The Mediterranean Diet

From the origins to the present day.

From Clinical Nutrition, Body Weight Management and Lifestyle Modification IRCCS De Bellis.

Everyone talks about the Mediterranean Diet, but in reality there are few who do it correctly, thus generating a lot of confusion in those who read. It represents a typical dietary model of the countries of the Mediterranean area and is recommended by the International Scientific Societies, in the Guidelines directed to the general population, in the primary and secondary prevention.

The Mediterranean diet is not the vegetarian diet, although foods of plant origin have their own relevance; it is not the diet of bread and pasta, although the consumption of cereals represents an important component; it is not a diet “poor in nutrients”, but genuine and the foods that compose it take on a so-called “functional” role; it is not grandma’s soup or soup, as it also represents a gastronomic heritage rich in recipes, smells and flavors; it is not a fashionable diet, due to its historical roots and proven scientific bases; It is not the diet that makes you fat or lose weight as it refers to particular qualitative aspects of nutrition and not to its energy content.

The traditional Mediterranean Diet, that is the one consumed by the populations of the Mediterranean basin in the immediate post-war period, that is in the years 50-60, is not just a way of eating but a set of knowledge , social habits and cultural traditions are being handed down by the populations bordering the Mare Nostrum therefore, rather than diet understood as a restrictive regime or limiting, we can speak of a ” Lifestyle” whose importance has been recognized worldwide by UNESCO, which in November 2010 recognized the Mediterranean diet as “intangible heritage of humanity“. The decision is based on the recognition that: “this simple and frugal way of eating meals has favored intercultural contacts and conviviality over time , giving life to a formidable corpus of knowledge, social customs and traditional celebrations of many Mediterranean populations”.

A single definition of Mediterranean Diet is not easy, given that in the Mediterranean area coexist countries with different cultural backgrounds, different ethnic and religious roots, different social and economic statuses and different agricultural production, involving different food choices.

In fact, there is no single “Mediterranean Diet”, but a common “Mediterranean ” dietary pattern that has these main characteristics:

abundance of foods of plant origin (vegetables, vegetables, fresh and dried fruits, legumes, bread and

pasta from reconstituted whole meal flour and other whole grains such as barley, spelt, oats, which ensure both a low glycemic index and a balancing and satiating role); zero kilometer;

use of olive oil as the main source of fats;
prevalent consumption of fresh and seasonal foods, almost always locally sourced and therefore zero kilometer
fish, white meat and eggs from free-range hens, consumed a few times a week;
daily but moderate consumption of cheeses and dairy yogurt from grazing animals, rich in omega 3 fatty acids and antioxidant vitamins;
low consumption of red meat (it was consumed only on Sundays in the wealthiest families and

occasionally by less well-off families, when farm and working animals were sacrificed because they were no longer able to provide an income);

regular use of aromatic herbs that allow you to create a diet of excellent flavor and great palatability, reducing the need to use salt and fatty seasonings in excessive quantities;
moderate intake of wine during meals;
Very low consumption of sweets, which were consumed only on the occasion of family and patronal festivals.

In relation to health, the concept of “Mediterranean lifestyle” should also be kept in mind, characterized by adequate physical activity, understood as physical exercise. regular, sufficient and continuous.

The nutrients contained in foods corresponding to these dietary habits are:

proteins few and mainly of vegetable origin;
carbohydrates with a low glycemic index and load, with simple sugars almost absent;
high monounsaturated/saturated fatty acid ratio ;
quantity and ratio of omega 3 / omega 6 fatty acids much greater than that of the diet of our days that tending to unity;
abundant beta carotene, tocopherols, vitamin C;
high polyphenols (which make the Mediterranean Diet a functional diet);
high calcium, magnesium and potassium ;
Low sodium

The Mediterranean diet is also a predominantly raw foodist diet, almost all dishes are cooked at low temperatures for a long time, and many foods and condiments, especially olive oil. , are added to raw dishes and therefore is also a diet low in AGE (Advanced Glycation End-products). Extensive literature indicates that AGEs are dangerous molecules for the body, because they have effects related to inflammation and aging and their involvement in pathogenesis of numerous degenerative diseases.

