Mediterranean diet: the past and the present.
Mortality statistics from the World Health Organization have provided early evidence that diet in the Mediterranean countries has been affecting the health of the respective populations and, in particular, their coronary health. Keys (1) has taken the lead arguing that the traditional Mediterranean diet has beneficial effects on health. Recent studies, capturing the evidence accumulated over the last three decades, have documented that the traditional Mediterranean diet meets several important criteria for a healthy diet. An attempt to conceptualize the proper diet and to make it able to function has been reported and a score has been developed and evaluated. Studies among the elderly in Greece, Denmark, Australia, Spain and China have shown that the overall Mediterranean dietary pattern was more important for longevity than single nutrients. These findings suggest, therefore, that a Mediterranean diet is associated with longer survival. Two additional questions should be addressed at this time: Is the Mediterranean diet an integral entity, or the sum of identifiable components that can and should be separately considered in the development of guidelines? Is the Mediterranean diet or its major components transferable to populations living far from the Mediterranean area? Answers to these questions would be important for scientific and policy reasons. The dietary patterns that prevail in the Mediterranean area have many common characteristics, most of which stem from the fact that olive oil plays an important role in all of them. Thus, although different regions in the Mediterranean basin have their own diets, it is legitimate to consider them as variants of a single entity, the Mediterranean diet. The Mediterranean diet can be described as the dietary pattern found in the olive growing areas of the Mediterranean region, in the late '50s and early '60s, when the consequences of World War II were overcome, but the fast-food culture had not reached the area yet (2). Olive oil is important both because of its several beneficial properties and because it allows the consumption of large quantities of vegetables and legumes in the form of salads and of cooked foods. Other essential components of the Mediterranean diet are wheat, grapes, and their derived products. Total lipid consumption may be high, around 40% of total energy intake as in Greece, or moderate, around 30% of total energy intake as in Italy. In all instances, however, the ratio of monounsaturated to saturated dietary lipids is much higher than in other places of the world, including northern Europe and North America (3).