What is a Mediteranen Diet?
The Mediterranean diet is a way of eating based on traditional foods and drinks of the countries surrounding the Mediterranean Sea. The archetypal traditional ‘Cretan’ Mediterranean diet was first established three decades ago as a cardio-protective diet in the Seven Countries Study . Keys and co-workers found that residents in Crete in Greece had the lowest mortality from heart disease and this was positively associated with their dietary pattern. This traditional dietary pattern is characterized by an abundance of plant-based foods such as leafy green vegetables, tomatoes, onions, garlic, herbs, whole grain cereals, nuts and seeds, olive oil used as the main added dietary fat, moderate amounts of low-fat dairy products, fish and seafood, smaller quantities of red meat and red wine to be consumed in moderation with meals [2-3] (Figure 1).
Benefits of a Mediterranean Diet
There is an array of benefits associated with consuming this dietary pattern such as reduction or maintenance of weight, primary and secondary prevention of cardiovascular disease (CVD), and it has more recently been linked to reducing non-alcoholic fatty liver disease (NAFLD) [3-6,16,17]. Since the establishment of the Mediterranean diet over three decades ago, there has been increasing scientific evidence regarding the consumption of this dietary pattern. Keys and co-workers proposed that the high consumption of monounsaturated fats due to increased intake of extra virgin olive oil, and low intakes of saturated fats contributed to the low morality rate seen within this population group . Wider research has since established the cardio-protective nature of the Mediterranean diet stems from the high consumption of bioactive compounds such as polyphenols in red wine and plant-based foods and extra-virgin olive oil, which is also believed to have an anti-inflammatory effect . The cardio-protective nature of this dietary pattern has been exemplified in two landmark studies: The Lyon Diet Heart Study and Prevención con Dieta Mediterránea (PREDIMED) intervention trial [2-3].
PREDIMED is a Spanish primary prevention randomised control trial (n=7447) in high-risk middle age people in Spain . The study had three intervention groups: 1) a Mediterranean diet enriched with extra virgin olive oil; 2) a Mediterranean diet enriched with mixed nuts and 3) a control low-fat diet. In 2013, the final report of the PREDIMED trial indicated a 30% absolute risk reduction in the incidence of a first major cardiovascular event .
The Lyon Diet Heart Study is a randomised secondary prevention trial (n=605), which evaluated whether a Mediterranean type diet could reduce the rate of secondary cardiovascular events. The study was published in 1999 and reported a 70% reduction in adverse cardiovascular events after initial MI compared to a control low fat diet . The findings of this study were so significant; the ethics committee could no longer justify keeping individuals in the control-arm and ceased the study.
These two landmark studies exemplify the cardio-protective nature of this dietary pattern. However, there are a range of other benefits associated with this dietary pattern such as:
• Reduction in NAFLD [5,15,17]
• Modest weight-loss [8,9]
• Reduction of abdominal adiposity or central obesity [9-12]
• Evidence for a decline in depression and anxiety disorders [13, 16]
• Slow cognitive decline and decrease risk of dementia 
• Declines in Type II Diabetes Mellitus [15,16]
• Declines in Cancer 
However, most of this present research has been done in a Mediterranean population, which limits its generalisability. Although, more and more research in non-Mediterranean populations are under wraps, so you need to watch this space – there is big things coming for this dietary pattern in a non-Mediterranean population group. While it is too early to call whether changes to Australian dietary guidelines should incorporate more Mediterranean-style foods, if the benefits of this dietary pattern are replicated in a non-Mediterranean population group, then this could be a very real reality in the future.
As such, the Mediterranean diet has become one of the highest regarded dietary patterns to date. Not only is the consumption of this dietary pattern associated with a range of health benefits, it is also known for its palatability and cost-effectiveness , the Mediterranean diet is the gift that keeps on giving.
Pass the olive oil please?
Figure 1 Source: http://oldwayspt.org/
Cassandra completed her Bachelor of Human Nutrition in 2015 at La Trobe University. Upon completion, Cassandra undertook her Honours year at La Trobe University the following year and ended the year with First Class Honours. Cassandra had the opportunity to work on the AusMed Heart Trial, which aims to prevent 12-month cardiac re-event rate using a Mediterranean diet intervention in a multi-ethnic cohort. Her Honours research focussed on the Effect of Mediterranean Diet on Visceral Fat in Australian Patients Post-Cardiac Event. Since cessation of her Honours year, Cassandra has been accepted into the Masters of Dietetic Practice at La Trobe University in 2017, which will allow her to fulfil her goal of becoming a clinical dietitian. At present, Cassandra is in the final stages of preparing to submit her systematic review for publication.
Cassandra’s areas of interest include: Mediterranean diet, cardiovascular disease, diabetes and obesity.