AGEs are the products of the most advanced stages of the non-enzymatic glycation reaction of proteins. This phenomenon occurs both in the body and in foods subjected to particular physico-chemical treatments (eg high temperatures and low humidity), so there is a share of endogenous AGE and one of dietary origin that contribute to the progressive accumulation of AGEs in tissues.

Almost all foods produced through industrial processes are very rich in AGE, not only because of the high temperature, but also because of the processing methods used, capable of alter the chemical nature of the substances involved. Even in the home it is possible to treat food so that it contains a greater or lesser amount of glycation products: burning, roasting, To toast means to form AGE.

The origins of research

The paternity of the research on the Mediterranean Diet is to be attributed to the nutritionist Lorenzo Piroddi (1911 – 1999), who in 1939 hypothesized the connection between eating habits and the onset of replacement diseases. To treat his patients, Piroddi developed a first version of the Mediterranean Diet, which limited the consumption of animal fats by favoring vegetable ones.

But the first scholar who brought the concept of the “Mediterranean Diet” to the attention of science was Ancel Keys (1904–2004).

Epidemiology and nutritionist at the School of Public Health of the University of Minnesota, who during World War II accidentally sensed the health benefits of this style food.

Keys, in the 40s was in fact in Crete, following the allied troops and noticed that the incidence of cardiovascular diseases, in that island, was considerably lower than that of the United States. In 1944 he landed in Paestum in the wake of the Fifth Army, was struck by the eating habits of the population of Cilento and elaborated the intuition that the low incidence of cardiovascular diseases in the two populations was due to the type of diet they adopted by centuries-old tradition. He was so convinced of the goodness of the diet and lifestyle typical of Southern Italy and other Mediterranean countries, that he moved with his family. to live in Pioppi, a small town in Cilento.

During his stay he noticed that the usual diet of the peasants of the small villages of Southern Italy was low in animal fats (they rarely ate meat, unlike of the rich who consumed it almost daily) but consisting mainly of bread, pasta in various forms and often consumed with legumes, legumes used for soups, seasonal fruits and vegetables available in their gardens, extra virgin olive oil, often also cheese and dried fruit when available , supplemented with wine. Food choices were dictated by poverty, frugality and thrift, but the peasants of Cilento and the island of Crete were long-lived and had a low prevalence of cardiovascular disease compared to citizens of Northern Europe and the United States and their own relatives who emigrated in previous years, despite consumption high of olive oil and therefore vegetable fats, it provides no less than 40% of the total daily energy.

These observations led Keys to launch the famous “Seven Countries Study”, the epidemiological study that involved seven countries: Finland, Japan, Greece, Italy, Holland , United and Yugoslavia and which compared the lifestyle and diets adopted by different populations; for Italy the sample came from Nicotera (Calabria), Crevalcore (Emilia), Montegiorgio (Marche) and Pioppi (Cilento).

The results confirmed the relationship between the diet followed and the incidence of certain diseases, clarifying in particular that the type of diseasesused, and not their quantity, had a great influence on cardiovascular diseases.

Among the populations of the Mediterranean basin, who ate mainly pasta, fruit and vegetables, moderate quantities of fish and used almost exclusively olive oil such as seasoning, the mortality rate from ischemic heart disease was much lower than in countries such as Finland and the United States, where the diet Daily included many saturated fats of animal origin (butter, lard, milk, cheese, red meat).

The conclusion of this research led Ancel Keys to define the Mediterranean Diet as the best “lifestyle” to live better and longer, making it popular all over the world.

This is how Ancel Keys describes the Mediterranean Diet, first in his 1975 book “Eat well, stay well: the Mediterranean way” and more recently in the presentation reported in the authoritative American Journal of Clinical Nutrition (Am J Clin Nutr 1995 ;61(suppl):1321-3), on the occasion of the first Congress on the Mediterranean Diet held in Boston in 1993, under the patronage of two famous scholars of the Mediterranean Diet, Dimitrios Trichopoulous and his wife Antonia Trichopoulou:

“The heart of what we consider the Mediterranean Diet is mainly vegetarian: pasta is present in different types, seasonal leafy vegetables seasoned with olive oil, all completed with fruit and moderate consumption of wine. No main meal in Mediterranean countries is complete without a large amount of vegetables. Mangiafoglia is the Italian name for “to eat leaves” and that constitutes the key part of a good Mediterranean Diet, in fact the one we associate with health and almost vegetarian or lactovegetarian, because cheese has always been an integral part of this diet.”

