The Mediterranean Diet: An Evidence-Based Approach PDF
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The Mediterranean Diet An Evidence-Based Approach The Mediterranean Diet An Evidence-Based Approach Edited by Victor R. Preedy King’s College London, London, UK Ronald Ross Watson University of Arizona, Tucson, AZ, USA AMSTERDAM (cid:129) BOSTON (cid:129) HEIDELBERG (cid:129) LONDON NEW YORK (cid:129) OXFORD (cid:129) PARIS (cid:129) SAN DIEGO SAN FRANCISCO (cid:129) SINGAPORE (cid:129) SYDNEY (cid:129) TOKYO Academic Press is an imprint of Elsevier AcademicPressisanimprintofElsevier 32JamestownRoad,LondonNW17BY,UK 525BStreet,Suite1800,SanDiego,CA92101-4495,USA 225WymanStreet,Waltham,MA02451,USA TheBoulevard,LangfordLane,Kidlington,OxfordOX51GB,UK Copyright©2015ElsevierInc.Allrightsreserved Nopartofthispublicationmaybereproducedortransmittedinanyformorbyany means,electronicormechanical,includingphotocopying,recording,oranyinformation storageandretrievalsystem,withoutpermissioninwritingfromthepublisher.Detailson howtoseekpermission,furtherinformationaboutthePublisher’spermissionspolicies andourarrangementswithorganizationssuchastheCopyrightClearanceCenterandthe CopyrightLicensingAgency,canbefoundatourwebsite:www.elsevier.com/ permissions. 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AntonioAgudo,MD,MSc,PhD(47),CatalanInstituteof Americo Bonanni (589), IRCCS Istituto Neurologico Oncology(ICO),Barcelona, Spain Mediterraneo NEUROMED, Pozzilli, Italy MarisaAlarco´n(601),InstitutBota`nicdeBarcelona(IBB- Gerardo Bosco, MD, PhD (271), University of Padova, CSIC-ICUB),Barcelona, Spain Padova,Italy Juan Jose´ Aldasoro (601), Institut Bota`nic de Barcelona Genevieve Buckland, MSc, PhD (47, 417), Catalan (IBB-CSIC-ICUB),Barcelona, Spain Institute ofOncology (ICO), Barcelona, Spain Smaragdi Antonopoulou, PhD (379), Harokopio Uni- Nadia Calabriso, PhD (135, 291), C.N.R. Institute of versity, Athens,Greece Clinical Physiology, Lecce, Italy; C.N.R. Institute of Yardena Arnoni, MSc (3), Hebrew University-Hadassah Clinical Physiology,Pisa, Italy Medical School,Jerusalem, Israel OguzhanCaliskan(621,629),DepartmentofHorticulture, SaraArranz,PhD(153),DepartmentofInternalMedicine, Mustafa Kemal University,Antakya-Hatay,Turkey Hospital Cl´ınic, Institut d’Investigacions Biome´diques AugustPiiSinyer(IDIBAPS),UniversityofBarcelona, Maria Annunziata Carluccio, PhD (135, 291), C.N.R. Barcelona,Spain; CIBERCB06/03Fisiopatolog´ıadela Institute of Clinical Physiology, Lecce, Italy; C.N.R. ObesidadylaNutricio´n,(CIBERobn),Girona,Spain Institute ofClinical Physiology, Pisa,Italy Hebatallah Husseini Atteia (441), Faculty of Pharmacy, J. Jesu´s Casas, PhD (23), University of Almer´ıa ceiA3, Zagazig University,Zagazig, SharkiaGov.,Egypt Almer´ıa, Spain Elena Azzini (249), National Institute for Food and Rosa Casas, Predoctoral Student (153), Department of Nutrition Research, Rome, Italy InternalMedicine,HospitalCl´ınic,Institutd’Investiga- LinaBadimon(367),HospitaldelaSantaCreuiSantPau, cions Biome´diques August Pi i Sinyer (IDIBAPS), Barcelona, Spain; IIB-Santpau, Barcelona, Spain; University of Barcelona, Barcelona, Spain; CIBER CIBEROBNInstitutodeSaludCarlosIII,Madrid,Spain; CB06/03 Fisiopatolog´ıa de la Obesidad y la Nutricio´n, Ca´tedra de Investigacio´n Cardiovascular, (UAB- (CIBERobn), Girona, Spain HSCSP-Fundacio´nJesu´sSerra),Barcelona,Spain