Evaluating and adapting the Mediterranean diet for non-Mediterranean populations : a critical appraisal

This review discusses the limitations of current techniques for evaluating the Mediterranean diet in non-Mediterranean populations, and how differences between the eating and lifestyle habits of these two populations may influence the implementation of a Mediterranean diet in non-Mediterranean populations. Food groups may vary significantly between Mediterranean and non-Mediterranean populations due to the precise foods within the food group and due to aspects of food production and preparation. Examples include MUFA in relation to its source (meat versus olive oil), vegetables in relation to the amount consumed and how they are prepared, alcohol in terms of its pattern of intake and source (wine versus other sources), and the nature of meat and dairy produce. Lifestyle factors such as meal patterns and exposure to sunlight may also act as confounding factors when assessing the overall benefits of a Mediterranean diet. Improving Mediterranean diet scores and measuring plasma nutrient levels may help mitigate the effects of these confounders. These considerations may have important health implications when implementing a Mediterranean diet in non-Mediterranean populations.