Many scientists have reported on health benefits associated with the traditional diet of much of the Mediterranean area: the primary basis of the diet is on plant-based foods (whole grains, vegetables, fruits), olive oil, moderate wine consumption, and limited intake of meat or dairy products. In 2003, Antonia Trichopoulou and her associates created a scoring system based on the number of components of the Mediterranean Diet (Med-Diet) consumed by subjects, giving a total score to judge the degree that individuals were following a Med-Diet pattern. The score is based on the intake of 7 items (cereal intake, ratio of monounsaturated to saturated fats, vegetables, fruits, nuts, fish, and moderate alcohol), considered to have positive effects, and 2 items (dairy products, meat and meat products) considered to have negative effects. Many groups have found that greater adherence to such a diet (a higher score) is associated with a lower risk of many diseases, and lower mortality. There are limited data on the relative merits of each component of the Med-Diet. In the present paper, the authors attempt to judge the proportion of the protection against mortality that can be attributed to each component of the score.
The authors’ calculations estimated that, in descending order of importance, moderate alcohol consumption (associated with a reduction of 14.7% in the protection against mortality when it was removed from the total score), cereal intake (12.2% reduction), ratio of monounsaturated to saturated fats (5.8%), and consumption of vegetables (5.8%), fruits and nuts (5.2%) and fish (5.0%) lowered mortality risk. Lower intakes of dairy products (reduction of 13.4%) and meat and meat products (3.4%) were also associated with lower mortality. Alcohol has long been known to relate to a lower risk of developing diabetes, and the present study indicates that it is an important factor in reducing the risk of mortality among subjects who have already developed diabetes, as has been shown in previous studies. This study indicates further that the full Med-Diet has very favorable effects on mortality among diabetics.
Forum members considered this to be a well-done attempt to tease apart the relative importance of each component of the Med-Diet as it relates to health outcomes among diabetics. They felt that these researchers from the MOLI-SANI study have published a convincing paper extending the known benefits of the Mediterranean diet to a cohort of type 2 diabetics, a group of subjects at high risk for cardiovascular and all-cause mortality.
There were some questions raised about the precision of the Med-Diet Score, as published and used in this study, in judging the relative contributions of the different dietary constituents, especially because of known complexities in judging the effects of avoiding one particular food when its absence may affect the intake of other foods. And for alcohol, the score used did not permit an evaluation of the role of the pattern of drinking or even the type of beverage consumed, which are known to affect the net effects of drinking on health.
Nevertheless, the results of this study add to an accumulating base of knowledge of the importance of the Mediterranean-type diet in reducing the risk of many health outcomes, including mortality among diabetics.
Reference: Bonaccio M, Di Castelnuovo A, Costanzo S, Persichillo M, De Curtis A, Donati MB, de Gaetano G, Iacoviello L, on behalf of the MOLI-SANI StudyInvestigators.
Adherence to the traditional Mediterranean diet and mortality in subjects with diabetes. Prospective results from the MOLI-SANI study. European Journal of Preventive Cardiology 2015. Pre-publication. DOI: 10.1177/2047487315569409.
For the full critique of this paper by members of the International Scientific Forum on Alcohol Research, please click here.