ReviewEffects of the Mediterranean diet on longevity and age-related morbid conditions
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”.
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