Intake of Mediterranean foods

  • Charalampos Siotos
  • Marco Vinceti
  • Androniki NaskaEmail author
Living reference work entry
Part of the Reference Series in Phytochemistry book series (RSP)


The traditional Mediterranean diet is characterized by: (a) high consumption of cereals, vegetables, fruit, nuts, legumes, fish, and seafood; (b) the use of olive oil as the main, if not the only, added lipid; (c) moderate consumption of milk and dairy products; (d) moderate intake of alcohol, in the form of wine and preferably during meals; and (e) low consumption of meat and meat products. The prevalent consumption of olive oil and the low consumption of animal products are reflected in the high ratio of monounsaturated to saturated fat intake, typical of the dietary pattern in the region. There is increasing evidence from observational and experimental epidemiological studies, further enriched by the conclusions of their systematic reviews and meta-analyses, that adherence to the Mediterranean dietary pattern promotes health and reduces the risk of premature death from chronic degenerative diseases. Mediterranean countries and especially the European ones have experienced a “westernization” process of their food habits, and have increased the per capita supply of non-Mediterranean foods (animal fats, vegetable oils other than olive oil, sugar, and meat) and decreased the supply of legumes and alcoholic beverages, including wine. The evidence that Mediterraneans are gradually departing from their traditional eating habits does not only refer to the adult population in the region, but it has also been reproduced in large-scale nutritional surveys among children, adolescents, and young adults – the trend-setters for future generations. Next to the effect on people’s health, the gradual abandoning of the traditional Mediterranean diet cannot support sustainable development in the way the Mediterranean diet does. Being adjusted to the cultural, climatic, and other environmental characteristics of the region, the Mediterranean diet is protective and helpful to biodiversity, accessible and economically affordable, and contributes to food and nutrition security.


Mediterranean diet Score Food intake Health 


  1. 1.
    Trichopoulou A, Lagiou P, Kuper H, Trichopoulos D (2000) Cancer and Mediterranean dietary traditions. Cancer Epidemiol Biomark Prev 9(9):869–873Google Scholar
  2. 2.
    Trichopoulou A, Lagiou P (1997) Healthy traditional Mediterranean diet – an expression of culture, history and lifestyle. Nutr Rev 55:383–389CrossRefGoogle Scholar
  3. 3.
    Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, Medina FX, Battino M, Belahsen R, Miranda G, Serra-Majem L, Mediterranean Diet Foundation Expert Group (2011) Mediterranean diet pyramid today Science and cultural updates. Public Health Nutr 14:2274–2284CrossRefGoogle Scholar
  4. 4.
    Martínez-González MA, Salas-Salvadó J, Estruch R, Corella DD, Fitó M, Ros E (2015) Benefits of the Mediterranean diet: insights from the PREDIMED study. Prog Cardiovasc Dis 58:50–60CrossRefGoogle Scholar
  5. 5.
    Piroddi M, Albini A, Fabiani R, Giovannelli L, Luceri C, Natella F, Rosignoli P, Rossi T, Taticchi A, Servili M, Galli F (2017) Nutrigenomics of extra-virgin olive oil: A review. Biofactors 43(1):17–41CrossRefGoogle Scholar
  6. 6.
    Trichopoulou A, Vasilopoulou E (2000) Mediterranean diet and longevity. Br J Nutr 84(Suppl 2):S205–S209CrossRefGoogle Scholar
  7. 7.
    WHO Europe. The European health for all database (July 2016).
  8. 8.
    Nestle M (1995) Mediterranean diets: historical and research overview. Am J Clin Nutr 61(Suppl 6):1313S–1320SGoogle Scholar
  9. 9.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348(26):2599–2608CrossRefGoogle Scholar
  10. 10.
    Alberti-Fidanza A, Fidanza F (2004) Mediterranean adequacy index of Italian diets. Public Health Nutr 7:937e41CrossRefGoogle Scholar
  11. 11.
    Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocké MC, Peeters PH, van der Schouw YT, Boeing H, Hoffmann K, Boffetta P, Nagel G, Masala G, Krogh V, Panico S, Tumino R, Vineis P, Bamia C, Naska A, Benetou V, Ferrari P, Slimani N, Pera G, Martinez-Garcia C, Navarro C, Rodriguez-Barranco M, Dorronsoro M, Spencer EA, Key TJ, Bingham S, Khaw KT, Kesse E, Clavel-Chapelon F, Boutron-Ruault MC, Berglund G, Wirfalt E, Hallmans G, Johansson I, Tjonneland A, Olsen A, Overvad K, Hundborg HH, Riboli E, Trichopoulos D (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991CrossRefGoogle Scholar
  12. 12.
