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Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Avenue East, Boston, MA 02215, E-mail: sliu{at}rics.bwh.harvard.edu
Mediterranean Diets, vol 87 of World Review of Nutrition and Dietetics, edited by AP Simopoulos and F Visoli, 2000, 184 pages, hardcover. S Karger AG, Basel, Switzerland.
From ancient hunter-gatherers to modern urban dwellers, diet has been integral to human existence. Over time, food preferences and eating habits have evolved into many different patterns, reflecting the diverse human experiences of present and passing cultures. These complex dietary patterns may have major implications for health and disease. It is therefore fitting to examine specific diets in relation to some major nemeses of contemporary societies, including the epidemics of heart disease and other chronic degenerative diseases. Since World War II, the most significant descriptive data on diet and heart disease have come from the Seven Countries Study in which Keys (1) and his colleagues related the different dietary patterns of 16 populations to cardiovascular disease mortality. The low rates of cardiovascular deaths in southern European countries bordering the Mediterranean led Keys to conclude that a dietary pattern traditionally adopted by people of that region, particularly the island of Crete, may explain the observed health benefits.
The authors of the latest volume in the series World Review of Nutrition and Dietetics have done a good service to the nutrition community by concisely summarizing the subsequent analytic and experimental data on the Mediterranean diet and its mechanism for reducing the risk of heart disease and cancer. Mediterranean Diets is a collection of 9 chapters discussing many aspects of this diet, including the staple use of olive oil, plant-based foods, and wine. The changing dietary patterns in the Mediterranean basin in recent years are also reviewed. The book focuses heavily on fats, with an in-depth discussion of the effects of different types of fats on cardiovascular health and an emphasis on the ratio of n-6 to n-3 polyunsaturated fats. Much of the discussion of fats is illuminated by the most up-to-date understanding of atherothrombosis.
Significant findings from several major trials are discussed in the book, including the Diet and Reinfarction Trial, the Lyon Diet Heart Study, and the most recent Gruppo Italiano per lo Studio della Sopravivenza nell' Infanto Miocardico (GISSI)-Prevenzione trial. Separate chapters are devoted to olive oil and wine, describing their significant roles in the Mediterranean diet and their potential protective ingredients. Fruit and vegetables receive only limited coverage, which is largely centered on the antioxidant mechanism. Similarly, the potential benefits of cereal grains are mentioned only briefly, with a superficial description of carbohydrate types and whole grains. The lack of discussion of physical activity is disappointing because physical activity is clearly a major correlate of dietary patterns and a significant determinant of health status. A chapter on policy implications would also have been welcome because the real challenge is how to adopt such a healthy diet in an increasingly westernized world. The book also suffers slightly from some unnecessary repetition in the discussion of most major topics, as books with multiple authors often do. For example, most chapters repeat the view that many different diets exist throughout the Mediterranean region and that there is no such thing as one Mediterranean diet. The reference lists are extensive but not comprehensive, showing preference for European studies. The conclusions of the authors are prudent but lack balance. Few counter-arguments to the Mediterranean diets are offered, but this may simply reflect the literature available in the field of diet and heart disease, namely, a voluminous literature relating to fats but relatively little on other aspects of diet.
Keys's view of the good Mediterranean diet is principally vegetarian, with special emphasis on its beneficial effect on serum cholesterol: "pasta in many forms, leaves sprinkled with olive oil, all kinds of vegetables in season, and often cheese, all finished off with fruit, and frequently washed down with wine" (2). Although the authors of Mediterranean Diets must have taken Keys's words to heart in defining the good Cretan diet, they have nevertheless gone beyond the original paradigm of serum cholesterol in explaining the biological mechanisms responsible for the significant benefits of that diet. Students and practitioners of nutrition and health will find great value in this book.
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