Mediterranean-Style Eating

What the evidence says

Mediterranean-style eating is a flexible pattern centered on vegetables, fruit, legumes, whole grains, nuts, olive oil and other unsaturated fats, with fish or other minimally processed proteins and fewer refined grains, processed meats, added sugars, and highly processed foods. Alcohol is not required and should not be started for health.^[5]

In the corrected PREDIMED analysis, Mediterranean patterns supplemented with extra-virgin olive oil or nuts reduced major cardiovascular events among older Spanish adults at high cardiovascular risk, with adjusted hazard ratios of 0.69 and 0.72 versus the control diet.^[1]

PREDIMED's original report was withdrawn after randomization and protocol irregularities were identified. Reanalysis remained favorable, but the deviations, donated foods, intensive dietary support, and selected high-risk population reduce certainty and generalizability.^[1][3]

CORDIOPREV randomized 1,002 people with established coronary disease and found fewer major cardiovascular events over seven years with a Mediterranean diet than a healthy low-fat diet. It was a single-center trial and 82.5% of participants were men. The older Lyon Diet Heart Study also reported fewer recurrent events but had methodological limitations.^[2][4]

A Cochrane review rated much of the clinical-endpoint evidence low to moderate and noted dependence on a few trials. Cardiovascular-event reduction in high-risk populations is more persuasive than claims of longer lifespan or that one food, such as olive oil or nuts, carries the whole effect.^[3][5]