Itandehui Castro-Quezada, MSc (13), University of Las Sara Bastida, PhD (217, 491), Universidad Complutense Palmasde GranCanaria, LasPalmasdeGranCanaria, deMadrid,Madrid, Spain Spain; CIBER Fisiopatologia Obesidad y Nutricio´n, GiovanniBeccari,PhD(563),DepartmentofAgricultural, InstitutodeSaludCarlos III, Lourdes,Spain Food and Environmental Sciences, University of GemmaChiva-Blanch,PhD(153),DepartmentofInternal Perugia, Perugia,Italy Medicine, Hospital Cl´ınic, Institut d’Investigacions Elliot M. Berry, MD, FRCP (3), Hebrew University- Biome´diquesAugustPiiSinyer(IDIBAPS),University Hadassah MedicalSchool, Jerusalem, Israel ofBarcelona,Barcelona,Spain; CIBERCB06/03Fisio- Francesca Biandolino (165), CNR—Institute of Coastal patolog´ıa de la Obesidad y la Nutricio´n, (CIBERobn), Marine Environment (IAMC),Taranto,Italy Girona, Spain Marialaura Bonaccio (589), IRCCS Istituto Neurologico Gea Oliveri Conti, MSc, PhD (547), Department of Mediterraneo NEUROMED, Pozzilli, Italy HygieneandPublicHealth“G.F.Ingrassia,”Laboratory Santiago Bonachela, PhD (23), University of Almer´ıa of Environmental Hygiene and Food (LIAA), Uni- ceiA3, Almer´ıa,Spain versity ofCatania, Catania, Italy xvii xviii Contributors Chiara Copat, MSc, PhD (547), Department of Hygiene Roberto Fallico, MD (547), Department of Hygiene and andPublicHealth“G.F.Ingrassia,”LaboratoryofEnvi- PublicHealth“G.F.Ingrassia,”LaboratoryofEnviron- ronmental Hygiene and Food (LIAA), University of mental Hygiene and Food (LIAA), University of Catania, Catania, Italy Catania, Catania, Italy PatrickCouture,MD,PhD(325),InstituteofNutritionand Paul Farajian, PhD (69), Agricultural University of FunctionalFoods,LavalUniversity,Que´becQC,Canada Athens,Athens, Greece Lorenzo Covarelli, PhD (563), Department of Agricul- Encarnacio´n Fenoy, MD (23), University of Almer´ıa tural, Food and Environmental Sciences, University of ceiA3, Almer´ıa, Spain Perugia, Perugia, Italy J.M. Fernandez, PhD (513), Lipids and Atherosclerosis RaffaeleDeCaterina, MD,PhD(291),“G.d’Annunzio” Unit, IMIBIC/Reina Sofia University Hospital/ University,Chieti,Italy University of Co´rdoba and CIBER Fisiopatolog´ıa VincenzoDeFeo(649),Universita` degliStudidiSalerno, Obesidad y Nutricio´n (CIBEROBW), Health Institute Fisciano (Salerno), Italy Carlos III, Madrid, Spain Giovanni de Gaetano, MD, PhD (589), IRCCS Istituto Maria Luz Fernandez, PhD (357), University of Con- NeurologicoMediterraneoNEUROMED,Pozzilli,Italy necticut, Mansfield, CT, USA Michel de Lorgeril, MD (337), Faculte´ de Me´decine, Jose´ Manuel Ferna´ndez-Real, PhD (505), Hospital Grenoble,France Dr. Josep Trueta, Girona,Spain LauraDeMartino(649),Universita`degliStudidiSalerno, MargheritaFerrante,MD(547),DepartmentofHygiene Fisciano (Salerno), Italy andPublicHealth“G.F.Ingrassia,”LaboratoryofEnvi- ronmental Hygiene and Food (LIAA), University of Christiana A. Demetriou, PhD (407), Department of Catania, Catania, Italy ElectronMicroscopy/MolecularPathology,TheCyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Elizabeth Fragopoulou, PhD (379), Harokopio Uni- Department of Epidemiology and Biostatistics, School versity, Athens, Greece ofPublicHealth,London, UK F.Fuentes-Jimenez,MD,PhD(513),LipidsandAthero- Paraskevi Detopoulou, PhD (379), General Hospital sclerosisUnit,IMIBIC/ReinaSofiaUniversityHospital/ Korgialenio-Benakio, Athens,Greece