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FROM THE ACADEMY
This article was written by EleeseCunningham, RDN, of the Academyof Nutrition and Dietetics’ KnowledgeCenter Team, Chicago, IL. Academymembers can contact the KnowledgeCenter by sending an e-mail [email protected]
h p://dx.doi.org/10.1016/j.jand.2014.06.004
1312 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
Question of the Month
I Have a Client Who Wants to Follow theMediterranean Diet—Where Do I Start?
THE TERM MEDITERRANEANdiet can be used to describe theeating pattern of at least 16countries that border the Med-
iterranean Sea, which presents somedifficulty in characterizing a Mediterra-nean diet. Research on the health ben-efits of a Mediterranean eating patterndate back to the 1950s with the SevenCountries Study that established theMediterranean diet as a heart-healthyeating pattern based on the traditionalfoods and cooking styles of this partof the world.1 Oldways created theMediterranean Diet Pyramid and in-cludes the followingamong thedefiningcharacteristics this pattern:
� An abundance of food from plantsources, including fruits andvegetables, potatoes, breads andgrains, beans, nuts, and seeds.
� Olive oil as the principal fat, withtotal fat ranging from less than25% to over 35% of energy, withsaturated fat no more than 7% to8% of energy.
� Daily consumption of low tomoderate amounts of cheese andyogurt.
� Twice-weekly consumption oflow to moderate amounts of fishand poultry; up to 7 eggs perweek (including those used incooking and baking).
� Fresh fruit as the typical dailydessert.
� Moderate consumption of wine,normally with meals; about oneto two glasses per day for menand one glass per day for women.From a contemporary publichealth perspective, wine should
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be considered optional and avoi-ded when consumption wouldput the individual orothers at risk.
� Red meat a few times per month.� Regular physical activity at a
level that promotes a healthyweight, fitness, and well-being.2
Recently, a large, randomized clinicaltrial provided further evidence tosupport a Mediterranean diet to reducethe risk for cardiovascular disease. In-vestigators in Spain randomized 7,447people at high risk for cardiovasculardisease to one of three diets: A Mediter-ranean diet supplemented with extra-virgin olive oil (4 tablespoons per day);a Mediterranean diet supplementedwith mixed nuts (30 grams per day ofwalnuts, hazelnuts, and almonds); or acontrol diet for which people wereadvised to lower their intake of dietaryfat. Participants in the control groupdecreased their fat intake by 2%, result-ing in a diet with 37% of calories from fat(exceeding the <30% fat intake thatdefines a low-fat diet) vs 39% for bothvariations of the Mediterranean diet.The trial was stopped early by the dataand safety monitoring board when aninterim analysis indicated the two Med-iterranean diet groups when comparedwith the control group reduced their riskof cardiovascular events (myocardialinfarction, stroke, or death from cardio-vascular disease) by 30%.3
Other research suggests that adher-ence to a Mediterranean diet patternhas a positive effect on a range ofmedical conditions beyond mortalitydue to cardiovascular disease. In-creasing evidence suggests it couldcounter diseases associated withchronic inflammation, including meta-bolic syndrome, atherosclerosis, cancer,diabetes, obesity, pulmonary diseases,and cognition disorders.4 Widely re-ported research regarding the healthbenefits of the Mediterranean diet islikely to influence some people toadopt some form of a Mediterraneandiet. For some, that may mean more
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olive oil; but according to the Academyposition paper on dietary fatty acids,because the dietary pattern also em-phasizes vegetables and fruits, n-3 fattyaciderich foods, nuts, low-fat dairy,and moderate red wine intake, re-ported benefits of a Mediterranean dieton CVD risk factors cannot be attrib-uted solely to the monounsaturatedfatty acid content.5
The Dietary Guidelines for Americansrecommends the Mediterranean diet aswell as the Dietary Approaches to StopHypertension (DASH) diet as eatingplans that can help promote health andprevent disease.6 Counseling the patientwho wants to incorporate the Mediter-ranean diet into their lifestyle beginswith collecting as much data as possiblebefore the first encounter, which canhelp assess how a patient’s currentintake compares to the Mediterraneandietary pattern. This nutrient-dense dietis consistentwith a “foodfirst” approachand RDNs can combine this with anindividualized approach that can helpclients make the characteristics of theMediterranean diet work for thosemotivated to make changes.
References1. Keys A. Seven Countries: A Multivariate
Analysis of Death and Coronary Heart Dis-ease. Cambridge, MA: Harvard UniversityPress; 1980.
2. Mediterranean Diet Pyramid. Oldwayswebsite. http://oldwayspt.org/resources/heritage-pyramids/mediterranean-pyramid/overview Accessed June 2, 2014.
3. Estruch R, Ros E, Salas-Salvadó J, et al. Pri-mary prevention of cardiovascular diseasewith a Mediterranean diet. N Engl J Med.2013;368(14):1279-1290.
4. Gotsis E, Anagnostis P, Mariolis A, Vlachou A,Katsiki N, Karagiannis A.Health benefits ofthe Mediterranean diet: An update of re-searchover the last 5 years. [published onlineahead of print April 27, 2014]. Angiology.http://dx.doi.org/10.1177/0003319714532169.
5. Dietary fatty acids. J Acad Nutr Diet.2014;114(1):136-153.
6. US Department of Agriculture and USDepartment of Health and Human Services.Dietary Guidelines for Americans, 2010. 7thEdition. Washington, DC: US GovernmentPrinting Office; 2010.
014 by the Academy of Nutrition and Dietetics.