    Buckland G, Agudo A, Travier N, Huerta JM, Cirera L, Tormo MJ, Navarro C, Chirlaque MD, Moreno-Iribas C, Ardanaz E, Barricarte A, Etxeberria J, Marin P, Quirós JR, Redondo ML, Larrañaga N, Amiano P, Dorronsoro M, Arriola L, Basterretxea M, Sanchez MJ, Molina E, González CA (2011) Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Br J Nutr 106(10):1581–1591CrossRefGoogle Scholar
  13. 13.
    Agnoli C, Krogh V, Grioni S, Sieri S, Palli D, Masala G, Sacerdote C, Vineis P, Tumino R, Frasca G, Pala V, Berrino F, Chiodini P, Mattiello A, Panico S (2011) A priori-defined dietary patterns are associated with reduced risk of stroke in a large Italian cohort. J Nutr 141(8):1552–1558CrossRefGoogle Scholar
  14. 14.
    Milà-Villarroel R, Bach-Faig A, Puig J, Puchal A, Farran A, Serra-Majem L, Carrasco JL (2011) Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet. Public Health Nutr 14(12A):2338–2345CrossRefGoogle Scholar
  15. 15.
    Malagoli C, Malavolti M, Agnoli C, Crespi CM, Fiorentini C, Farnetani F, Longo C, Ricci C, Albertini G, Lanzoni A, Veneziano L, Virgili A, Pagliarello C, Santini M, Fanti PA, Dika E, Sieri S, Krogh V, Pellacani G, Vinceti M (2015) Diet Quality and Risk of Melanoma in an Italian Population. J Nutr 145(8):1800–1807CrossRefGoogle Scholar
  16. 16.
    Serra-Majem L, Ribas L, Ngo J, Ortega R, Garcia A, Perez C, Aranceta J (2004) Food, youth and the Mediterranean Diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 7:931–935Google Scholar
  17. 17.
    Tognon G, Hebestreit A, Lanfer A, Moreno LA, Pala V, Siani A, Tornaritis M, De Henauw S, Veidebaum T, Molnár D, Ahrens W, Lissner L (2013) Mediterranean diet, overweight and body composition in children from eight European countries: Cross-sectional and prospective results from the IDEFICS study. Nutr Metab Cardiovasc Dis 24(2):205–213CrossRefGoogle Scholar
  18. 18.
    Menotti A, Kromhout D, Blackburn H, Fidanza F, Buzina R, Nissinen A (1999) Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group. Eur J Epidemiol 15(6):507–515CrossRefGoogle Scholar
  19. 19.
    Menotti A, Puddu PE (2015) How the Seven Countries Study contributed to the definition and development of the Mediterranean diet concept: a 50-year journey. Nutr Metab Cardiovasc Dis 25(3):245–252CrossRefGoogle Scholar
  20. 20.
    Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D (1995) Diet and overall survival in elderly people. BMJ 311(7018):1457–1460CrossRefGoogle Scholar
  21. 21.
    Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92(5):1189–1196CrossRefGoogle Scholar
  22. 22.
    Verberne L, Bach-Faig A, Buckland G, Serra-Majem L (2010) Association between the Mediterranean diet and cancer risk: a review of observational studies. Nutr Cancer 62(7):860–870CrossRefGoogle Scholar
  23. 23.
    Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, Briel M (2011) Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 124(9):841–851CrossRefGoogle Scholar
  24. 24.
    Martinez-Gonzalez MA, Bes-Rastrollo M, Serra-Majem L, Lairon D, Estruch R, Trichopoulou A (2009) Mediterranean food pattern and the primary prevention of chronic disease: recent developments. Nutr Rev 67(Suppl 1):S111–S116CrossRefGoogle Scholar
  25. 25.
    Muñoz MA, Fíto M, Marrugat J, Covas MI, Schröder H, REGICOR and HERMES Investigators (2009) Adherence to the Mediterranean diet is associated with better mental and physical health. Br J Nutr 101(12):1821–1827CrossRefGoogle Scholar
  26. 26.
    Loughrey DG, Lavecchia S, Brennan S, Lawlor BA, Kelly ME (2017) The impact of the Mediterranean diet on the cognitive functioning of healthy older adults: A systematic review and meta-analysis. Adv Nutr 8(4):571–586Google Scholar
  27. 27.
    Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA, PREDIMED Study Investigators (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368(14):1279–1290CrossRefGoogle Scholar
  28. 28.
    Guasch-Ferré M, Salas-Salvadó J, Ros E, Estruch R, Corella D, Fitó M, Martínez-González MA, PREDIMED Investigators (2017) The PREDIMED trial, Mediterranean diet and health outcomes: How strong is the evidence? Nutr Metab Cardiovasc Dis 27(7):624–632CrossRefGoogle Scholar
  29. 29.
    Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337:a1344CrossRefGoogle Scholar
  30. 30.
