Definitions and potential health benefits of the Mediterranean diet: views from experts around the world

Abstract

The Mediterranean diet has been linked to a number of health benefits, including reduced mortality risk and lower incidence of cardiovascular disease. Definitions of the Mediterranean diet vary across some settings, and scores are increasingly being employed to define Mediterranean diet adherence in epidemiological studies. Some components of the Mediterranean diet overlap with other healthy dietary patterns, whereas other aspects are unique to the Mediterranean diet. In this forum article, we asked clinicians and researchers with an interest in the effect of diet on health to describe what constitutes a Mediterranean diet in different geographical settings, and how we can study the health benefits of this dietary pattern.

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Antonia Trichopoulou is Professor Emeritus at the School of Medicine, University of Athens, Greece and Vice President of the non-profit Hellenic Health Foundation. Trichopoulou was the first to develop a Mediterranean diet score to measure adherence to this diet and facilitate the study of its health effects.

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Miguel A Martínez-González is Professor and Chair of the Department of Preventive Medicine and Public Health University of Navarra, Spain. Martínez-González leads Network RD 06/0045 of the PREDIMED study, the first primary prevention trial to demonstrate that consuming a Mediterranean diet reduces the incidence of major cardiovascular events. He is also a principal investigator on the SUN (Seguimiento Universidad de Navarra) cohort study, and a visiting scholar at the Department of Nutrition, Harvard School of Public Health.

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Tammy Tong is undertaking her doctoral studies (PhD) at the MRC Epidemiology Unit in Cambridge, UK. Her work is focused on assessing the applicability of the Mediterranean diet in the UK context, and in examining etiological associations of the diet with cardio-metabolic disorders.

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Nita Forouhi is the Group Leader of the nutritional epidemiology program at the MRC Epidemiology Unit in Cambridge, UK. Trained in Medicine, Epidemiology and Public Health, Nita is interested in etiology, prevention and between-population differences. Nita is leading a program of research that aims to understand the association between diet/nutrition and the risk of diabetes, obesity and related disorders. Her research has a particular focus on developing and using improved methods to assess diet, including the use of objectively measured nutritional biomarkers.

Figure 5

The Mediterranean diet pyramid. Reproduced from [19], who encourage use of this image without restriction.

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Shweta Khandelwal is currently working as a Research Scientist and Adjunct Assistant Professor at the PHFI, New Delhi. She is a trained public health nutritionist and her current research is focused on exploring the role of omega-3 fatty acids on cardiovascular disease risk factors among the Indian population. She is also the lead for capacity building initiatives in Public Health Nutrition at PHFI and CCDC.

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Dorairaj Prabhakaran is a cardiologist and epidemiologist by training. He served as Additional Professor of Cardiology at AIIMS until 2007, when he became the Executive Director of the Initiative for Cardiovascular Health Research in Developing Countries (IC Health) and the CCDC. He is also the Director of the NHLBI-United Health funded Center of Excellence in Cardio-metabolic Risk Reduction in South Asia (CoE-CARRS) at the PHFI which is one of the eleven centers worldwide supported under the Global Health Initiative of NHLBI, USA. His research work spans from mechanistic research to understand the causes of the increased propensity of cardiovascular diseases among Indians to developing potential solutions for CVDs through translational research and human resource development. CVDs, cardiovascular diseases; NHLBI, National Heart, Lung and Blood Institute.

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Dariush Mozaffarian is Dean of the Friedman School of Nutrition Science & Policy at Tufts University. His research focuses on the effects of lifestyle, particularly diet, on cardiometabolic health and disease, on the global impacts of suboptimal nutrition on chronic diseases, and on the effectiveness of policies to improve diet and reduce disease risk. Image credit: Kent Dayton.

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Michel de Lorgeril is a cardiologist and nutritionist at the French National Centre for Scientific Research and the School of Medicine at Grenoble University, France. In the 1990s he proposed a theory to explain the French paradox (low mortality rate from cardiac disease in France compared with UK and USA despite similar risk profiles), and his research group demonstrated that the plant omega-3 fatty acid (alpha-linolenic acid) is cardioprotective. Michel de Lorgeril was the principal investigator on the landmark Lyon Diet Heart Study, the first clinical trial to demonstrate the beneficial effects of the Mediterranean diet in the prevention of ischemic heart disease.