ABSTRACT
The traditional Mediterranean diet (MD) was shown to be associated with a lower incidence of cardiovascular disease (CVD) in the 1950s. Randomized controlled trials and epidemiological studies have subsequently reported lower CVD rates in people following a traditional or a “modernized” form of MD. In 1994 and 1999, the reports of the intermediate and final analyses of the trial Lyon Diet Heart Study showed a striking protection of the MD against CVD complications. In 2003, a major epidemiological study in Greece showed a strong inverse association between a “Mediterranean diet score” and the risk of cardiovascular complications. In 2011–2012, several reports showed that even non-Mediterranean populations can gain benefits from long-term adherence to the MD. In 2013, the PREDIMED trial demonstrated a significant risk reduction of CVD complications with MD in a lower risk population than that of the Lyon trial. Contrary to the pharmacological approach, the adoption of MD is also associated with a significant reduction in new cancers and overall mortality. Thus, in terms of evidence-based medicine, the full adoption of a modern version of the MD pattern should be considered as one of the most effective approaches for the prevention of CVD complications. On the other hand, there is a worldwide type 2 diabetes epidemic with no clear biological explanation. Lifestyle factors are probably important and lifestyle interventions, including physical exercise and healthy nutrition, have been proposed to prevent type 2 diabetes and its complications. The optimal dietary pattern seems to be again the MD model that appears to also be the most appropriate to maintain the pleasure of eating—and therefore the long-term adherence to the MD pattern—and thus protect against the main complications of type 2 diabetes, that is, cardiovascular diseases and cancers, and to prolong survival with a good quality of life.
