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Because residents of most Mediterranean countries enjoy greater longevity and have a lower incidence of coronary artery disease than people living in the U.S., the Mediterranean diet has been proposed as one means of reducing the risk of cardiovascular disease and death. Essential components of the Mediterranean diet are fresh fruits, vegetables, herbs, and berries; nuts and whole-grain breads, cereals, and pasta; fresh fish; olive oil; and wine in moderation (150 mL/day for women, 300 mL/day for men). Diets high in omega-3 oils (from vegetables, nuts, and fish, particularly fatty fish such as salmon, sardines, tuna, bluefish, and swordfish) and monounsaturated fats (from olive oil, canola oil, avocados, and nuts) have been shown to lower plasma triglyceride and low-density lipoprotein cholesterol and to reduce cardiovascular and all-cause mortality both in healthy adults and in survivors of myocardial infarction. The Mediterranean diet is high in flavonoids (from peppers, tomatoes, onions, berries, tea, and red wine), which exert an antioxidant effect on LDL cholesterol and are also believed, on the basis of limited studies, to reduce cardiovascular mortality. The Mediterranean diet is low in saturated (animal) fats, such as occur in red meat, lard, milk, butter, and cheese, and it excludes trans-fatty acids (produced by the hydrogenation of vegetable oils in the manufacture of margarine, shortening, and substitutes for animal fats used in cooking and frying). Both saturated fats and trans-fatty acids raise plasma levels of cholesterol and triglycerides and increase the risk of cardiovascular disease and death. The observation that Italians have higher cholesterol levels than Americans but a lower risk of cardiovascular death suggests that improved cardiovascular health and survival on the Mediterranean diet does not depend solely on changes in lipid levels. Studies have shown a beneficial effect of olive oil on blood pressure in patients under treatment for hypertension. Some apparent benefits of the Mediterranean diet may be due to lifestyle differences between Mediterranean cultures and that of the U.S. Valuable features of the Mediterranean diet are that it requires no drastic changes in calorie allowances, is found palatable by most people, and is not more expensive than regular diets. Potential benefits of the Mediterranean diet must be balanced against possible adverse effects. High consumption of fat from any source can lead to obesity unless offset by regular vigorous exercise. Consumption of alcohol is a risk factor for breast and other cancers and in those susceptible for alcoholism.