The Mediterranean Diet is defined quantitatively in different ways, especially through the techniques of the food pyramid and the Mediterranean adequacy indices.

The most representative food pyramids of the Mediterranean Diet are the American one developed by Walter Willett, doctor at the Harvard School of Public Health in collaboration with Oldways and the one Influenced by the leader-ship of Antonia Trichopoulou and her husband Dimitrios, respectively professor in Athens and professor of epidemiology at Harvard.

The Harvard pyramid recommends:

daily derivatives of unrefined cereals, vegetables, legumes, fruits, nuts, olive oil , cheese and yogurt;
weekly fish, eggs, small meat, desserts;
monthly red meat;
wine in moderation with meals, abundant water;
daily physical activity.

This pyramid was created starting from the data and research then available on the subject of nutrition and based on the Cretan, Greek and Italian food traditions, the in which the rate of spread of chronic diseases recorded in the 60s was the lowest in the world:

The Greek pyramid recommends the same eating behavior only those legumes and nuts are provided not daily but weekly.

In 2003 the USDA food pyramid was reviewed by two authoritative American epidemiologists at Harvard University with specific and recognized nutritional expertise (Walter Willett and Meir Stampfer), who published in Scientific American their proposal for revision, which presents, compared to the previous government pyramid, some significant differences. The pyramid of Willett and Stampfer has ignited, among experts, a lively debate. The authors have in fact adopted some “breaking” choices with respect to the past and, as often happens, this decision has led to different assessments in the scientific community.

The new pyramid, first of all, fully incorporates two concepts, which have emerged clearly in recent years, namely that not all fats have the same nutritional value, and on the other hand that the classic differentiation between simple and complex carbohydrates, in vogue for several decades, is probably no longer adequate to allow consumers to select foods with the best health characteristics.

With regard to fats, in particular, the new pyramid has made drastic choices. While

in the previous version all fats were placed towards the apex (with the meaning, well known to all, of suggesting moderation in consumption), currently only saturated fats, and specifically butter, they maintain this “uncomfortable” position. The fats of vegetable origin are instead placed towards the base of the pyramid, with a specific indication that suggests consuming them every day, and probably during all meals. Margarines, relatively rich in “trans” fats (also referred to as TFA, acronym of the English Trans Fatty Acid) i.e., hydrogenated fats generated from the hydrogenation or industrial hardening of oils, they are instead banned from the pyramid, not being present even in its highest part. During the hydrogenation process, the structure of fatty acids undergoes a significant alteration: it is a geometric molecular conversion from cis to trans that modifies its functions and metabolism within the human body. Compared to saturated or hydrogenated fatty acids in cis form, trans fatty acids favor even more the increase of LDL while reducing the HDL; A diet rich in trans fatty acids may represent a risk factor for cholesterol dyslipidemia and cardio-vascular complications; Therefore, the use of margarines in place of animal lipids is not to be considered a completely correct food choice.

This somewhat innovative approach to fat consumption presumably derives from information collected directly from the authors, who have been coordinating three years now. Extensive epidemiological cohort studies (the study of nurses, the study of health professionals, the study of doctors) that provided a huge amount of information also relating to the correlation between specific aspects of nutrition and the risk of cardiovascular events.

