Hostname: page-component-7b7567c8c-7pwfn Total loading time: 0 Render date: 2026-11-14T19:06:33.699Z Has data issue: false hasContentIssue false
  • English
  • Français

The Mediterranean diet: science and practice

Published online by Cambridge University Press:  02 January 2007

Walter C Willett
Walter C Willett*
Affiliation:
Department of Nutrition, Harvard School of Public Health, Huntington Avenue, Boston, MA 02115, USA
*
*Corresponding author: E-mail walter.willett@channing.harvard.edu
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the 'Save PDF' action button.
Objective

To provide an overview of research relevant to the Mediterranean diet.

Design

Personal perspectives.

Setting

International.

Subject

Populations in Europe, North America, Asia.

Results

Approximately 50 years ago, Keys and colleagues described strikingly low rates of coronary heart disease in the Mediterranean region, where fat intake was relatively high but largely from olive oil. Subsequent controlled feeding studies have shown that compared to carbohydrate, both monounsaturated and polyunsaturated fats reduce LDL and triglycerides and increase HDL cholesterol. Importantly, these beneficial metabolic effects are greater in the presence of underlying insulin resistance. In a detailed analysis within the Nurses' Health Study, trans fat from partially hydrogenated vegetable oils (absent in traditional Mediterranean diets) was most strongly related to risk of heart disease, and both polyunsaturated and monounsaturated fat were inversely associated with risk. Epidemiologic evidence has also supported beneficial effects of higher intakes of fruits and vegetables, whole grains, fish, and daily consumption of moderate amounts of alcohol. Together with regular physical activity and not smoking, our analyses suggest that over 80% of coronary heart disease, 70% of stroke, and 90% of type 2 diabetes can be avoided by healthy food choices that are consistent with the traditional Mediterranean diet.

Conclusion

Both epidemiologic and metabolic studies suggest that individuals can benefit greatly by adopting elements of Mediterranean diets.

Keywords

MediterraneanDietNutrition

Information

Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 1a , February 2006, pp. 105 - 110
Copyright
Copyright © The Author 2006