UniversityofCo´rdobaandCIBERFisiopatolog´ıaObe- EmmanuelJ.Diamantopoulos,MD,PhD(313),Evange- sidad y Nutricio´n (CIBEROBW), Health Institute lismos State GeneralHospital,Athens, Greece Carlos III, Madrid, Spain ZoraDjuric(451),UniversityofMichigan,AnnArbor,MI Jose´ J.Gaforio,MD,PhD(205,281),UniversityofJae´n, 48118, USA Jae´n, Spain MariaBenedettaDonati,MD,PhD(589),IRCCSIstituto MartaGaraulet,PhD(237),UniversityofMurcia,Murcia, NeurologicoMediterraneoNEUROMED,Pozzilli,Italy Spain Jorge Doreste-Alonso (61), University of Las Palmas de Vanessa Garcia-Larsen, PhD (123), Respiratory Epi- Gran Canaria, Madrid, Spain demiology,OccupationalMedicine,andPublicHealth, National Heart and Lung Institute, Imperial College KarimaElRhazi,MD,PhD(123),DepartmentofEpide- London, London, UK miologyandPublicHealth,FacultyofMedicineofFes, UniversitySidiMohamedBenAbdillah,Fes,Morocco HannahGardener,ScD(345),UniversityofMiamiMiller Sahar Elsayed El-Swefy (441), Faculty of Pharmacy, School of Medicine, Miami, FL, USA Zagazig University,Zagazig, Sharkia Gov., Egypt EvaGesteiro(491),HospitaldeMe´rida,Me´rida,Badajoz, Manuel Espa´rrago Rodilla, PhD (491), Hospital de Spain Me´rida, Me´rida,Badajoz,Spain Mark R. Goldstein, MD, FACP (259), NCH Physician RamonEstruch,MD,PhD(153),DepartmentofInternal Group, Naples,FL, USA Medicine, Hospital Cl´ınic, Institut d’Investigacions CarlosA.Gonza´lez,MD,PhD(417),CatalanInstituteof Biome´diquesAugustPiiSinyer(IDIBAPS),University Oncology (ICO-Idibell), Barcelona, Spain ofBarcelona,Barcelona,Spain; CIBERCB06/03Fisio- patolog´ıa de la Obesidad y la Nutricio´n, (CIBERobn), EvanthiaGouveri,MD(313),EvangelismosStateGeneral Girona,Spain Hospital,Athens, Greece Contributors xix Sergio Granados, PhD (205), The Methodist Hospital Luca Mascitelli, MD (259), Comando Brigata alpina Research Institute, Houston, TX, USA “Julia”, MultinationalLand Force,Udine,Italy KeithGrimaldi,PhD(105),NationalTechnicalUniversity Marika Massaro, PhD (291),C.N.R.Institute ofClinical ofAthens, Athens, Greece Physiology,Pisa, Italy AndreasHadjisavvas,PhD(407),DepartmentofElectron F. Xavier Medina (37), Universitat Oberta de Catalunya Microscopy/MolecularPathology,TheCyprusInstitute (UOC), Barcelona, Spain ofNeurology andGenetics, Nicosia, Cyprus Guiomar Mendieta (367), Hospital de la Santa Creu i Patricia Henr´ıquez-Sa´nchez (61), University of Las Sant Pau, Barcelona, Spain; IIB-Santpau, Barcelona, Palmas de Gran Canaria, Madrid, Spain; Instituto de Spain Salud Carlos III, Madrid, Spain MartaMes´ıas,PhD(185),ConsejoSuperiordeInvestiga- Joaqu´ın Herna´ndez, PhD (23), University of Almer´ıa cionesCienc´ıficas,(CSIC), Spain ceiA3, Almer´ıa,Spain Renata Micha, PhD (91), Agricultural University of Licia Iacoviello, MD, PhD (589), IRCCS Istituto Neuro- Athens, Athens, Greece; Harvard School of Public logico Mediterraneo NEUROMED, Pozzilli, Italy Health,Boston,MA,USA Marcello Iriti, PhD (143, 199), Milan State University, Jose´ Mar´ıa Moreno-Navarrete, PhD (505), Hospital Milan, Italy Dr.Josep Trueta, Girona, Spain DimitraKarageorgou,MSc(91),AgriculturalUniversity Francisco J. Moyano, PhD (23), University of Almer´ıa ofAthens, Athens, Greece ceiA3, Almer´ıa,Spain Niki Kontou, RD, PhD (393), Saint Savvas Cancer Hos- M.PilarNavarro,PhD(185),ConsejoSuperiordeInves- pital, Athens, Greece; Harokopio University, Athens, tigaciones