The Mediterranean diet revisited--towards resolving the (French) paradox.

The Mediterranean diet traditionally refers to diets typical of the olive‐growing regions of the Mediterranean, but has a number of important constituents in addition to olive oil. These include: a large consumption of salads and legumes, and also wheat, olives, grapes, other fruits and their derivative products, including alcohol.1 As noted by Trichopoulou and Lagiou,1 total fat consumption may be high, at around 40% of total energy, as in Greece, or moderate, at around 30% of total energy, as in Italy. In Italy, the diet is characterized by pasta consumption, whereas in Spain fish consumption is particularly high. Ferro‐Luzzi and Sette2 and de Lorgeril3 also comment on the difficulty of adequately defining a Mediterranean diet. According to Trichopoulou,1 moderate alcohol consumption is an essential component, but moderate is not defined quantitatively. Ancel Keys, pioneer of the Seven Countries Study, had a hand in promoting the idea of a Mediterranean diet in his cookery book, written with his wife, ‘How to eat and stay well, the Mediterranean way’. The French paradox is a reference to the observation that a high consumption of animal fats is paradoxically coexistent with one of the lowest incidence of ischaemic heart disease in Europe.4 But others5 have noted that France is not alone and that other southern European countries show this effect. Data from Ancel Keys' epic Seven Countries Study, the planning of which started in 1947, showed that, although edible fat intake in grams per day in Italy and parts of Yugoslavia were quite low, in Crete, where heart disease mortality was very low, intake was second only to Finland's, but was characterized by a high olive oil and a low saturated fat intake.6 The Greeks have the highest olive oil consumption: a staggering 20 kg/person/year,7 whereas …