References

1Keys, A. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge, MA: Harvard University Press, 1980.CrossRefGoogle Scholar
2Willett, WC. Nutritional Epidemiology. 2nd ed. New York: Oxford University Press, 1998.CrossRefGoogle Scholar
3Hegsted, DM. Serum-cholesterol response to dietary cholesterol: a re-evaluation. American Journal of Clinical Nutrition 1986; 44: 299–305.CrossRefGoogle ScholarPubMed
4Hu, FB, Willett, WC. Optimal diets for prevention of coronary heart disease. Journal of the American Medical Association 2002; 288(20): 2569–78.CrossRefGoogle ScholarPubMed
5US Department of Agriculture, US Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans, 5th ed. Home and Garden Bulletin No. 232. Washington, DC: US Government Printing Office, 2000.Google Scholar
6World Health Organization. The World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: WHO, 2002.Google Scholar
7World Health Organization. Diet, Nutrition and the Prevention of Chronic Disease. WHO Technical Report series 916. Geneva: WHO, 2003.Google Scholar
8American Heart Association. Dietary guidelines for healthy American adults. Circulation 1996; 94: 1795–800.CrossRefGoogle Scholar
9Cooper, R, Cutler, J, Desvigne-Nickens, P, Fortmann, SP, Friedman, L, Havlik, R, et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the National Conference on Cardiovascular Disease Prevention. Circulation 2000; 102: 3137–47.CrossRefGoogle ScholarPubMed
10Rosamond, WD, Chambless, LE, Folsom, AR, Cooper, LS, Conwill, DE, Clegg, L, et al. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. New England Journal of Medicine 1998; 339: 861–7.CrossRefGoogle ScholarPubMed
11Mensink, RP, Katan, MB. Effect of monounsaturated fatty acids versus complex carbohydrates on high-density lipoprotein in healthy men and women. Lancet 1987; 1: 122–5.CrossRefGoogle ScholarPubMed
12Mensink, RPM, Katan, MB. Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. New England Journal of Medicine 1990; 323: 439–45.CrossRefGoogle ScholarPubMed
13Ascherio, A, Katan, MB, Zock, PL, Stampfer, MJ, Willett, WC. Trans fatty acids and coronary heart disease. New England Journal of Medicine 1999; 340: 1994–8.CrossRefGoogle ScholarPubMed
14Hu, FB, Stampfer, MJ, Manson, JE, Rimm, E, Colditz, GA, Rosner, BA, et al. Dietary fat intake and the risk of coronary heart disease in women. New England Journal of Medicine 1997; 337: 1491–9.CrossRefGoogle ScholarPubMed
15Mauger, JF, Lichtenstein, AH, Ausman, LM, Jalbert, SM, Jauhiainen, M, Ehnholm, C, et al. Effect of different forms of dietary hydrogenated fats on LDL particle size. American Journal of Clinical Nutrition 2003; 78(3): 370–5.CrossRefGoogle ScholarPubMed
16Mozaffarian, D, Pischon, T, Hankinson, SE, Rifai, N, Joshipura, K, Willett, WC, et al. Dietary intake of trans fatty acids and systemic inflammation in women. American Journal of Clinical Nutrition 2004; 79(4): 606–12.CrossRefGoogle ScholarPubMed
17Baer, DJ, Judd, JT, Clevidence, BA, Tracy, RP. Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study. American Journal of Clinical Nutrition 2004; 79(6): 969–73.CrossRefGoogle Scholar
18Hu, FB, Manson, JE, Stampfer, MJ, Colditz, G, Liu, S, Solomon, CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. New England Journal of Medicine 2001; 345: 790–7.CrossRefGoogle ScholarPubMed
19Albert, CM, Hennekens, CH, O'Donnell, CJ, Ajani, UA, Carey, VJ, Willett, WC, et al. Fish consumption and risk of sudden cardiac death. Journal of the American Medical Association 1998; 279: 23–8.CrossRefGoogle ScholarPubMed
20Albert, CM, Campos, H, Stampfer, MJ, Ridker, PM, Manson, JE, Willett, WC, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. New England Journal of Medicine 2002; 346(15): 1113–8.CrossRefGoogle ScholarPubMed
21Baylin, A, Kabagambe, EK, Ascherio, A, Spiegelman, D, Campos, H. Adipose tissue alpha-linolenic acid and nonfatal acute myocardial infarction in Costa Rica. Circulation 2003; 107(12): 1586–91.CrossRefGoogle ScholarPubMed
22de Lorgeril, M, Salen, P, Martin, J-L, Monjaud, I, Delaye, J, Mamelle, N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99: 779–85.CrossRefGoogle ScholarPubMed
23Hu, FB, van Dam, RM, Liu, S. Diet and risk of type II, diabetes: the role of types of fat and carbohydrate. Diabetologia 2001; 44(7): 805–17.CrossRefGoogle ScholarPubMed
24Schulze, MB, Manson, JE, Ludwig, DS, Colditz, GA, Stampfer, MJ, Willett, WC, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Journal of the American Medical Association 2004; 292(8): 927–34.CrossRefGoogle Scholar
25Jeppesen, J, Schaaf, P, Jones, G, Zhou, MY, Chen, YD, Reaven, GM. Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. American Journal of Clinical Nutrition 1997; 65: 1027–33.CrossRefGoogle ScholarPubMed
26Liu, S, Willett, WC, Stampfer, MJ, Hu, FB, Franz, M, Sampson, L, et al. A prospective study of dietary glycaemic load, carbohydrate intake, and risk of coronary heart disease in US women. American Journal of Clinical Nutrition 2000; 71: 1455–61.CrossRefGoogle ScholarPubMed
27Oh, K, Hu, FB, Cho, E, Rexrode, KM, Stampfer, MJ, Manson, JE, et al. Carbohydrate intake, glycaemic index, glycaemic load, and dietary fiber in relation to risk of stroke in women. American Journal of Epidemiology 2005; 161(2): 161–9.CrossRefGoogle ScholarPubMed
28Bray, GA, Popkin, BM. Dietary fat intake does affect obesity!. American Journal of Clinical Nutrition 1998; 68: 1157–73.CrossRefGoogle ScholarPubMed
29Willett, WC, Leibel, RL. Dietary fat is not a major determinant of body fat. American Journal of Medicine 2002; 113(Suppl 9B): 47S–59S.CrossRefGoogle ScholarPubMed
30Stampfer, MJ, Hu, FB, Manson, JE, Rimm, EB, Willett, WC. Primary prevention of coronary heart disease in women through diet and lifestyle. New England Journal of Medicine 2000; 343: 16–22.CrossRefGoogle ScholarPubMed
31Trichopoulou, A, Costacou, T, Bamia, C, Trichopoulos, D. Adherence to a Mediterranean diet and survival in a Greek population. New England Journal of Medicine 2003; 348: 2599–608.CrossRefGoogle Scholar
32McCullough, ML, Feskanich, D, Rimm, EB, Giovannucci, EL, Ascherio, A, Variyam, JN, et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. American Journal of Clinical Nutrition 2000; 72: 1223–31.CrossRefGoogle Scholar
33McCullough, ML, Feskanich, D, Stampfer, MJ, Rosner, BA, Hu, FB, Hunter, DJ, et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. American Journal of Clinical Nutrition 2000; 72(5): 1214–22.CrossRefGoogle Scholar
34McCullough, ML, Feskanich, D, Stampfer, MJ, Giovannucci, EL, Rimm, EB, Hu, FB, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. American Journal of Clinical Nutrition 2002; 76(6): 1261–71.CrossRefGoogle ScholarPubMed
35International Agency for Research on Cancer. Weight Control and Physical Activity Vol. 6. Lyon: IARC Press, 2002.Google Scholar
36Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). A Report of the Panel on Macronutrients, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Washington, DC: National Academy of Sciences,2002. Available at http://www.nap.edu/catalog/10490.html.Google Scholar
37US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans, 6th ed. Washington, DC: US Government Printing Office, 01 2005.Google Scholar
38Willett, WC. Diet and health: What should we eat? Science 1994; 264: 532–7.CrossRefGoogle ScholarPubMed
39World Health Organization. The World Health Report 2003: Shaping the Future. Geneva: WHO, 2003.Google Scholar