Elsevier

Maturitas

Volume 64, Issue 2, 20 October 2009, Pages 67-79
Maturitas

Review
Effects of the Mediterranean diet on longevity and age-related morbid conditions

https://doi.org/10.1016/j.maturitas.2009.07.013Get rights and content

Abstract

Objectives

To delineate the influences of the Mediterranean diet (MD) on human mortality and age-related morbid conditions, principally the metabolic syndrome, hypertension, cardiovascular disease, excess body weight, cancer, poor bone mineralization and rheumatoid arthritis, and neurodegenerative disorders.

Method

Citations were selected from a PubMed search according to their clinical and experimental relevance.

Results and conclusions

Individuals who adhere to the principles of the traditional MD tend to have a longer life-span. Both men and women who report eating foods closest to the MD are about 10–20% less likely to die over the course of a study of heart disease, cancer or any other cause. The longevity of Mediterranean people has been related to olive oil, and its several microcomponents of antioxidant potential, present in all MD variants. The prevalence of the metabolic syndrome may be reduced by a MD. The MD is significantly inversely associated with both systolic and diastolic blood pressure. It also has benefits in relation to the prevention of cardiovascular events, reduces the risk of mortality after myocardial infarction, and reduces peripheral arterial disease. The risk of obesity decreases with increasing adherence to the traditional MD. The MD also has a preventive effect on cancer, through its antiproliferative and pro-apoptotic effects, mostly due to the components of virgin olive oil and vegetables. There is some evidence of the benefits of the MD in relation to bone metabolism, rheumatoid arthritis, and neurodegenerative age-related diseases (cognitive deficit, Alzheimer's disease, Parkinson's disease).

Introduction

During millions of years of evolution, human beings were largely subject to low-fat, high-carbohydrate diets (the foods generally available to our ancestors). The Paleolithic diet was based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts [1], [2]. The diet of late archaic hominid populations and their contemporaneous modern humans included marine food supply [3]. Modern civilization was born around the Mediterranean Sea. Ancient Greeks and Romans created a culinary culture that lasted for centuries, into present times [4]. For example, the Ancient Greeks used olives as their main source of fat instead of animal meat; they believed – in contrast to those they deemed barbarians – that animal fat was an unhealthy food. Olive oil was created to help preserve the olives. Barbarians ate more meat and animal products such as milk and cheese because they were nomadic and had less opportunity to grow olive trees or to prepare olive oil. The discovery of America lead to the incorporation of new fruits and vegetables that enriched European gastronomy: tomatoes, corn, potatoes, chocolate, etc. In the 5th century BC Herodotus mentioned a fountain in the land of the Ethiopians, whose healing water was responsible of the exceptional longevity of this people. In Spain, during Moorish rule (from the 8th to the 15th century), stories about the water of eternal life or youth were very popular, and would have been known to the explorers who journeyed to America. Thus, in 1513 the Spanish explorer Juan Ponce de León claimed to have found “restorative waters” in what today is Florida.

Eating is one of life's great pleasures, and there are many time-tested diets that are compatible with good health. In the 1950s, it was reported that people in Crete had long lives because they had much lower rates of stroke, heart disease and certain cancers [5]. Researchers noted that the risk of heart disease was much lower for people throughout the Mediterranean region [6], [7], [8], despite the high intake of monounsaturated fatty acids (MUFAs), found in olive oil; and so began research regarding the ‘Mediterranean diet’ (MD). The World Health Organization sponsored a study regarding the dietary habits of people from seven different countries (Greece, Italy, Yugoslavia, Holland, Finland, the USA and Japan). The research covered a span of 30 years, with the participation of approximately 13,000 subjects aged 40–59. The study found that Cretan men had exceptionally low death rates from heart disease, despite their moderate to high intake of fat [7]. The Cretan diet was similar to other traditional MDs, consisting mostly of olive oil, bread, abundant fruit and vegetables, fish, and a moderate amount of dairy foods and wine. However, one must bear in mind that, when these studies were carried out, the Mediterranean region was an economically depressed area, and most people had a relatively restricted diet, with little meat; moreover, their lifestyle often featured hard physical work, and rates of obesity were very low. Thus, the reported health benefits of the MD may be related more to a physically active lifestyle and other social and cultural issues. Traditional Mediterranean mealtimes were leisurely family affairs, not a fast-food meal at work. The popularity of the MD has grown worldwide during the last 20 years, due to its link with greater longevity and lower rates of cardiovascular disease, cancer and age-associated cognitive decline [9], [10], [11], [12]. The MD is a nutritional model based on the traditional diets of some of the countries of the Mediterranean basin, particularly Greece, southern Italy, Portugal, Cyprus, Spain, and Turkey. A recent meta-analysis confirmed the benefits of a MD in individuals aged 65 years and over [13].

Although there is no anti-ageing elixir, a healthy lifestyle may prolong the human life-span. The objective of the present article is to place in perspective the possible benefits of the MD on menopausal women's health, a period of life with high morbidity, and its value in relation to some age-associated conditions.

