Mediterranean Diet

The Mediterranean diet consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes and nuts, and moderate alcohol consumption. ^[1] It is abundant in minimally processed plant-based foods, rich in monounsaturated fat from olive oil but lower in saturated fat, meats, and dairy products, and seems an ideal nutritional model for cardiovascular health. ^[2] The Mediterranean diet is one of the most studied and well-known dietary patterns worldwide and has been associated with a wide range of health benefits. ^[3]

The five most important adaptations induced by the Mediterranean dietary pattern are a lipid-lowering effect, protection against oxidative stress, inflammation and platelet aggregation, modification of hormones and growth factors, inhibition of nutrient-sensing pathways by specific amino acid restriction, and gut-microbiota-mediated production of metabolites influencing metabolic health. ^[4] The Mediterranean diet is associated with characteristic modifications to the gut microbiota, including enhanced growth of short-chain-fatty-acid-producing species, which are favourably associated with inflammatory and oxidative status and overall metabolic health. ^[5] Its effects on the components of metabolic syndrome are related to its high dietary fiber, omega-3 and omega-9 fatty acids, complex carbohydrates, antioxidants, minerals, vitamins, and bioactive polyphenols, which combat obesity, dyslipidemia, hypertension, and diabetes. ^[6]

In the PREDIMED trial, 7447 men and women at high cardiovascular risk were randomized, and hazard ratios for a composite of myocardial infarction, stroke, or cardiovascular death were 0.70 for the Mediterranean diet with extra-virgin olive oil and 0.70 for the Mediterranean diet with nuts compared with the control group. ^[7] A meta-analysis of four randomized controlled trials with 10,054 participants found the Mediterranean diet reduced major adverse cardiovascular events with an odds ratio of 0.52 and cardiovascular death with an odds ratio of 0.54, while showing no significant effect on all-cause mortality. ^[8] A meta-analysis found that adherence to the Mediterranean diet was associated with a combined hazard ratio of 0.82 for cognitive impairment, 0.89 for dementia, and 0.70 for Alzheimer's disease, indicating an 11 to 30 percent reduction in risk of age-related cognitive disorders. ^[9] A systematic review and meta-analysis of cross-sectional studies comprising 13,733 participants found that higher Mediterranean diet adherence was associated with longer telomere length. ^[10] A critical review of observational cohorts and randomized controlled trials concluded that the available evidence is large, strong, and consistent, with better adherence to the Mediterranean diet associated with clinically meaningful reductions in coronary heart disease, ischemic stroke, and total

The largest body of evidence for the health benefits of dietary patterns is attributable to the Mediterranean diet, which is associated with the prevention and management of age-associated non-communicable diseases including cardiovascular, metabolic, and neurodegenerative diseases, cancer, and fragility fractures. ^[11] Consuming a Mediterranean diet rich in minimally processed plant foods has been associated with a reduced risk of developing multiple chronic diseases and increased life expectancy. ^[4] The Mediterranean diet is also ecologically sustainable, with relatively low environmental impacts, making it a sustainable lifestyle model that could be followed in other regions with culturally appropriate variations. ^[3]