    Liyanage T, Ninomiya T, Wang A, Neal B, Jun M, Wong MG, Jardine M, Hillis GS, Perkovic V (2016) Effects of the Mediterranean Diet on Cardiovascular Outcomes-A Systematic Review and Meta-Analysis. PLoS One 11(8):e0159252CrossRefGoogle Scholar
  31. 31.
    Schwingshackl L, Hoffmann G (2015) Adherence to Mediterranean diet and risk of cancer: An updated systematic review and meta-analysis of observational studies. Cancer Med 4(12):1933–1947CrossRefGoogle Scholar
  32. 32.
    Dinu M, Pagliai G, Casini A, Sofi F (2017) Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. [Epub ahead of print]
  33. 33.
    Kouris-Blazos A, Gnardellis C, Wahlqvist ML, Trichopoulos D, Lukito W, Trichopoulou A (1999) Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Brit J Nutr 82:57–61CrossRefGoogle Scholar
  34. 34.
    Osler M, Schroll M (1999) Diet and mortality in a cohort of elderly people in a north European community. Int J Epidemiology 26:155–159CrossRefGoogle Scholar
  35. 35.
    Woo j WKS, Leung SS, Chook P, Liu B, Ho SC, Chan SW, Feng JZ, Celermajer DS (2001) The Mediterranean score of dietary habits in Chinese populations in four different geographical areas. Eur J Clin Nutr 55(3):215–220CrossRefGoogle Scholar
  36. 36.
    Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, van Staveren WA (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292(12):1433–1439CrossRefGoogle Scholar
  37. 37.
    Mitrou PN, Kipnis V, Thiébaut AC, Reedy J, Subar AF, Wirfält E, Flood A, Mouw T, Hollenbeck AR, Leitzmann MF, Schatzkin A (2007) Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 167(22):2461–2468CrossRefGoogle Scholar
  38. 38.
    Konstantinidou V, Covas MI, Sola R, Fitó M (2013) Up-to date knowledge on the in vivo transcriptomic effect of the Mediterranean diet in humans. Mol Nutr Food Res 57(5):772–783CrossRefGoogle Scholar
  39. 39.
    Trichopoulou A, Naska A, Costacou T, on behalf of the DAFNE III Group (2002) Disparities in food habits across Europe. Proc Nutr Soc 61:553–558CrossRefGoogle Scholar
  40. 40.
    Naska A, Fouskakis D, Oikonomou E, Almeida MD, Berg MA, Gedrich K, Moreiras O, Nelson M, Trygg K, Turrini A, Remaut AM, Volatier JL, Trichopoulou A, DAFNE participants (2006) Dietary patterns and their socio-demographic determinants in ten European countries. Data from the DAFNE databank. Eur J Clin Nutr 60(2):181–190CrossRefGoogle Scholar
  41. 41.
    Vareiro D, Bach-Faig A, Raidó Quintana B, Bertomeu I, Buckland G, Vaz de Almeida MD, Serra-Majem L (2009) Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas. Public Health Nutr 12(9A):1667–1675CrossRefGoogle Scholar
  42. 42.
    Naska A, Berg MA, Cuadrado C, Freisling H, Gedrich K, Gregoric M, Kelleher C, Leskova E, Nelson M, Pace L, Remaut AM, Rodrigues S, Sekula W, Sjöstrom M, Trygg K, Turrini A, Volatier JL, Zajkas G, Trichopoulou A, Data Food Networking (DAFNE) participants (2009) Food balance sheet and household budget survey dietary data and mortality patterns in Europe. Br J Nutr 102(1):166–171CrossRefGoogle Scholar
  43. 43.
    Balanza R, García-Lorda P, Pérez-Rodrigo C, Aranceta J, Bonet MB, Salas-Salvadó J (2007) Trends in food availability determined by the Food and Agriculture Organization’s food balance sheets in Mediterranean Europe in comparison with other European areas. Public Health Nutr 10(2):168–176CrossRefGoogle Scholar
  44. 44.
    Naska A, Vasdekis VG, Trichopoulou A, Friel S, Leonhäuser IU, Moreiras O, Nelson M, Remaut AM, Schmitt A, Sekula W, Trygg KU, Zajkás G (2000) Fruit and vegetable availability among ten European countries: how does it compare with the ‘five-a-day’ recommendation? DAFNE I and II projects of the European Commission. Br J Nutr 84(4):549–556Google Scholar
  45. 45.
    Benhammou S, Heras-González L, Ibáñez-Peinado D, Barceló C, Hamdan M, Rivas A, Mariscal-Arcas M, Olea-Serrano F, Monteagudo C (2016) Comparison of Mediterranean diet compliance between European and non-European populations in the Mediterranean basin. Appetite 107:521–526CrossRefGoogle Scholar
  46. 46.