Section snippets

Longevity and mortality

Ageing is the expression of biological changes, and the result of a cumulative and irreversible non-proliferative cell state that leads to senescence. There are many biological explanations of ageing but none is accepted as the sole theory. They have included telomere shortening, damage to the genetic integrity of the body's cells, autoantibody generation, and cumulative oxidative damage [14], [15], [16].

A number of studies have examined the association between the MD and longevity. In general,

Mediterranean diet and the metabolic syndrome

The metabolic syndrome (METS) has been associated with cardiovascular risk, atherosclerosis, increased risk of type 2 diabetes and cardiovascular mortality [29], [30], [31]. The prevalence of the METS increases with age. Some studies have estimated that its prevalence may be as high as 25% of the general population [32], [33], [34]. In a 15-year prospective study, it was observed that the METS was significantly more common in women (31.5%) than in men (12.4%) [35], whereas in a cross-sectional

Hypertension

Nutritional factors and micronutrients have been associated with hypertension. Hypertensive individuals can remarkably reduce their blood pressure through nutritional changes. Increasing the amount of vegetables and fruit and reducing the amount of fat and cholesterol will not only reduce blood pressure but can help with weight loss, which also lowers blood pressure. Thus, fruit and vegetable consumption appears to be inversely related to systolic and diastolic pressure [47]. In young adults,

Mediterranean diet and cardiovascular risk

Genetic and environmental factors are involved in the genesis of CVD. Thus, genetic polymorphisms have been associated with increased cardiovascular risk [54] but these may be attenuated by appropriate lifestyle and diet. The effect of adherence to the MD on survival among elderly people with previous myocardial infarction (MI) has been studied within the EPIC cohort [55]. Increased adherence to the MD by 2 units on the study scale was associated with an 18% lower overall mortality rate, though

Mediterranean diet and body weight

The prevalence of obesity has alarmingly increased in industrialised countries, reaching 30–50% among the general population [66]. This change has been related to social transformation, such as women being incorporated into the workforce, food marketing and an American lifestyle promoted through the mass media [67], [68]. Obesity is closely related to inflammation and cardiovascular morbidity. Overweight and obesity are associated with metabolic abnormalities that increase the atherogenic

Mediterranean diet and cancer

The MD is rich in vegetables, tomato, fruit, fish and olive oil, which all provide important dietary components that may contribute to lower risk of cancer. Lycopene is a major component in tomatoes that has been found to have a potential anticarcinogenic activity [78]. Previous studies also showed that fish consumption correlated with reduced risk of cancer [79]. In addition, VOO has in vitro antiproliferative and pro-apoptotic effects. The most potent olive oil polyphenol is oleuropein

Bone metabolism and rheumatoid arthritis

The low incidence of osteoporosis in Mediterranean countries might be explained by diet. There are data showing that, in humans, fruits and grains may protect bone metabolism [98]. Appel et al. [99] reported a reduction of renal calcium loss when the number of fruit and grain servings increased from 3.6 to 9.5. The DASH study showed a significant reduction of bone turnover markers [100].

Epidemiological studies support a positive influence of those diet components on bone mass [101], [102],

Central nervous system

Elevated oxidative and nitrosative stress impair neuron integrity and function [121]. Countering this, plant foods rich in antioxidant phenolics have protective effects on central neurons [122], [123], [124].

In a case–control study, adherence to the MD, as a predictor of Alzheimer's disease, was evaluated after adjusting the results for age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, smoking, medical co-morbidity index, and BMI [125]. High adherence to the MD was

Characteristics of the traditional Mediterranean lifestyle

For decades, researchers have been intrigued by the apparent health benefits of the MD. However, it is not really a ‘diet’ in the way most people would think of. The word ‘diet’ should not to be confused with a weight-loss program, but rather as individuals’ usual food and drink intake. Thus, it is more of a dietary pattern – or, rather, several complementary dietary patterns that have existed around the Mediterranean basin for centuries. In fact, there is no single MD; indeed more than 20

Final remarks

Nutrition and lifestyle have driven human evolution [1], [2], [180], [181], [182]. People on a MD had more than a 20% lower chance of dying over a 10-year period than those not on such a diet and that was independent of their age, body weight and gender [19]. It is likely that the MD has some of the nutritional properties of the human Paleolithic diet [1], [2], [181]. However, there are many factors involved in cardiovascular risk and related conditions, carcinogenesis, bone metabolism and

Competing interest

None.

Provenance

Unsolicited and externally peer reviewed.

Acknowledgments

This research has been partially supported by the B/017543/08 AECID (“Agencia Española de Cooperación Internacional para el Desarrollo”) grant from the Spanish “Ministerio de Asuntos Exteriores y Cooperación”.

References (189)

  • M.P. Mena et al.

    Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the Mediterranean diet

    Am J Clin Nutr

    (2009)
  • L.M. Steffen et al.

    Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

    Am J Clin Nutr

    (2005)
  • T. Psaltopoulou et al.

    Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study

    Am J Clin Nutr

    (2004)
  • K.R. Tuttle et al.

    Comparison of low-fat versus Mediterranean-style dietary intervention after first myocardial infarction (from The Heart Institute of Spokane Diet Intervention and Evaluation Trial)

    Am J Cardiol

    (2008)
  • E. Ciccarone et al.

    A high-score Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with Type 2 diabetes

    J Thromb Haemost

    (2003)
  • H. Schröder et al.

    Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population

    J Nutr

    (2004)
  • M.A. Mendez et al.

    Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity

    J Nutr

    (2006)
  • E.M. Inelmen et al.

    Differences in dietary patterns between older and younger obese and overweight outpatients

    J Nutr Health Aging

    (2008)
  • F.Y. Tang et al.

    Concomitant supplementation of lycopene and eicosapentaenoic acid inhibits the proliferation of human colon cancer cells

    J Nutr Biochem

    (2009)
  • L.B. Dixon et al.

    Adherence to the USDA Food Guide, DASH Eating Plan, and Mediterranean dietary pattern reduces risk of colorectal adenoma

    J Nutr

    (2007)
  • C.J. Prynne et al.

    Fruit and vegetable intakes and bone mineral status: a cross sectional study in five age and sex cohorts

    Am J Clin Nutr

    (2006)
  • S.C. Cunnane et al.

    Docosahexaenoic acid and shore-based diets in hominin encephalization: a rebuttal

    Am J Hum Biol

    (2007)
  • S. Lindeberg et al.

    A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease

    Diabetologia

    (2007)
  • C.B. Stringer et al.

    Neanderthal exploitation of marine mammals in Gibraltar

    Proc Natl Acad Sci USA

    (2008)
  • L.E. Grivetti

    Mediterranean food patterns: the view from Antiquity, Ancient Greeks and Romans

  • L.G. Allbaugh

    Food and nutrition

    Crete: a case study of an underdeveloped area

    (1953)
  • A. Keys et al.

    Dietary fat and serum cholesterol

    Am J Public Health

    (1957)
  • A. Keys et al.

    Epidemiological studies related to coronary heart disease: characteristics of men aged 40–59 in seven countries

    Acta Med Scand Suppl

    (1966)
  • A. Keys et al.

    The diet and 15-year death rate in the Seven Countries Study

    Am J Epidemiol

    (1986)
  • Tennison P. The Mediterranean diet. Dallas News, May 13, 1987....
  • M. O’Neill

    A dietary debate: is the Mediterranean diet a nutritional Eden?

    The New York Times

    (3, 1993)
  • A. Trichopoulou et al.

    Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study

    BMJ

    (2005)
  • L. Serra-Majem et al.

    Scientific evidence of interventions using the Mediterranean diet: a systematic review

    Nutr Rev

    (2006)
  • B. Roman et al.

    Effectiveness of the Mediterranean diet in the elderly

    Clin Interv Aging

    (2008)
  • S. Martien et al.

    Acquisition of oxidative DNA damage during senescence: the first step toward carcinogenesis?

    Ann NY Acad Sci

    (2007)
  • P.M. Kris-Etherton et al.

    Polyunsaturated fatty acids and cardiovascular health

    Nutr Rev

    (2004)
  • K.T. Knoops et al.

    Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project

    JAMA

    (2004)
  • A. Haveman-Nies et al.

    Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study

    Am J Epidemiol

    (2002)
  • C. Bamia et al.

    Dietary patterns and survival of older Europeans: the EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition)

    Public Health Nutr

    (2007)
  • G. Masala et al.

    A dietary pattern rich in olive oil and raw vegetables is associated with lower mortality in Italian elderly subjects

    Br J Nutr

    (2007)
  • P.N. Mitrou et al.

    Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study

    Arch Intern Med

    (2007)
  • F. Sofi et al.

    Adherence to Mediterranean diet and health status: meta-analysis

    BMJ

    (2008)
  • G.M. Reaven

    Banting lecture 1988. Role of insulin resistance in human disease

    Diabetes

    (1988)
  • A.G. Bertoni et al.

    Insulin resistance, metabolic syndrome, and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA)

    Diabetes Care

    (2007)
  • E. Oda

    The metabolic syndrome as a concept of adipose tissue disease

    Hypertens Res

    (2008)
  • E.S. Ford et al.

    Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey

    JAMA

    (2002)
  • E.E. Alvarez León et al.

    Mediterranean diet and metabolic syndrome: a cross-sectional study in the Canary Islands

    Public Health Nutr

    (2006)
  • G. Buckland et al.

    Sociodemographic risk factors associated with metabolic syndrome in a Mediterranean population

    Public Health Nutr

    (2008)
  • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood...
  • G. Baños et al.

    Medicinal agents in the metabolic syndrome

    Cardiovasc Hematol Agents Med Chem

    (2008)
  • Cited by (0)

    View full text