Especially in the “nurses’ study” (Nurses’ Health Study), which is the one that boasts the longest follow-up, it is observed that as the consumption of fatty acids increases. monounsaturated and especially the consumption of polyunsaturated, the risk of cardiovascular events decreases. The quintile of the population with a higher consumption of polyunsaturated has, in fact, in the aforementioned study, a risk of cardiovascular events about 30-35% lower than the quintile of the population in the same study with the lowest intake of these fatty acids. At the other extreme, heavy consumers of “trans” fatty acids have a significant and significant increase in cardiovascular events compared to women who consume a lower amount of these fats. The authors therefore stigmatize the consumption of fats of animal origin, or hydrogenated vegetable fats, while explicitly promoting the consumption of oils, vegetables, in all their forms (and therefore from olive to seeds to corn).

Even with regard to carbohydrates, the choices adopted in the new pyramid are rather drastic. Bread, pasta from refined flours, rice from refined grains, previously placed at the base of the government pyramid, are relegated, in this proposal for revision, at the apex of the pyramid itself. It is a practically complete subversion, a group of foods that in the previous indication was to represent the basis of daily nutrition is now instead classified as “to be consumed in a limited manner”. At the base of the pyramid are placed brown rice, bread and pasta from whole flour cereals, rich in fiber, of which it is suggested a daily consumption.

It is presumable that the basis of differentiation between these two categories of foods is to be found in their different propensity to release glucose into the blood once consumed and, in other words, is due to their different glycemic index. Many observations of the nurse cohort suggest that preferential consumption of foods with a low glycemic index is associated with better cardiovascular prevention. In fact, foods with a low glycemic index tend to be associated with higher values of HDL, to reduced plasma values of some indicators of inflammation, to more favorable plasma triglyceride levels. Subsequently, Mediterranean scientists and representatives of international institutions present at the III International Conference of CIISCAM (International Interuniversity Center for Studies on Mediterranean Food Cultures), held in Parma on November 3, 2009, they discussed the evolution of the Mediterranean Diet and elaborated the new food pyramid for the Mediterranean Diet, in response to that American, launched in 2009 and copyrighted by USA.

The New Pyramid based on the latest evidence that correlates the Mediterranean Diet to health benefits is aimed at the healthy adult population and takes into account the evolution of the times and of society, highlighting the basic importance:

of physical activity, as regular practice offers great health benefits , such as regulating energy consumption and maintaining optimal body weight (the farmer and the worker of the past decades they worked manually around the clock and moved mostly on foot or by non-motorized means of locomotion);
of socialization, as beyond the nutritional aspect, conviviality amplifies the social and cultural value of food. Cooking and sitting around the table with family and friends provides a sense of community;
sustainability, suggesting to favor the consumption of traditional and local products on a seasonal basis (concept of short supply chain and protection of agriculture).

The New Pyramid follows the criterion of the previous one, includes all food groups by basing the foods on which the diet is based and relegates to higher levels, graphically stricter, those that must be consumed in moderate quantities, or occasionally, reserving them for holidays and exceptional events. Whether a diet is healthy or harmful depends on the proportion of each of these groups and their frequency of consumption.

For the first time it illustrates, at the base, the concept of structuring the main meals and, gradually upwards, the other foods necessary to complete the meal , distributed, depending on whether the recommended consumption frequency is daily or weekly. At every meal, going up the pyramid it is therefore necessary to consume, cereals, fruits and vegetables (finally suggested in greater quantities than fruit) lending a lot Be careful to “vary the colors of the natura”, playing with them helps to give the right amount of antioxidants, substances that protect the body from the negative effect of free radicals.

As far as cereals are concerned, the thing that immediately catches the eye on the nutritional level is the explicit reference (visible at the base of the Pyramid, therefore in first position) to the “cereals preferably whole meal” as the Mediterranean Diet is not an abundance of bread and pasta but rather bread, pasta and brown rice as well as various simple cereals (barley, spelt, ifgale, wheat Saracen, Kamut).

In addition, a daily intake of water between 1 liter and a half and 2 liters must be guaranteed, as proper hydration is essential to maintain a good balance of body water.

Next to the pyramid there are very important indications concerning the “frugality” on which the quantities of the portions should be based and the “moderation” of the consumption of the wine, as long as religious or social beliefs allow it.

It is a Mediterranean Diet revisited in the name of modernity and well-being, without neglecting the different cultural and religious traditions and the different national identities.

