Applying Our Knowledge of the Mediterranean Diet to U.S.

Adults The Mediterranean Diet has become a very popular eating plan that is not only enjoyable to follow but is also full of well-researched, health-promoting benefits. Many of these healthpromoting benefits can be attributed to the high-quality nutrition that is provided by the Mediterranean Diet. For example, individuals following the Mediterranean Diet typically have excellent intake of omega-3 fats, dietary fiber, B-complex vitamins, essential minerals, and antioxidant phytonutrients. Since this diet originates in a part of the world where regional, locally grown fresh foods predominate and where fishing is plentiful, it can be difficult for the average U.S. adult who eats large amounts of processed and prepackaged food to shift his or her food practices over to a Mediterranean Diet and enjoy its outstanding nutritional benefits. Nutritional epidemiologists working at the Jean Mayer USDA Human Research Center at Tufts University in Boston, MA have recently developed a new "map" that can be used by adults in the U.S. (and any other countries) who want to enjoy the great nutrient benefits of the Mediterranean Diet, but may not be able to eat all of the same regional foods that characterize the Mediterranean region. This map-called the Mediterranean-Style Dietary Pattern Score, or MSDPS-involves 13 target food groups: whole grain cereals, fruits, vegetables, dairy foods, wine, fish, poultry, olives-legumes-nuts, potatoes, eggs, sweets, meats, and olive oil. If an individual is eating large amounts of processed and prepackaged food buts wants to enjoy the nutritional benefits of the Mediterranean Diet, he or she will most likely have to change food practices in each of these 13 areas. In the case of fresh fruits, vegetables, whole grain cereals,

olives-legumes-nuts, fish, and olive oil, there will most likely be a need for increased intake. In the case of eggs, meats, and sweets, decreased intake will most likely be needed. In the case of dairy foods, wine, poultry, and potatoes, there will most likely be a need for moderation of intake. Although the USDA did not establish practical dietary goals for each of these 13 food groups, they wanted to determine whether these 13 food groups were the right ones to consider when determining whether the nutrient intake of a population was similar to the nutrient intake associated with a Mediterranean Diet. In order to test the appropriateness of their 13 food groups, the USDA research team used the MSDPS to analyze the dietary intake of 5,135 persons who participated in the Framingham Heart Study (FHS) Offspring Cohort between the years 1971-2001. The Framingham Heart Study is perhaps the most famous study of heart disease ever undertaken, and a lot of our knowledge about heart disease and diet comes from results provided by this study. While the Framingham Study originally looked at the relationship between diet, lifestyle, medication use, and heart disease in about 5,000 men and women living in the town of Framingham, Massachusetts, it was a study that had nothing whatsoever to do with the Mediterranean Diet. In fact, during the very first year of the Framingham Study in 1948, researchers did not even know about the health benefits of the Mediterranean Diet! However, even though the Framingham participants were not following a Mediterranean Diet, and had no awareness of the nutritional benefits of a Mediterranean Diet, the researchers hypothesized that perhaps the nutritional benefits of the Mediterranean Diet were still present in the diet of some participants. The USDA researchers predicted that their 13 food-group structure for analyzing the nutrient benefits of the

Mediterranean Diet would be able to show which Framingham participants had dietary intake that was closest to providing the nutrient benefits of the Mediterranean Diet and which participants had dietary intake that failed to provide these benefits. What they found was fascinating. By analyzing the diets of the Framingham participants according to these 13 different food groups, the USDA researchers were able to determine the nutritional content of their diets in a way that allowed for comparison to the nutritional content of the Mediterranean Diet. The Framingham participants' intake of fiber, omega-3 fatty acids, beta-carotene, lycopene, vitamin C, vitamin E, calcium, magnesium, and phosphorus could all be accurately determined using these 13 food groups. Those Framingham participants who had greater intake in desirable food areas (fresh fruits, vegetables, whole grain cereals, oliveslegumes-nuts, fish, and olives), lower intake in the undesirable areas (eggs, meats, and sweets) and moderate intake in the remaining areas (dairy foods, wine, poultry and potatoes) had nutrient intake that more closely resembled nutrient intake on the Mediterranean Diet. For example, the Framingham participants who ate more foods in these areas had over twice the amount of betacarotene and 50% more folate and vitamin C than participants whose ate poorly in these areas. By looking comprehensively at the diets of the Framingham participants in all 13 food groups, the USDA researchers were able to successfully evaluate their nutritional intake and the extent to which it resembled nutritional intake on the Mediterranean Diet. WHFoods Recommendations

When adopting a Mediterranean Diet, everything you eat matters! Even though certain foods like olive oil, fresh vegetables, and cold-water fish are essential for deriving the nutritional benefits of a Mediterranean Diet, all of your food choices are important. In addition to increasing your intake of these spotlight foods, you will most likely need to reduce your intake of eggs, meats, and sweets and keep your intake of dairy foods, wine, poultry, and potatoes at a moderate level if you want to enjoy the nutritional benefits of the Mediterranean Diet. References

Rumawas ME, Dwyer JT, Mckeown NM et al. The Development of the Mediterranean-Style Dietary Pattern Score and Its Application to the American Diet in the Framingham Offspring Cohort. J Nutr 2009: Vol. 139, No. 6, 1150-1156. 2009.