Definition, foods, and health effects of the Mediterranean Diet

The term “Mediterranean Diet” was introduced in the 1950’s by the studies of nutritionist Ancel Keys (at that time he lived in Salerno, near Naples, Italy) and colleagues, and refers to dietary habits characterized by the consumption of large quantities of vegetables, legumes, fruits, cereals, with extravirgin olive oil as the main source of fat, and low intake of meat, especially red meat.
These dietary habits were formulated through the century, are an healthy protecting diet with also pleasant taste that contribute to a better quality of life.

Note: Ancel Keys was also the creator of K Ration Diet, a portable meal contained 3000 Kcal for soldiers in emergency situation during World War II.


Mediterranean Diet and chronic degenerative diseases

The most well-known research on this eating pattern is the Seven Countries Study, conducted in the 1950’s and 1960’s by Keys and colleagues who, in the early 1950’s (so before the starting of the Study) observed very low rates of coronary heart disease and certain types of cancer in the population of the island of Crete in Greece, in much of the rest of Greece and in southern Italy than the United States of America.
These observations led Keys at all. to subsequent research in the Seven Countries Study that involved 12,763 men from Finland, Greece, Italy, Japan, the Netherlands, the U.S., and Yugoslavia, ages 40-59 and continued for 25 years, in which they looked at the correlation with decreased risk of all-cause and cardiovascular disease (CVD)-related deaths. The Study showed that saturated fats are the major dietary villain and who followed the largely plant-based Mediterranean Diet had decreased risk of cardiovascular disease.

After Key’s Study, many others have showed, in different industrialized and non-industrialized population, the beneficial role of this eating pattern not only on the occurrence of cardiovascular disease but also on chronic degenerative diseases.
In a recent meta-analysis an Italian research team have analyzed the association between adherence to a Mediterranean Diet, mortality, and incidence of diseases in 12 studies, six done in Mediterranean population and the remaining in US populations, northern Europeans, and Europeans living in Australia, with a total of 1 574 299 subjects followed for a time of 3-18 years. This study have showed that “greater adherence to a Mediterranean Diet is significantly associated with a reduced risk of overall mortality, cardiovascular mortality, cancer incidence and mortality, and incidence of Parkinson’s disease and Alzheimer’s disease” (Sofi F. at al. BMJ 2008, see References).
So, these dietary habits are a primary and secondary prevention of major chronic diseases and must be preserved and promoted against the worldwide trends toward dietary uniformity (even in countries of Mediterranean basin) as, of course, all the major scientific associations strongly encourage.
Greater adherence to the traditional Mediterranean Diet is associated with a longer survivor.
It is a eating pattern which uses simple ingredients and simple ways of cooking; the widely accepted components present in recipes are:

an high consumption of:

  • * extravirgin olive oil (without it Mediterranean Diet does not exist; it is a good source of monounsaturated fats with more than 2000 microcompounds; for dressing salads, spreading on bread or cooking, but preferable raw)
  • * vegetables
  • * fruits and nuts
  • * legumes as peas, beans, chickpeas, lentils, fava beans and lupins
  • cereals, better if unrefined as in the past (the heart of this diet is mainly vegetarian so there is a high intake of fiber and antioxidants that exist in abundance in vegetables, fruit and extravirgin olive oil)
  • fish and seafood

low consumption of:

  • * meat, meat products
  • high-fat dairy products
  • high ratio of monounsaturated to saturated fatty acids (this, for example, improves lipid profiles and glycaemic control in people with diabetes)
  • * moderate intake of ethanol primarily in the form of red wine generally during meals

* At least in the Greek population segment participating to EPIC study these are the dominant components predictor of lower mortality.

The intake of industrial trans fatty acids as less as possible (zero would be better!).

It is misleading to focus on a single element of this eating pattern; it does not exist “the magic bullet” as shown by trials focused on a single element (i.e. vitamin supplementation). People don’t eat a isolated nutrient but a complex of them and, more important, nutrients interact with each other in synergistic or antagonist way. So, the health benefits of Mediterranean diet are due to all its components, not at a particularly.
It’s the whole pattern who exerts the effect; one could say: united we stand, divided we fall!

