This article is about the dietary recommendation that became popular in the 1990s. For food of the areas around the Mediterranean Sea, seeMediterranean cuisine.
Some ingredients that form a large part of the Mediterranean diet
TheMediterranean diet is a concept first proposed in 1975 by American biologistAncel Keys and chemist Margaret Keys. It is inspired by the eating habits andtraditional foods ofGreece,Italy, and the Mediterranean coasts ofFrance andSpain, as observed in the late 1950s to early 1960s.[1][2] The diet is distinct fromMediterranean cuisine, which encompasses the diverseculinary traditions ofMediterranean countries,[3] and from theAtlantic diet of northwestern Spain and Portugal, albeit with some shared characteristics.[4] The Mediterranean diet is the most well-known and researched dietary pattern in the world.[5]
Mediterranean cuisine and its associated traditions and practices were recognized as anIntangible Cultural Heritage of Humanity byUNESCO in 2010 under the name "Mediterranean Diet".[a][18] The Mediterranean diet is sometimes broadened to include particularlifestyle habits, social behaviors, and cultural values closely associated with certain Mediterranean countries,[19] such as simple but variedcooking methods,[20]communal meals,post-lunch naps, and regular physical activity.[17][21]
The Mediterranean diet is low insaturated fat with high amounts ofmonounsaturated fat anddietary fiber. One possible factor is thepotential health effects of olive oil in the Mediterranean diet. Olive oil contains monounsaturated fats, most notablyoleic acid, which is under clinical research for its potential health benefits.[22] TheEuropean Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies approved health claims on olive oil, for protection by itspolyphenols against oxidation of blood lipids[23] and for the contribution to the maintenance of normal bloodLDL-cholesterol levels by replacing saturated fats in the diet with oleic acid[24] (Commission Regulation (EU) 432/2012 of 16 May 2012).[25] A 2014 meta-analysis concluded that an elevated consumption of olive oil is associated with reduced risk of all-cause mortality, cardiovascular events and stroke, while monounsaturated fatty acids of mixed animal and plant origin showed no significant effects.[26]
The United States 2015–2020 national guidelines devised a "Healthy Mediterranean-Style Eating Pattern" from the Mediterranean diet patterns and its positive health outcomes. It was designed from the "Healthy U.S.-Style Eating Pattern", but recommends more fruits and seafood, and less dairy.[16] A 2020 review of research on the Mediterranean diet indicated that it may optimize cardiovascular health.[27]
A 2017 review found evidence that practice of a Mediterranean diet could lead to reduced risk ofcardiovascular diseases, overallcancer incidence,neurodegenerative diseases,diabetes, andearly death.[14] A 2018 review showed that practice of the Mediterranean diet may improve overall health status, such as reduced risk of non-infectious diseases, may reduce totalcosts of living, and may reduce costs for nationalhealthcare.[28] A 2016 review found similar weight loss as other diets.[29]
The Mediterranean diet is included among dietary patterns that may reduce the risk of cardiovascular diseases.[15] A 2013Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascularrisk factors.[30] A 2013 meta-analysis compared Mediterranean,vegan, vegetarian, low-glycemic index, low-carbohydrate,high-fiber, andhigh-protein diets with control diets. The research concluded that Mediterranean,low-carbohydrate,low-glycemic index, andhigh-protein diets are effective in improving markers of risk for cardiovascular disease and diabetes, while there was limited evidence for an effect of vegetarian diets on glycemic control and lipid levels unrelated to weight loss.[31] A Mediterranean diet was recommended in 2016 as a means of loweringapolipoprotein B.[32]
However, more cautious reviews arose in 2016, raising concerns about the quality of previoussystematic reviews examining the impact of a Mediterranean diet on cardiovascular risk factors.[34] These reviews encouraged the need for further standardized research,[35] with one review and meta-analysis concluding that the quantity and quality of the available evidence were highly variable, cautioning that limitations exist about the certainty of possible clinical outcomes from consuming a Mediterranean diet.[36] Other reviews in 2016-17 reached further conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors, such as lowering the risk forhypertension and other cardiovascular diseases.[14][37]
A 2019Cochrane review found that uncertainty exists about the effects of a Mediterranean‐style diet on cardiovascular disease occurrence and risk factors in people both with or without extant cardiovascular disease.[30] The review further discussed that research on the diet provided evidence for only modest benefits against cardiovascular disease risk factors, with the research having low to moderate quality.[30]
A 2023 review provided evidence for a reduction of mortality and cardiovascular disease risk in women on a Mediterranean-type diet.[38] A 2024 meta-analysis found that adherence to consuming these foods was associated with reduction in cardiovascular disease risk.[39]
In 2014, two meta-analyses found that the Mediterranean diet was associated with a decreased risk oftype 2 diabetes,[40][41] findings similar to those of a 2017 review.[14] The American Diabetes Association and a 2019 review indicated that the Mediterranean diet is a healthy dietary pattern that may reduce the risk of diabetes.[42][43]
Ameta-analysis in 2008 found that strictly following the Mediterranean diet was correlated with a decreased risk of dying from cancer by 6%.[44] Another 2014 review found that adherence to the Mediterranean diet was associated with a decreased risk of death from cancer.[45] A 2017 review found a decreased rate of cancer, although evidence was weak.[14] An updated review in 2021 found that the Mediterranean diet is associated with a 13% lower risk of cancer mortality in the general population.[46]