    Iaccarino Idelson P, Scalfi L, Valerio G (2017) Adherence to the Mediterranean Diet in children and adolescents: A systematic review. Nutr Metab Cardiovasc Dis 27(4):283–299CrossRefGoogle Scholar
  47. 47.
    Elmadfa I, Meyer A, Nowak V, Hasenegger V, Putz P, Verstraeten R, Remaut-DeWinter AM, Kolsteren P, Dostálová J, Dlouhý P, Trolle E, Fagt S, Biltoft-Jensen A, Mathiessen J, Velsing Groth M, Kambek L, Gluskova N, Voutilainen S, Erkkilä A, Vernay M, Krems C, Strassburg A, Vasquez-Caicedo AL, Urban C, Naska A, Efstathopoulou E, Oikonomou E, Tsiotas K, Bountziouka V, Benetou V, Trichopoulou A, Zajkás G, Kovács V, Martos E, Heavey P, Kelleher C, Kennedy J, Turrini A, Selga G, Sauka M, Petkeviciene J, Klumbiene J, Holm Totland T, Andersen LF, Halicka E, Rejman K, Kowrygo B, Rodrigues S, Pinhão S, Ferreira LS, Lopes C, Ramos E, Vaz Almeida MD, Vlad M, Simcic M, Podgrajsek K, Serra Majem L, Román Viñas B, Ngo J, Ribas Barba L, Becker W, Fransen H, Van Rossum B, Ocké M, Margetts B, Rütten A, Abu-Omar K, Gelius P, Cattaneo A (2009) European Nutrition and Health Report 2009. Ann Nutr Metab 55(Suppl 2):1–40Google Scholar
  48. 48.
    Kafatos A, Diacatou A, Voukiklaris G, Nikolakakis N, Vlachonikolis J, Kounali D, Mamalakis G, Dontas AS (1997) Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study. Am J Clin Nutr 65(6):1882–1886Google Scholar
  49. 49.
    De Lorenzo A, Alberti A, Andreoli A, Iacopino L, Serranò P, Perriello G (2001) Food habits in a southern Italian town (Nicotera) in 1960 and 1996: still a reference Italian Mediterranean diet? Diabetes Nutr Metab 14(3):121–125Google Scholar
  50. 50.
    Pereira-da-Silva L, Rêgo C, Pietrobelli A (2016) The diet of preschool children in the Mediterranean countries of the European Union: A systematic review. Int J Environ Res Public Health 13(6):E572CrossRefGoogle Scholar
  51. 51.
    Roccaldo R, Censi L, D’Addezio L, Toti E, Martone D, D’Addezio D, Cernigliaro A, ZOOM8 Study Group (2014) Adherence to the Mediterranean diet in Italian school children. Int J Food Sci Nutr 65(5):621–628CrossRefGoogle Scholar
  52. 52.
    Kontogianni MD, Vidra N, Farmaki AE, Koinaki S, Belogianni K, Sofrona S, Magkanari F, Yannakoulia M (2008) Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. J Nutr 138(10):1951–1956Google Scholar
  53. 53.
    Lazarou C, Panagiotakos DB, Matalas AL (2009) Level of adherence to the Mediterranean diet among children from Cyprus: the CYKIDS study. Public Health Nutr 12(7):991–1000CrossRefGoogle Scholar
  54. 54.
    Farajian P, Risvas G, Karasouli K, Pounis GD, Kastorini CM, Panagiotakos DB, Zampelas A (2011) Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: The GRECO study. Atherosclerosis 217(2):525–530CrossRefGoogle Scholar
  55. 55.
    Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A (2009) Meat intake and mortality: A prospective study of over half a million people. Arch Intern Med 169(6):562–571CrossRefGoogle Scholar
  56. 56.
    Akbaraly T, Sabia S, Hagger-Johnson G, Tabak AG, Shipley MJ, Jokela M, Brunner EJ, Hamer M, Batty GD, Singh-Manoux A, Kivimaki M (2013) Does overall diet in midlife predict future aging phenotypes? A cohort study. Am J Med 126(5):411–419CrossRefGoogle Scholar
  57. 57.
    Burlingame B, Dernini S (2011) Sustainable diets: the Mediterranean diet as an example. Public Health Nutr 14(12A):2285–2287CrossRefGoogle Scholar
  58. 58.
    Trichopoulou A (2012) Diversity v. globalization: traditional foods at the epicentre. Public Health Nutr 15(6):951–954CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Charalampos Siotos
    • 1
  • Marco Vinceti
    • 2
    • 3
  • Androniki Naska
    • 1
    Email author
  1. 1.Department of Hygiene, Epidemiology and Medical Statistics, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  2. 2.Research Center for Environmental, Genetic and Nutritional Epidemiology (CREAGEN)University of Modena and Reggio EmiliaModenaItaly
  3. 3.Department of EpidemiologyBoston University School of Public HealthBostonUSA

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