Traditional diets and disease patterns of the Mediterranean, circa 1960.

The 16 countries that border the Mediterranean sea differ markedly in geography, as well as in the health, political institutions, and economic status of their populations. Although many studies have examined the effects of lifestyle factors on the health of Mediterranean populations, few have investigated nutritional aspects, and even fewer have examined dietary patterns across countries. Few sources of data permit comparison of food and nutrient intakes among the various Mediterranean populations. I explore the concept of a Mediterranean diet through analysis of World Health Organization standardized mortality data and the only available data on food patterns throughout the region, the Food and Agriculture Organization food balance sheets, from the early 1960s to the present. Caveats about the use of food balance data are well known; they reflect disappearance of food groups from the marketplace, and only indirectly indicate information about dietary intake. Even with these limitations, the data indicate some similarities in the food availability patterns of Mediterranean countries: a relatively high proportion of energy from cereals, vegetables, and fruits, relatively less meat consumption than in northern Europe, and greater reliance on vegetable than on animal fats. This pattern is associated with distinctly lower rates of chronic diseases than those found in many developed countries in Europe and elsewhere. Changes in health patterns during the past 30 y reflect changes in food availability patterns during that period toward those more typical of northern Europe and the United States.