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Back to the ancient diet: A matter of urgency for Southern Mediterranean countries

      According to the World Health Organization, the standardized cardiovascular disease (CVD) mortality rates vary considerably from country to country around the developed world, with Mediterranean countries and Japan having among the lowest rates [
      • World Heart Organization Study Group
      Diet, nutrition, and the prevention of chronic diseases.
      ]. The latter confirms the results from the 25-year follow-up (1960–1985) of the Seven Countries Study [
      • Keys A.
      • Menotti A.
      • Karvonen M.J.
      • Aravanis C.
      • Blackburn H.
      • Buzina R.
      • et al.
      The diet and 15-year death rate in the Seven Countries Study.
      ] which reported that the prevalence of CVD was between 2% and 10% in southern European countries, in contrast to 10–18% in northern European countries. Several scientists during the past years have attributed, at least in part, the differences in mortality rates between various countries of the world to the quite different nutritional habits of the people [
      • World Heart Organization Study Group
      Diet, nutrition, and the prevention of chronic diseases.
      ]. First of all, Ancel Keys and the other investigators of the multi-cultural Seven Countries Study observed that the dietary habits of people living in the northern regions of the study (i.e., north Europe and USA) were mainly characterized by increased intake of saturated fat, while people living in the Mediterranean region (Greece, Italy) and Japan, consumed more frequently fruit, vegetables and used monounsaturated fat (olive oil), as the main added fat [
      • Keys A.
      • Menotti A.
      • Karvonen M.J.
      • Aravanis C.
      • Blackburn H.
      • Buzina R.
      • et al.
      The diet and 15-year death rate in the Seven Countries Study.
      ]. This observation led the investigators of the Seven Countries Study to first define a healthy dietary pattern that was observed in the Mediterranean cohorts, and especially among peasants in Crete (i.e., the “Cretan” Mediterranean diet), and relate it to the lower incidence of CVD and all-cause mortality in these populations. Many observational studies and clinical trials have attributed the protective effect of Mediterranean diet or diets to the reduction of blood pressure levels, inflammation and coagulation markers, platelet aggregation and other haemorheological factors, as well as in the reduction or even in the control of body mass index [
      • De 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.
      ,
      • Trichopoulou A.
      • Costacou T.
      • Bamia C.
      • Trichopoulos D.
      Adherence to a Mediterranean diet and survival in a Greek population.
      ,
      • Panagiotakos D.B.
      • Pitsavos C.
      • Stefanadis C.
      Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk.
      ,
      • Sofi F.
      • Cesari F.
      • Abbate R.
      • Gensini G.F.
      • Casini A.
      Adherence to Mediterranean diet and health status: meta-analysis.
      ]. It is important to mention that there are several forms of Mediterranean diet in the Mediterranean basin, as well as around the world, according to local environmental and cultural peculiarities [
      • Alberti A.
      • Fruttini D.
      • Fidanza F.
      The Mediterranean Adequacy Index: further confirming results of validity.
      ,
      • Babio N.
      • Bulló M.
      • Basora J.
      • Martínez-González M.A.
      • Fernández-Ballart J.
      • Márquez-Sandoval F.
      • on behalf of the Nureta-PREDIMED investigators
      • et al.
      Adherence to the Mediterranean diet and risk of metabolic syndrome and its components.
      ]. Nevertheless, olive oil is the main added lipid of this dietary pattern, which is also characterized by high intake of vegetables and fruits, legumes, wheat, olives and grapes and their various derivative products, as well as moderate intake of fish and alcohol, and especially wine.
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