0159252.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454–9.

    Article  PubMed  Google Scholar 

  28. Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, et al. Effect of an indo-Mediterranean diet on progression of coronary artery disease in high risk patients (indo-Mediterranean diet heart study): a randomised single-blind trial. Lancet. 2002;360:1455–61.

    Article  PubMed  Google Scholar 

  29. Burr ML, Ashfield-Watt PA, Dunstan FD, Fehily AM, Breay P, Ashton T, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr. 2003;57:193–200.

    Article  CAS  PubMed  Google Scholar 

  30. Ng GW, Chan UM, Li PC, Wong WC. Can a Mediterranean diet reduce the effects of lipodystrophy syndrome in people living with HIV? A pilot randomised controlled trial. Sex Health. 2011;8:43–51. https://doi.org/10.1071/SH09065.

    Article  PubMed  Google Scholar 

  31. Becerra-Tomás N, Blanco Mejía S, Viguiliouk E, Khan T, Kendall CWC, Kahleova H, et al. Mediterranean diet, cardiovascular disease and mortality in diabetes: a systematic review and meta-analysis of prospective cohort studies and randomized clinical trials. Crit Rev Food Sci Nutr 2019 24:1–21. doi: https://doi.org/10.1080/10408398.2019.1565281. [Epub ahead of print].

  32. Sofi F, Abbate R, Gensini GF, 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(5):1189–96. https://doi.org/10.3945/ajcn.2010.29673. Epub 2010 Sep 1

    Article  CAS  PubMed  Google Scholar 

  33. Wang DD, Toledo E, Hruby A, Rosner BA, Willett WC, Sun Q, et al. Plasma ceramides, Mediterranean diet, and incident cardiovascular disease in the PREDIMED trial (Prevención con Dieta Mediterránea). Circulation. 2017;135(21):2028–40. https://doi.org/10.1161/CIRCULATIONAHA.116.024261. Epub 2017 Mar 9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Alberti KGMM, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome – a new worldwide definition. Lancet. 2005;366(9491):1059–62.

    Article  PubMed  Google Scholar 

  35. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. A randomized trial. JAMA. 2004;292:1440–6.

    Article  CAS  PubMed  Google Scholar 

  36. Pan B, Wu Y, Yang Q, Ge L, Gao C, Xun Y, et al. The impact of major dietary patterns on glycemic control, cardiovascular risk factors, and weight loss in patients with type 2 diabetes: a network meta-analysis. J Evid Based Med. 2019;12(1):29–39. https://doi.org/10.1111/jebm.12312. Epub 2018 Aug 1.

  37. Steffen LM, Van Horn L, Daviglus ML, Zhou X, Reis JP, Loria CM, et al.. A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (coronary artery risk development in young adults) study. Br J Nutr. 2014;112(10):1654–1661. https://doi.org/10.1017/S0007114514002633. Epub 2014 Sep 19. PMID: 25234439.

Suggested Further Readings

  • Benson G, Hayes J. An update on the Mediterranean, vegetarian, and DASH eating patterns in people with type 2 diabetes. Diabetes Spectrum. 2020;33(2):125–32. This paper compares the Mediterranean Diet with two other major dietary patterns

    Article  PubMed  PubMed Central  Google Scholar 

  • Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, et al. PREDIMED study investigators. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. This paper is the classic one on the reduction in cardiovascular disease and the Mediterranean Diet

    Article  CAS  PubMed  Google Scholar 

  • Keys A. Mediterranean diet and public health: personal reflections. Am J Clin Nutr. 1995;1(Suppl):1321S–3S. This paper provides insight into the man who was instrumental in initiating interest in this dietary pattern

    Article  Google Scholar 

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Correspondence to George A. Bray .

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Bray, G.A., Champagne, C.M. (2022). The Mediterranean Diet: A Healthy Dietary Plan. In: Wilson, T., Temple, N.J., Bray, G.A. (eds) Nutrition Guide for Physicians and Related Healthcare Professions. Nutrition and Health. Humana, Cham. https://doi.org/10.1007/978-3-030-82515-7_15

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  • DOI: https://doi.org/10.1007/978-3-030-82515-7_15

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