Cienc´ıficas, (CSIC), Spain Greece FilomenaNazzaro(649),IstitutodiScienzedell’Alimen- Kyriacos Kyriacou, PhD (407), Department of Electron tazione, Avellino, Italy Microscopy/MolecularPathology,TheCyprusInstitute ofNeurology andGenetics, Nicosia, Cyprus ChakibNejjari,MD,PhD(123),DepartmentofEpidemi- ology and Public Health, Faculty of Medicine of Fes, GiuseppeLaTorre,MD,MSc,DSc(533),SapienzaUni- UniversitySidiMohamedBenAbdillah,Fes,Morocco versity ofRome, Rome, Italy DenisLairon,PhD(303),Aix-MarseilleUniversity,Mar- LenaMariaNilsson,PhD(579),Umea˚University,Umea˚, Sweden seille, France Benoˆıt Lamarche, PhD (325), Institute of Nutrition and Tzortzis Nomikos, PhD (379), Harokopio University, FunctionalFoods,LavalUniversity,Que´becQC,Canada Athens, Greece Jaime Lee (81), Swinburne University, Hawthorn, VIC, FrancescaOliviero,PhD(461),DepartmentofMedicine— Australia DIMED,UniversityofPadova,Padova,Italy Maria A. Loizidou, PhD (407), Department of Electron Ilkay Erdogan Orhan (639), Gazi University, Ankara, Microscopy/MolecularPathology,TheCyprusInstitute Turkey; EasternMediterraneanUniversity,Famagusta, ofNeurology andGenetics, Nicosia, Cyprus Turkey Alicia Lo´pez-Biedma, MSc (281), University of Jae´n, AntonioPaoli,MD,BSc(105,271),UniversityofPadova, Jae´n, Spain Padova,Italy Helen Macpherson, PhD (81), Swinburne University, Christopher Papandreou, PhD (429), Harokopio Uni- Hawthorn, VIC, Australia versity ofAthens, Athens,Greece Giuseppe Maiani (249), National Institute for Food and MatthewPase,PhD(81),SwinburneUniversity,Hawthorn, Nutrition Research, Rome, Italy VIC,Australia Emilia Mancini (649), Universita` degli Studi di Salerno, Mariangela Pellegrino, PhD (135), C.N.R. Institute of Fisciano (Salerno),Italy Clinical Physiology,Lecce, Italy Colin R.Martin(519), Faculty of Health, Uxbridge,UK Andrew Pipingas, PhD (81), Swinburne University, MiguelA´ngelMart´ınez-Gonza´lez(61),InstitutodeSalud Hawthorn,VIC, Australia Carlos III, Madrid, Spain; University of Navarra, Concetta Potenza, MD, MSc (533), Sapienza University Madrid, Spain of Rome, Rome, Italy xx Contributors ErmelindaPrato(165),CNR—InstituteofCoastalMarine Cristina Sa´nchez-Quesada, MSc (281), University of Environment(IAMC), Taranto,Italy Jae´n, Jae´n, Spain VictorR.Preedy(519),King’sCollegeLondon,London,UK Almudena Sa´nchez-Villegas (61), University of Las Palmas de Gran Canaria, Madrid, Spain; Instituto de Mario Pulido-Moran, MSc (205), Granada University, Salud CarlosIII, Madrid,Spain Granada, Spain Rosella Saulle, MD, MSc (533), Sapienza University of Leonardo Punzi, MD, PhD (461), Department of Rome, Rome, Italy Medicine—DIMED,UniversityofPadova,Padova,Italy Jose´ L. Quiles,PhD (205),Granada University, Granada, Andrew Scholey, PhD (81), Swinburne University, Spain Hawthorn, VIC, Australia Ma del Carmen Ram´ırez-Tortose, PharmD, PhD (205, Salvatore Sciacca, MD (547), Department of Hygiene 281),University ofGranada, Granada, Spain andPublicHealth“G.F.Ingrassia,”LaboratoryofEnvi- ronmental Hygiene and Food (LIAA), University of Caroline Richard, RD, PhD (325), Institute of Nutrition Catania, Catania, Italy and Functional Foods, Laval University, Que´bec QC, Canada Egeria Scoditti, PhD (135, 291), C.N.R. Institute of Clinical Physiology, Lecce, Italy; C.N.R. Institute of Beatriz Rodr´ıguez Bernal (491), Universidad Complu- Clinical Physiology, Pisa, Italy