The Indices of evaluation of adherence to the Mediterranean Diet, on the other hand, have been formulated in order to carry out a global assessment of the quality of the diet and to establish how much a Diet approach the traditional Mediterranean model of reference. They tend to identify the type of diet by synthesizing it by means of a single score, deriving from different components (such as food, food groups or a combination of foods and nutrients); That is, we try to have a single measure of food adherence.

The most used indicators of adequacy to the Mediterranean Diet are:

the Mediterranean Adequacy Index (MAI), created by Albert-Fidanza, is built on the Mediterranean Diet of reference, i.e. the one recorded in 1960 in Nicotera (which was then designated in the Seven Countries Study as the third Italian rural area), dividing the percentage of energy deriving from the consumption of typical Mediterranean foods by that deriving from foods of a Diet not typically Mediterranean. The MAI of the men of Nicotera aged 40-50 was equal to 7.5.

Analyzing the MAI it was possible to see how the diet of population groups examined in Italy in the last four decades has changed, progressively abandoning the nutritional characteristics reference of the Italian-Mediterranean diet. Even the diet of the subjects of Nicotera, has undergone profound qualitative changes and over time, in fact after 42 years the NEVER has dropped to 3.5 for men .

The Mediterranean Diet Score (MDS), created by Antonia Trichopoulou, is a scale that indicates the degree of adhesion through 9 components and determines a score from 0 to 9 (from the minimum degree to the maximum degree of adherence to the Mediterranean diet).
The MedDiet Score, created by Panagiotakos, evaluates the consumption of 11 categories of food products with a punting from 0 to 5 depending on the portions taken weekly.

Prospective epidemiological studies have shown an inverse association between adherence to the Mediterranean diet and risk of chronic and degenerative diseases, more frequent causes of mortality in industrialized countries. . Greater adherence to the Mediterranean diet is associated with a reduction in the incidence of CVD and cardiovascular mortality by 10% and a reduction in all-cause mortality by 8%.

The foods of the Mediterranean diet

The undisputed protagonists of the Mediterranean diet are: olive oil, whole grains, fresh fruit, vegetables, fish, legumes, a moderate amount of dairy products and meat, red wine.

Olive oil

It is the heart of the Mediterranean diet, and determines its flavor. It is the most used fat and this is good: it is rich in monounsaturated fatty acids and in particular oleic acid (70-86%), thanks to this particular characteristic it is one the best condiments to control serum concentrations of very low density lipoproteins rich in LDL cholesterol which tends to remain in the blood, and to settle on the walls of the arteries. In addition, the relatively high concentration of oleic acid in membrane phospholipids makes the cell less susceptible to oxidation, reducing the formation of proinflammatory molecules.

It is rich in polyphenols, substances that in addition to having antioxidant characteristics, stimulate the expression of genes that protect us from cancer.

Some of these compounds, in particular flavonoids and if chiridotids, have shown significant effects in the prevention of chronic diseases such as cardiovascular diseases, some types of cancers, premature aging and degenerative diseases of the nervous system, so they could help explain the health effects of extra virgin olive oil beyond the content of oleic acid.

Olive oil is not only important for its intrinsic properties, but also because it replaces other fats widely used in non-Mediterranean cuisines, such as those of animal origin (lard or butter) or from vegetable oils of lower quality. Let’s not forget, however, that it is still a fat and that all fats, regardless of other nutritional characteristics, have the same caloric intake.

Whole grains

They are representative of the Mediterranean Diet, in fact they occupy the base of the food pyramid with vegetables and fruits. Cereals are a group of foods that include maize, barley, rice, wheat (soft and durum wheat) and spelt. They are an important source of nutritional energy and provide this energy in the form of starch, a polysaccharide from which glucose is obtained after the digestive process, and are also a good source protein. Whole grains are those that keep bran and germ intact and are rich in iron, B vitamins and fiber that facilitate transit intestinal and limit the contact of some harmful elements with the gastrointestinal mucosa.

Many cereals can be ground to make different types of flour, which may have retained their original composition for the entire production route or have been reconstituted. These flours are then used for the production of pasta, bread and other bakery products.