Overweight adults who adopt Mediterranean diets may lose weight by consuming fewer calories.[47][48][49] A 2019 review found that the Mediterranean diet may help obese people lower the quantity and improve the nutritional quality of food intake, with an overall effect of possibly losing body weight.[15]
A 2016 systematic review found a relation between greater adherence to a Mediterranean diet and better cognitive performance; it is unclear if the relationship is causal.[50]
According to a 2013 systematic review, greater adherence to a Mediterranean diet is correlated with a lower risk ofAlzheimer's disease and slower cognitive decline.[51] Another 2013 systematic review reached similar conclusions, and also found a negative association with the risk of progressing frommild cognitive impairment to Alzheimer's, but acknowledged that only a small number of studies had been done on the topic.[52]
Observational studies have found a correlation between adherence to the Mediterranean diet and a lower risk of depression but have not proven that a Mediterranean diet lowers the risk of depression.[53][54]
As the Mediterranean diet usually includes products containinggluten, such as pasta and bread, increasing use of the diet may have contributed to the growing rate ofgluten-related disorders.[55]
The Mediterranean dietfood pyramid, summarizing the pattern of eating associated with this diet
There are variations of the "Mediterranean diets" in different countries and among the individual populations of the Mediterranean basin, due to ethnic, cultural, economic and religious diversities.[56] The "Mediterranean diet" as defined by dietitians generally includes the following components,[15] which are not typical of diets in theMediterranean Basin:[57][58]
High intakes ofolive oil (as the principal source of fat), and aplant-based diet: vegetables (including leafy green vegetables, onions, garlic, tomatoes, and peppers), fresh fruits (consumed as desserts or snacks), cereals (mostlywhole grains), nuts, and legumes.
Moderate intakes of fish and otherseafood, poultry, eggs,dairy products (primarily cheese and yogurt), and red wine.
Low intakes of red meat,processed meat, refined carbohydrates, and sweets.
These proportions are sometimes represented in theMediterranean Diet Pyramid. In a diet with roughly this composition, the fat content accounts for 25% to 35% of the total intake ofcalories, while the amount of saturated fat is, at most, 8% of the calorie content.[58]
Somecuisines of the Mediterranean region are not fully consistent with Mediterranean diet guidelines. For instance, olive oil is not the staple fat in the cuisines of all countries which border the Mediterranean: innorthern andcentral Italy,lard andbutter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables;[59] in bothNorth Africa and theMiddle East, sheep'stail fat and rendered butter (samna) are traditional staple fats.[60]
Comparison of dietary recommendations for three Mediterranean diet plans
Consuming a Mediterranean diet or plant-based diet may contribute to improvingenvironmental andagricultural sustainability,[65][66] possibly due to lower use of dairy products,ruminant meat, andultra-processed foods.[67][68] The environmental impact and amount of energy needed to feed livestock exceeds its nutritional value.[69][70] In a 2014 lifecycle analysis ofgreenhouse gas emissions, researchers found that a Mediterranean-like diet may reduce food production emissions below those of an omnivorous diet for 2050, with aper capita reduction of 30%.[71][72]
Elements of the Mediterranean diet have been traced to several ancient cultures in the region, particularly the Greeks and Romans, using olive oil, seafood, bread, and wine.[73] The Mediterranean diet as a concept was first publicized in 1975 by American biologistAncel Keys and chemist Margaret Keys, a husband-and-wife team.[73] The Keys were the first to draw a correlation between cardiovascular disease and diet, based on studies in the 1950s in southern Italy.[73]
Objective data showing possible benefits of the Mediterranean diet originated fromepidemiological studies in southern Italy andCrete; these were confirmed later by theSeven Countries Study directed by Keys and published in 1970,[74][75] which was followed by a book-length report in 1980.[76] A 25-year follow up study published in 1996 determined that populations that had adopted a "Mediterranean diet"—defined as incorporating olive oil, bread, pasta, vegetables, herbs and seafood, with moderate consumption of meat—presented low levels of blood cholesterol and reduced incidence of coronary heart disease.[75][77]
The Mediterranean diet was further studied in the 1990s byWalter Willett and colleagues of theHarvard University School of Public Health.[78][79][80][81] The Mediterranean diet is based on a paradox: although people living in Mediterranean countries tend to consume relatively high amounts of fat, they generally have lower incidence of cardiovascular disease than those living in countries with similar levels of fat consumption, such as the United States; a parallel phenomenon is known as theFrench paradox.[82]
In 2018, clinical research showed favorable outcomes for using the Mediterranean diet to lower the risk ofmetabolic syndrome.[85]
Researchers frequently use questionnaires such as the MEDAS questionnaire (Mediterranean diet adherence screener) to monitor how closely someone is adhering to a Mediterranean-style diet, and can also be used by individuals monitoring their own diet.[86][87]
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Hoffman, Richard; Gerber, Mariette (2012).The Mediterranean Diet: Health and Science. Chichester, West Sussex:Wiley-Blackwell.ISBN978-1-118-78502-7.
Preedy, Victor R.; Watson, Ronald Ross, eds. (2020).The Mediterranean Diet: An Evidence-Based Approach (2nd ed.). Cambridge, Massachusetts:Academic Press.ISBN978-0-12-818649-7.
Romagnolo, Donato F.; Selmin, Ornella I., eds. (2016).Mediterranean Diet: Dietary Guidelines and Impact on Health and Disease. Humana Cham.ISBN978-3-319-27969-5.
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