Recent Findings of Studies on the Mediterranean Diet: What are the implications for current dietary recommendations?

Results from these clinical trials, particularly PREDIMED, provide convincing evidencethat a Mediterranean-style dietary pattern is effective for improving both cardiovascularoutcomes and multiple CVD risk factors. Dietary patterns such as the Mediterraneandiet result in multiple changes in nutrient consumption that most likely act inan additive, or even synergistic, manner. If these healthy dietary patterns can be sustainedover the long term, the evidence base indicates that CVD risk can be markedlyreduced. Even small dietary modifications can have a clinically significant benefit. Theprimary and secondary analyses of PREDIMED demonstrate that both EVOO andmixed nuts can be effectively incorporated into a Mediterranean-style diet to providesubstantial cardiovascular benefits.The addition of the Mediterranean diet to the list of evidence-based dietary patternsmay help individuals achieve better long-term adherence to a cardioprotective diet ifthe composition of the Mediterranean diet more closely aligns with their cultural andpersonal preferences than other recommended dietary patterns. Significant dietary changes can be achieved in the short term, but dietary and lifestyle modifications canbe difficult to sustain. Consequently, waning compliance results in diminished CVDrisk reduction. Thus, a nutrient-dense dietary pattern that provides options to reflectpersonal preferences may help patients maintain a healthy diet and achieve maximalreduction in CVD risk.A Mediterranean-style dietary pattern reflects most food and nutrient goals recommendedby the DGA 2010 and 2013 AHA/ACC Lifestyle Guideline. Minor modificationsto the traditional Mediterranean dietary pattern can be made to reduce sodium andsaturated fat intake and meet current dietary recommendations. Emphasizing lowfator fat-free dairy in place of full-fat cheeses, removing skin from poultry, and emphasizingnuts high in unsaturated fat (eg, walnuts, almonds, hazelnuts, and pistachios)would further reduce saturated fat intake and promote LDL-C reduction, a primarygoal of the AHA/ACC Lifestyle Guideline. Although it is not the primary dietary patternrecommended, implementation of a Mediterranean-style diet improves cardiovascularoutcomes even in the absence of reductions in traditional CVD risk factors. In additionto cardiovascular outcomes, numerous other studies have demonstrated reductionsin multiple, major CVD risk factors, including lipids and lipoproteins, blood pressure,and body weight, which would be expected to further decrease CVD risk. Thus, it ispossible that future dietary guidelines will place greater emphasis on the Mediterraneandiet as a dietary pattern for the prevention and treatment of CVD, in additionto other chronic diseases.