Current epidemiological evidence indicates that whole grains have a beneficial effect on health; Foods from whole grains substantially reduce the risk of cardiovascular disease, diabetes and cancer and also play a role in body weight management and in the health of the digestive system. The essential macro and micronutrients with the phytonutrients found in whole grains contribute synergistically to their beneficial effects.

The inverse association between whole grain intake and cardiovascular disease was demonstrated by a meta-analysis evaluating seven cohort studies showing that the largest Whole grain intake (2.5 servings versus 0.2 per day) was associated with a 21% lower risk of cardiovascular events. On the contrary, there was no correlation with the intake of refined cereals, in which the relative concentration of starch is higher because most of the bran and some Parts of the germ are removed in the refining process.

A recent intervention trial showed a greater reduction in fat mass even without change in body weight, in the group that consumed whole grains compared to that with refined cereals.

Also for the risk of type 2 diabetes mellitus, an inverse association with the intake of whole grains has been demonstrated; beneficial effects may be due to the structure of whole grains and nutrients found in whole grains, such as magnesium and antioxidants such as vitamin E, phytic acid and selenium.

A recent meta-analysis of 25 prospective observational studies confirmed the reduction in the risk of colorectal cancer, for an increase of 3 servings per day of whole grains. The nutritional components of whole grains, which exert their action in improving the state of health by preventing chronic-degenerative diseases, include tocotrienols, lignans and phenolic compounds, and anti-nutrients such as phytic acid, tannins and enzyme inhibitors.

Fresh fruit and vegetables

They are foods with reduced caloric value, rich in fiber, water, vitamins and minerals.

The dietary fiber present in fruits and vegetables increases the relaxation of the stomach with an increase in the sense of satiety which consequently leads not to exceed in consumption or other types of foods with higher caloric value. The servings of fruits and vegetables consumed per day should be five. Always choosing seasonal fruits and vegetables limits the risk of taking harmful substances used in agriculture, helps preserve biodiversity and also organoleptic qualities are superior.

Fish

It is a food that has shaped and determined the history of the countries bordering the Mediterranean. It is an excellent source of protein, vitamin D, long-chain omega-3 polyunsaturated fatty acids and some mineral salts such as selenium, phosphorus and potassium that regulate exchanges of substances through the membrane of the cells and therefore condition the normal functionality of all the cells of our body.

Particular attention goes to the presence of omega-3 fatty acids, which include eicosatetraenoic acid and docosahexaenoic acid, defined as essential as our body is not able to produce them, and must therefore necessarily be taken with the diet. The consumption of omega-3 protects the cardiovascular system, decreasing the risk of coronary heart disease, hypertension, atherosclerosis, thrombosis.

They have antithrombotic effects as they inhibit platelet aggregation, replacing arachidonic acid there is the production of thromboxane A3 without aggregating effects and weak vasoconstrictor and antidyslipidemics effects, as they reduce the expression of ApoB100 of LDLs.

Legumes

Often called the “meat of the poor”, they have a dual function, both for the presence of slow-absorbing carbohydrates and for the good protein quota they possess.

The combination of cereals and legumes is complex from the protein point of view, since it provides the body with all the essential amino acids we need. Legumes have fair amounts of mineral salts, some vitamins and dietary fiber, which helps to achieve the sense of satiety. They also help modulate the glycemic response of the meal.

Dairy products and meat

As for meat, we tend to prefer white to red. It is rich in proteins, fats whose share depends on the type of breeding and origin of the animal, vitamins and mineral salts. Milk is an excellent source of protein, minerals and vitamins.

Wine

Attention goes to the presence of antioxidants such as resveratrol and quercetin.

These substances are important because they have the power to protect proteins, lipids and nucleic acids of cells from the attack of free radicals. Obviously it is not possible to pursue an anti-radical or otherwise comprehensive protective objective, because it would coincide with a quantity of excessive alcohol. The concept therefore remains valid that a good glass of red wine can help to exert actions favorable not only to the reduction of cardiovascular risks, but also to the improvement of lipid framework, hemostatic balance, blood pressure, insulin sensitivity, the level of HDL cholesterol.