Role in the reduction of greenhouse gas emissions

These dietary habits can improve public health also contribute to reducing greenhouse gas emissions (carbon dioxide (CO2), methane, nitrous oxide and the like) related to the food production, especially meat (the 4/5 emission related to agriculture resulting from the livestock sector).
Population is growing, will exceed 7 billion by 2012 and according to forecasts will reach 9 billion by 2046. This growth is also accompanied by increased meat consumption per capita: it is estimated that population growth by 2030 will cause an increase in meat production by 85% compared to 2000, mainly by the growing demand from countries with transition economies. From the environmental point of view this is an extremely dangerous phenomenon because greenhouse-gas emissions from livestock sector exceeds that due to transport (18% versus 14% of total) and is second only to energy production (21% of total).
So, what is the relationship between greenhouse-gases and Mediterranean diet?
Mediterranean diet is characterized by the prevailing consumption of foods of plant origin such as vegetables, legumes, cereals and olive oil while it reduced meat consumption, especially red. From the above it is evident the less environmental impact, and the consequent public health benefits linked to it, of Mediterranean diet than other diets where meat consumption, especially red, is considerably greater.
And then the individual person should carefully examine his diet not only for its direct consequences on himself but also for the planet and then back on itself.


Estruch R., Ros E., Salas-Salvadó J., et al. Primary prevention of cardiovascular disease with a Mediterranean Diet. N Engl J Med February 25, 2013. doi:10.1056/NEJMoa1200303

Fiala N. Hamburger a effetto serra. Le scienze. Dicembre 2009

Friel S., Dangour A.D., Garnett T., Lock K., Chalabi Z., Roberts I., Butler A., Butler C.D., Waage J., McMichael A.J. and Haines A. Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture. Lancet 2009;374:2016-25. doi:10.1016/S0140-6736(09)61753-0

Giugliano D. and Esposito K. Mediterranean Diet and Cardiovascular Health. Annals NY Acad Sci 2005;1056(1):253-60. doi:10.1196/annals.1352.012

Giugliano D. and Esposito K. Mediterranean diet and metabolic diseases. Curr Opin Lipidol 2008;19:63-8. doi:10.1097/MOL.0b013e3282f2fa4d

Keys A. Mediterranean diet and public health: personal reflections. Am J Clin Nutr 1995;61:1321S-23S doi:10.1093/ajcn/61.6.1321S

Keys A., Aravanis C., Blackburn H., Buzina R., Djordjevic B.S., Dontas A.S., Fidanza F., Karvonen M.J., Kimura N., Menotti A., Mohacek I., Nedeljkovic S., Puddu V., Punsar S., Taylor H.L., Van Buchem F.S.P. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease.  Harvard University Press, Cambridge, Harvard University Press, ISBN: 0-674-80237-3, 1980. 381 pp.

Martínez-González M.Á., de la Fuente-Arrillaga C., Nunez-Cordoba J.M., Basterra-Gortari F.J., Beunza J.J., Vazquez Z., Benito S., Tortosa A., Bes-Rastrollo M. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 2008;336:1348-51. doi:10.11bmj.39561.501007.BE

Nestle M. Mediterranean diets: historical and research overview. Am J Clin Nutr 1995;61:1313S-20S doi:10.1093/ajcn/61.6.1313S

Samieri C., Okereke O.I., E. Devore E.E. and Grodstein F. Long-term adherence to the Mediterranean Diet is associated with overall cognitive status, but not cognitive decline, in women. J Nutr 2013;143:493-9. doi:10.3945/​jn.112.169896

Schröder H. Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. J Nutr Biochem 2007;18:149-60. doi:10.1016/j.jnutbio.2006.05.006

Sofi F., Cesari F., Abbate R., Gensini G.F. and Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008;337:a1344. doi:10.1136/bmj.a1344

Subak S. Global environmental costs of beef production. Ecol. Econom. 1999;30:79-91. doi:10.1016/S0921-8009(98)00100-1

Trichopoulou A., Bamia C. and Trichopoulos D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 2009;338:b2337. doi:10.1136/bmj.b2337

Trichopoulou A., Costacou T., Bamia C., Trichopoulos D. Adherence to a Mediterranean Diet and Survival in a Greek Population. N Engl J Med 2003;348:2599-08. doi:10.1056/NEJMoa025039

VanItallie T.B. Ancel Keys: a tribute. Nutr Metab (Lond) 2005;2:4. doi:10.1186/1743-7075-2-4

Scroll Up