Characteristics of the Mediterranean diet

Even considering the above-mentioned distinctions, there are many characteristics that are common to all the different varieties of the Mediterranean diet, given the role and importance that the different nutritional groups have in the cuisine of Mediterranean countries. For example, four things that are common to all of them are the high consumption of fruits and vegetables, the widespread consumption of fish, the use of olive oil and the tradition of deep-frying.

The following table summarizes the role of the different nutritional groups in the Mediterranean diet, incidentally also describing the average Spanish diet. On the left side, the direction of the arrows (either up or down) indicate a higher or lower consumption of the foods that are contained in the corresponding nutritional group; on the right side we find the repercussion of that consumption in some of the most characteristic nutritional parameters. Even though the table is pretty self-explanatory, we will briefly comment on some of its points.

Table: Characteristics of the Mediterranean diet as regards the consumption of the different nutritional groups.

Fruits and vegetables

		Fibre -------> Pectin

		Vitamin C, Betacarotene and folic acid

		Other non-nutritional components that have a positive impact on degenerative disease.

Vegetable oils(olive oil)

		PUFA and MUFA

		Vitamin E

Fish (specially fatty fish)

		PUFA -------> (Omega-3)

		Calcium

Cereals(bread and pasta)

		Complex carbohydrates

		Caloric content

Legumes

		Protein

		Calcium and magnesium

		Fibre

Milk

		Calcium

Meat and meat products intake

		Protein, iron

		SFA

Eggs intake

		Protein

Butter and margarine

		SFA

Sugar

Salt

Wine

		Instead of other alcoholic beverages (beer, liqueur)

Higher intake

Lower intake

Moderate intake

Unknown

G. Varela (1993), Adapted from O. Moreiras (1987).

A high consumption of fruits and vegetables results in a high fibre intake � especially pectin � as well as a high intake of betacarotene,

folic acid and vitamin C. As for the latter, our country has the highest intake of it in Europe, a considerable thing given the high levels of vitamin C consumption among Europeans. It is also important to point out that approximately 50% of all European consumption of ascorbic acid comes from raw food, an important aspect given the extremely thermolabile character of this vitamin, easily destroyed by the thermal processes involved in the preparation of food. This high percentage of raw food intake makes it possible to cover the nutritional recommendations for this nutrient even in the hypothetical case where all cooked meals were completely depleted of vitamin C.

The high consumption of vegetable oils (especially olive oil) in Mediterranean countries is widely known. This preference leads to a high intake of polyunsaturated acids (PUFA), and monounsaturated acids (MUFA), especially in the case of olive oil. It is not necessary to point out the importance of these types of fatty acids in the prevention of cardiovascular disease. Note that when olive oil is eaten raw, it is also a great source of vitamin E. In short, the role of fat in the Mediterranean diet is of great importance.

Spain is, along with Portugal, the highest consumer of fish and seafood in Europe. Fish consumption varies among the different Mediterranean countries. As a general rule, countries on the Mediterranean west eat a lot more fish than those in the east. The nutritional value of fish is extraordinary, not only because of the great quality of its protein, but also because fish is a great source of PUFA omega 3, a great aid in the prevention of cardiovascular disease. Small fish � eaten whole or tinned � are also a great source of bioavailable calcium.

The nutritional value of legumes is well known. Their protein content is

very similar to foods of animal origin, both in quantity and quality, while the ratio between nutritional value and price favours the consumption of legumes. Also, proteins obtained from legumes are very well complemented with the proteins of other foods. For this reason, these are usually prepared together in many of the most traditional Mediterranean diets. Unfortunately, despite the many benefits that it offers, the consumption of legumes has declined alarmingly in recent years, particularly in the western side of the Mediterranean.

The same phenomenon is taking place as regards the consumption of bread and cereals, and is having a great impact on the imbalance of what is known as the Caloric Profile of the Diet, in other words, the caloric intake of macronutrients. In Spain, in 1964, this profile was very close to the recommended levels (10-30-60), but as it has been the case with the rest of developed countries in recent years, there has been a decline in carbohydrate intake as a consequence of the increase in protein and fat intake (14-40-46).

The consumption of dairy products in Mediterranean countries does not follow a homogeneous pattern. For example, in Spain there is a high consumption of milk, but not of cheese, while for the Greek cheese is the most popular item, used in most of their traditional dishes, such as salads, in which it becomes an excellent source of protein and calcium.

Consumption of meat and meat products in Mediterranean countries is moderate, but the components of this group vary greatly from one country to the next. This difference can be observed in the intake of chicken. For instance, in Spain chicken is a very popular item; however, that is not the case in other countries. This is a significant fact for us since chicken fat is the healthiest (least saturated) when compared to the fat that comes from beef or pork.

Another well-known characteristic of Mediterranean countries is the low intake of solid fats, like butter. This is in great part due to the fact that we do not spread these products on our bread, as it is customary in many countries outside of the Mediterranean area. It is also due to the use of oil instead of solid fats (like butter) in cooking. Egg consumption is homogeneous throughout the region, in tune with the rest of the developed world, and it is not a major problem when it comes to cholesterol intake in the diet.

We have serious doubts about the accuracy of the information that we have about sugar, salt and alcohol in all the countries in question. It is well known that the most suitable way to study food consumption in general is the Family Survey. However, this method only shows food intake at home, not taking into account what is consumed outside of the home, which in the particular case of alcohol, sugar and salt is very significant. Despite the limitations of this data, we can say that in the case of Spain we see a low sugar intake, with figures that do not reach a 10% of the total caloric intake.

Drinking red wine moderately is also a very traditional aspect of Mediterranean culture. Nowadays, the accepted standard allows an intake of 30 grams of alcohol per person per day (approximately half a bottle of table wine), this being considered moderate and even beneficial for healthy adults. (In the case of women, however, this amount should be a little lower.)

Now, in closing, let us insist on a point we made above: within the diversity that characterises the Mediterranean diet, if we had to narrow it down to four characteristics that certainly define this diet, these would be a high consumption of fruits and vegetables, a high intake of fish, the use of oils (specially olive oil) and the tradition of deep-frying.

Gregorio Varela Mosquera

President of the Spanish Nutrition Foundation