tense deMadrid,Madrid,Spain IsabelSeiquer,PhD(185),ConsejoSuperiordeInvestiga- Blanca Roma´n-Vin˜as, MD, PhD (13), CIBER Fisiopato- ciones Cienc´ıficas, (CSIC), Spain logia Obesidad y Nutricio´n, Instituto de Salud Carlos III, Lourdes, Spain; Fundacio´n para la Investigacio´n LedaSemyonov,MD(533),SapienzaUniversityofRome, Nutricional, University of Barcelona Science Park, Rome, Italy Barcelona, Spain Llu´ısSerra-Majem,MD,PhD(13,37,61),Universityof EmilioRos,MD,PhD(175),LipidClinic,Endocrinology& Las Palmas de Gran Canaria, Las Palmas de Gran NutritionService,Institutd’InvesigacionsBiome`diques, Canaria, Spain; CIBER Fisiopatologia Obesidad y August Pi Sunyer, Hospital Clinic, Barcelona, Spain; Nutricio´n,InstitutodeSaludCarlosIII,Lourdes,Spain; CIBER Fisiopatologia de la Obesidad y Nutricio´n Fundacio´nparalaInvestigacio´nNutricional,University (CIBERobn), Instituto de Salud Carlos III (ISCIII), of Barcelona Science Park, Barcelona, Spain; Interna- Barcelona,Spain tional Foundation of Mediterranean Diet, London, UK;UniversityofLasPalmasdeGranCanaria,Madrid, D.Rosado-Alvarez,MD,PhD(513),LipidsandAtheroscle- Spain; Instituto de Salud CarlosIII, Madrid, Spain rosis Unit, IMIBIC/Reina Sofia University Hospital/ University of Co´rdoba and CIBER Fisiopatolog´ıa Dean A. Sewell, BA, PhD (473), Heriot-Watt University, Obesidad y Nutricio´n (CIBEROBW), Health Institute Edinburgh,UnitedKingdom CarlosIII,Madrid,Spain Paolo Sfriso (461), Department of Medicine—DIMED, Jose´-Luis R´ıos (611), Universitat de Vale`ncia, Burjassot, Universityof Padova, Padova,Italy Vale`ncia, Spain Aziz Sheikh, BSc, MSc, MD (473), The University of Cristina Ruano (61), University of Las Palmas de Gran Edinburgh,Edinburgh, United Kingdom Canaria, Madrid, Spain; Instituto de Salud Carlos III, Madrid, Spain Nevena Skroza, MD, MSc (533), Sapienza University of Rome, Rome, Italy Semra Akar Sahingoz, PhD (115), University of Gazi, Ankara, Turkey Paolo Spinella, MD (461), Department of Medicine— DIMED,University ofPadova, Padova, Italy PatriciaSalen,BSc(337),Faculte´deMe´decine,Grenoble, France LauraTosi,PhD(563),DepartmentofAgricultural,Food Jose´ L. Sa´nchez Benito, MD (519), Vocalia de Alimen- and Environmental Sciences, University of Perugia, tacio´n y Nutricio´n del Colegio de Farmace´uticos de Perugia, Italy COFM, Madrid, Spain Ibrahim Tumen (639), BartinUniversity,Bartin,Turkey EvaSa´nchezSoriano,MD(519),NurseHospitalPuertade PalmiraValderas-Martinez,PredoctoralStudent(153), Hierro, Madrid,Spain Department of Internal Medicine, Hospital Cl´ınic, Francisco J. Sa´nchez-Muniz, PhD (217, 491), Univer- Institut d’Investigacions Biome´diques August Pi i sidad Complutense de Madrid,Madrid, Spain Sinyer(IDIBAPS),UniversityofBarcelona,Barcelona, Contributors xxi Spain; CIBERCB06/03Fisiopatolog´ıadelaObesidad PaoloVineis,MD,PhD(407),DepartmentofEpidemiology yla Nutricio´n, (CIBERobn),Girona, Spain andBiostatistics,SchoolofPublicHealth,London,UK Elena M. Varoni, DD, PhD (143, 199), Milan State Fernando Warleta, BSc (281), University of Jae´n, Jae´n, University,Milan,Italy; McGillUniversity,Montreal, Spain QC,Canada; UniversityofEasternPiedmont‘A.Avo- ClintonB.Wright,MD,MSc(345),UniversityofMiami gadro’, Novara, Italy MillerSchool ofMedicine,Miami,FL, USA Gemma Vilahur (367), Hospital de la Santa Creu i Sant Pau,Barcelona,Spain; IIB-Santpau,Barcelona,Spain; Leo