Health implications of Mediterranean diets in light of contemporary knowledge. 2. Meat, wine, fats, and oils.

Consumption of beef, pork, and lamb has traditionally been low in Mediterranean countries. Regular consumption of red meat has been associated in epidemiologic studies with increased risks of coronary heart disease (CHD) and colon and other cancers; possible mechanisms may involve dietary cholesterol, saturated fat, heme iron, and the presence of carcinogens formed in cooking. Also, high consumption of red meat, the major source of animal protein in most Western diets, increases urinary calcium losses and is therefore likely to contribute to osteoporotic fractures. In Mediterranean diets the major source of dietary fat has traditionally been olive oil, which, compared with saturated and partially hydrogenated fats, reduces low-density-lipoprotein (LDL) cholesterol and, compared with carbohydrates, increases high-density-lipoprotein (HDL) cholesterol. A wealth of epidemiologic evidence supports a potent protective effect of moderate alcohol consumption against CHD, probably in part by increasing HDL concentrations. Although dietary factors alone may not fully explain the excellent health of Mediterranean populations, available evidence strongly suggests important contributions of high consumption of fruit, vegetables, and whole grains; moderate intake of alcohol; and low consumption of animal products, saturated and hydrogenated fats, and refined carbohydrates.