Each food, therefore, has beneficial effects on health, when the consumption of these foods is adequate and proportionate in the right quantities, suitable to meet the needs energy and nutrients of the organism.

It is essential to stress that all meals of a day, starting with breakfast, lunch, dinner and snacks, must be balanced, i.e. contain all the nutrients we need, a goal that can be easily achieved with a diet as varied as possible as the Mediterranean diet indicates.

Always pay attention to the quantities, but above all to the balance of nutrients that provide energy, respecting in particular the following proportions: 55-60% of energy from carbohydrates, 12-15% from proteins , 25-30% from fats.

We can also say, with certainty, that the Mediterranean diet can be a useful tool to reduce body weight , with moderate calorie restriction associated with physical activity.

But does the Mediterranean Diet still exist?

It may seem strange, but the much publicized Mediterranean Diet, the one that we should all follow to feel better and prevent diseases of well-being and that represented the basis of eating habits until the middle of the twentieth century in all the countries of the area, is gradually disappearing from the Mediterranean countries, from our South , Greece, Spain and also the Middle East and North Africa, due to a wide diffusion of the Western economy, urban and technological culture and the globalization of production and consumption. Food choices are geared towards what the market offers, depending on the efficiency and speed of transport, distribution networks and the effectiveness of conservation technologies and become increasingly disconnected from seasonality and tradition.

The data of the INRAN-SCAI 2005-2006 survey on the food consumption of Italians show that the Mediterranean Diet is becoming a memory for adults, it will become a chapter of history for the

the fattest children in Europe, and it is already a news story for adolescents and young people who pursue a diet often calorically contained but with foods with high caloric density.

From the post-war period to today, the Mediterranean style has undergone a profound change: the diet has been progressively enriched with foods high in proteins, saturated fats and simple sugars because Both meals outside the home (out of necessity and laziness) and the consumption of ready meals (very different qualitatively from those consumed in the 60s) and also the portions of Italians have increased by 30-40 % (from 2,500 to 3,300 kcal / day), with a progressive depletion of proteins of vegetable origin and complex carbohydrates . This increase in caloric intake was not followed by adequate energy expenditure because even the lifestyle became more sedentary as it was linked by transport and I work more and more on machines, thus resulting in a significant reduction in daily energy expenditure.

We live, therefore, in an era of “apparent well-being“, where the lengthening of life expectancy is also recorded the growth of overweight and obesity and all the pathologies to them Related.

The Mediterranean food model must not be abandoned, but rediscovered, re-evaluated and proposed daily in the tables of Italians.

Sources:

The new Mediterranean Diet. Stefania Ruggeri, Gabriele Rubini. Gribaudo 2014
The Mediterranean Diet between myth and reality. Lucio Lucchin, Antonio Caretto. Il Pensiero Scientifico Editore 2012
The Mediterranean Diet of Puglia. Tholos Editrice 2012
Menotti A, Lanti M, Puddu PE, Kromhout D. Coronary heart disease incidence in northern and southern European populations: a reanalysis of the seven countries study for a European coronary risk chart. Heart 84:238-44, 2000.)
Leclercq C, Arcella D, Piccinelli R, Sette S, Le Donne C, Turrini A: The Italian National Food Consumption Survey INRAN-SCAI 2005-06: main results in terms of food consumption. Public Health Nutr. 2009 Dec; 12 (12): 2504-32
Sette S, Le Donne C, Piccinelli R, Arcella D, Turrini A, Leclercq C; On Behalf of the INRAN-SCAI 2005-06 Study Group : The third Italian National Food Consumption Survey, INRAN-SCAI 2005-06 – Part 1: Nutrient intakes in Italy. Nutr Metab Cardiovasc Dis 2010 Jul 29
Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 2010;92:1189–1196.
Sofi F. et al. Mediterranean diet and helath status: an updated meta-analysis and a proposal for a literature-based adherence score- Public Health Nutrition 2013
Bork CI et al. Mediterranean diet and cardiovascular disease. Ugeskr Laeger. 2014 Jul 7;176(28).