R. Zacharski, MD (259), Veterans Affairs Hospital, CIBEROBN Instituto de Salud Carlos III, Madrid, White River Junction, VT, USA; Geisel School Spain of Medicineat Dartmouth College,Hanover,NH, USA Lorena Villalon (81), Swinburne University, Hawthorn, AntonisZampelas,PhD(69,91),AgriculturalUniversity VIC, Australia of Athens,Athens, Greece GemmaXifraVillarroya(505),HospitalDr.JosepTrueta, Sara Zuber, MD (533), Sapienza University of Rome, Girona, Spain Rome, Italy Preface The Mediterranean diet is frequently considered a nutritional “elixir” that reduces risk factors associated with disease. Hitherto, there has been a great deal of ambiguity about the evidence supporting the concept of the Mediterranean diet, andtherehavebeenmanyunfoundedmythsassociatedwithitscompositionandthetherapeuticeffectivenessofadopting suchadietaryregimen.However,thepastfewdecadeshaveseenmajoradvancesintheunderstandingoftheMediterranean dietanditsapplication.Unfortunately,detailsoftheMediterraneandietarefragmentaryorunfocusedwithlittleattentionto itscomposition,ethos,andpotentialapplications.TheselimitationshavebeensuccinctlyaddressedinTheMediterranean Diet: AnEvidence-Based Approach. ThisbookisanauthoritativesynopsisofmanyofthecomplexfeaturesoftheMediterraneandiet,rangingfromitshis- toricalbasis,supportiveevidence andepidemiologicalstudies,totheantioxidant,anti-inflammatory,hypolipidemicand otherpropertiesofindividualcomponents.ThisbookembracesaholisticapproachandeffectivelyinvestigatestheMed- iterranean diet from the cell level tothe nutritional well-beingof geographical populations. Thebook isdivided into 4 sections: Section 1:The Mediterranean Diet: Concepts and General Aspects Section 2:Components of theMediterranean Diet Section 3:Health and NutritionalAspects ofthe Mediterranean Diet Section 4:NovelNutraceuticals andEdible PlantsUsed in theMediterranean Region Section1beginswithmaterialontheMediterraneandietwithrespecttooriginsandevolution,nutritionaladequacy, agriculturalpractices, sustainability, mortality, qualityoflife, childrenand adolescents,cognitivehealth, cardiovascular diseases,genomics,dietquality,nutritionalknowledgeandsocio-economicfeatures.TherefollowsinSection2coverage ofoliveoil,wine,beer,fish,nuts,minerals,melatonin,hydroxytyrosolandfrying.Section3hasmaterialonmetabolism, metabolic syndrome, obesity and diabetes, cardiovascular disease, cancer, brain and behavior, immunology, life stages, organs and applications, adverse aspects, and methods for interventions with, or adherence to, the Mediterranean diet. Finally,Section4dealswithgeneticdiversityofplants,apoptoticactivitiesofplantspecies,hawthornfruit,figs,Cupressus sempervirensand essential oils. Contributorsareauthorsofinternationalandnationalstanding,leadersinthefieldandtrendsetters.Emergingfieldsof theMediterraneanDietscienceandimportantdiscoveriesrelatingtodietandnutritionareincludedhere.Thisbookrep- resentsessentialreadingfornutritionists,dieticians,healthcareprofessionals,researchscientists,biochemists,physicians, general practitioners, and public healthpractitioners, aswell as those interestedinhealthingeneral. Victor R.Preedy Ronald RossWatson xxiii Chapter 1 On the Origins and Evolution of the Mediterranean Diet Yardena Arnoni,MSc and Elliot M. Berry, MD, FRCP HebrewUniversity-HadassahMedicalSchool,Jerusalem,Israel. INTRODUCTION Ample empirical evidence exists for the health benefits of the Mediterranean diet. The nutritional benefits of the foods incorporatedinthemodernMediterraneandiethavebeenwellelucidated,andaplethoraofliteraturehasbeenpublished tosupporttheclaimsofhealthanddiseaseprevention[1].YetthehistoricalandbiblicaloriginsoftheMediterraneandiet remain to be emphasized. While the name itself attests to the geographical location, the composition of the original Mediterranean diet needs to be considered in its original environment. The word diet is derived from the Greek diaeta, meaningnotjustfoodbut“wayoflife.”TheMediterraneandietisaninterwoven,multiculturallabyrinththathasdeveloped overtime,absorbingtherichnessofthediverseculturesofdifferentoccupiers/conquerorswhilemaintainingoriginallocal traditions. ThetermMediterraneandietwascoinedin1960bytheAmericanphysiologistAncelKeysandhiswifeMargaretin theirbookHowtoEatWellandStayWelltheMediterraneanWay[2].Theyidentifiedtheeatingbehaviorsofcountries such as Greece—Crete in particular—and southern Italy, with extension to other geographical areas around the Mediterraneanbasin.Basedontheirpioneerstudies,thedietarypatternsofthesecountrieswereassociatedwithlongevity and reduced rates of coronary heart disease morbidity and mortality, cancers, and other chronic diseases related to diet in the 1960s [3,4]. The Mediterranean diet, however, did not begin in the 1960s but extends further back to biblical times. GEOGRAPHIC AND EVOLUTIONARY HISTORY The world of the biblical Mediterranean diet covers regions of land connected to a sea and extending to an ocean. The geographicandevolutionaryoriginsofthedietareofinterestbecausetheyencompassthehistoryofWesterncivilization. Theriseofagriculture(domesticationofcrops)andanimalhusbandrytookplacefromca.10,000to4000BCE,whereas the wheel, metallurgy, writing, and city-states arose from ca. 4000 to 1000 BCE. These essential developments in the evolutionofcivilizationoriginatedintheFertileCrescent:fromMesopotamia,theancientNearEast,Canaan,andEgypt. ThebiblicalperiodfromthetimeofthepatriarchsuntilKingDavidinJerusalemwasfromca.1950to1000BCE;thefall ofTroyandtheGreekcolonizationofIoniaoccurredinthetwelfthcenturyBCEandDavid’scaptureofJerusaleminca. 1000 BCE. Evidenceofdietarypatternshasbeenobtainedfromarchaeo-botanyandwrittenrecords.Theoriginsandspreadofdomes- ticatedgrainshasbeentracedtotheFertileCrescent,spreadingfromMesopotamia(thecradleofcivilization)[5–7](Figures1 and2).It seems thatsuch foodusereached the Middle East before the Greek islands. While there are manysimilarities betweenthetraditionalGreek(Cretan)MediterraneandietandthatdescribedinthePentateuch,thedifferencesareofinterest becausetheyhavespecialnutritionalbenefits.TheBiblespeaksofthesevenspecies—wheat,barley,grapes,figs,pome- granates, olives, and honey—as well as a land “flowing with milk and (date) honey” (Deuteronomy 8:8), which are, coincidently,thebasicstaplesofMediterraneancuisine.InRomantimes,historiansrecordedthattheproduceoftheland ofIsraelwasofparticularlyhighqualityandwasservedatthebesttables.Suchcross-culturalinfluencesmaybeseenduring theLastSupper,whichpossiblywasaPassoversederandwasitselfadaptedfromtheGreeksymposiumbroughttotheregion aftertheconquestsofAlexandertheGreatinthefourthcenturyBCE. TheMediterraneanDiet ©2015ElsevierInc.Allrightsreserved. 3
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