Preface xi
1 Overview 1
1.1 Development of the MedDiet 1
1.1.1 A brief history of the MedDiet 2
1.1.2 The traditional MedDiet and present day MedDiets 2
1.1.3 International differences 6
1.1.4 National representations of the MedDiet 7
1.1.5 Sources of information for the general public 13
1.2 Lifestyle factors 13
1.2.1 Meal patterns 14
1.2.2 Siestas 16
1.2.3 Physical activity 16
1.2.4 Sunshine 16
1.3 Health benefits 16
1.3.1 Mediterranean dietary patterns 17
1.3.2 Endorsements 19
1.4 The MedDiet, past, present and future 19
1.4.1 Current trends 19
1.4.2 The Greek experience 23
1.4.3 Not all bad news 24
1.4.4 Future prospects 25
References 25
SECTION 1: CONSTITUENTS.
2 Constituents and Physiological Effects of Mediterranean
Plant Foods 31
2.1 Introduction 31
2.2 Carbohydrates 32
2.2.1 Glycaemic index 32
2.2.2 Honey 34
2.2.3 Physiological effects of carbohydrates 35
2.2.4 Fibre 36
2.3 Fats 38
2.4 Organic acids 39
2.5 Minerals 40
2.6 Vitamins 40
2.6.1 Water soluble vitamins 40
2.6.2 Fat soluble vitamins 41
2.7 Phytochemicals 44
2.7.1 Classes of phytochemicals 46
2.7.2 Sensory properties of phytochemicals 46
2.7.3 Phenolics 50
2.7.4 Terpenes 56
2.7.5 Sulphur-containing compounds 62
2.7.6 Polyacetylenes 62
2.7.7 Nitrogen-containing compounds 63
2.8 Mediterranean plants as medicines 63
References 64
3 Influences of the Supply Chain on the Composition of
Mediterranean Plant Foods 67
3.1 Significance of the supply chain 67
3.2 Growth conditions 68
3.2.1 A brief overview of plant metabolism 68
3.2.2 Soil 70
3.2.3 Sun 71
3.2.4 Water 71
3.2.5 Other environmental factors 71
3.3 Plant cultivar 72
3.4 Food retailers and food processing 74
3.4.1 Anatomical distribution of nutrients 74
3.4.2 Freshness 75
References 76
4 Influences of Food Preparation and Bioavailability on
Nutritional Value 77
4.1 Introduction 77
4.2 Food preparation 78
4.2.1 Chopping 78
4.2.2 Cooking 79
4.3 Nutrient bioavailability 82
4.3.1 Pharmacokinetics of phytochemicals 82
4.3.2 Liberation 83
4.3.3 Absorption 83
4.3.4 Distribution 86
4.3.5 Metabolism 87
4.3.6 Excretion 90
4.3.7 Inter-individual variations in phytochemical
pharmacokinetics 90
References 92
5 Guide to the Composition of Mediterranean Plant Foods
94
5.1 Types of plant foods consumed as part of a MedDiet 95
5.1.1 Consumption 95
5.1.2 Diversity of consumption 95
5.2 Vegetables 96
5.2.1 Green leafy vegetables 96
5.2.2 Other green vegetables 102
5.2.3 Root vegetables 103
5.2.4 Alliums 104
5.2.5 Solanaceous vegetables 107
5.2.6 Legumes 109
5.3 Wheat products 112
5.4 Fruits 114
5.4.1 Citrus fruits 114
5.4.2 Apples and related fruits 118
5.4.3 Stone fruits 120
5.4.4 Grapes 121
5.4.5 Other berries 122
5.4.6 Pomegranates 122
5.4.7 Figs 123
5.4.8 Dates 123
5.4.9 Olives 123
5.5 Herbs and spices 127
5.6 Nuts and seeds 129
5.6.1 Nuts 129
5.6.2 Seeds 132
References 132
6 Olive Oil and Other Fats 137
6.1 Overview 137
6.2 Olive oil 138
6.2.1 Consumption and production 138
6.2.2 Origin and varieties of olive trees 139
6.2.3 Olive oil production 139
6.2.4 Traceability and European regulations 143
6.2.5 Biochemical composition 144
6.3 Other fat sources 147
6.3.1 Nuts and seeds 147
6.3.2 Herbs and spices 148
6.3.3 Meat and dairy 148
6.3.4 Eggs 150
6.3.5 Fish and shellfish 151
References 151
7 Wine and Other Drinks 154
7.1 Wine 154
7.1.1 Introduction 154
7.1.2 Production 155
7.1.3 Composition 156
7.1.4 Metabolism of wine 158
7.1.5 Consumption patterns and health 159
7.1.6 The resveratrol controversy 162
7.2 Aniseed-flavoured spirits 164
7.2.1 Consumption 164
7.2.2 Composition 165
7.2.3 Physiological effects 165
7.3 Tea 165
7.3.1 Consumption 165
7.3.2 Composition 166
7.3.3 Physiological effects 167
7.4 Coffee 168
7.4.1 Consumption 168
7.4.2 Composition and physiological effects 168
References 169
SECTION 2: HEALTH EFFECTS.
8 Epidemiological Methods 175
8.1 Introduction 175
8.2 Study designs 176
8.2.1 Descriptive epidemiology 176
8.2.2 Ecological studies 178
8.3 Analytical epidemiology 178
8.3.1 Case-control and prospective studies 179
8.4 Intervention studies 180
8.5 Expression and interpretation of data from epidemiological
studies 180
8.6 Dietary patterns 181
8.6.1 A priori dietary patterns 181
8.6.2 A posteriori dietary patterns 183
8.7 Criteria for judging epidemiological data 184
References 185
9 General Mechanisms for Disease Prevention 187
9.1 Introduction 188
9.2 Methods for studying the effects of nutrients on disease
mechanisms 189
9.2.1 General considerations 189
9.2.2 In vitro models 190
9.2.3 Animal models 191
9.2.4 Human intervention studies 191
9.3 Oxidative stress 192
9.3.1 What are free radicals? 192
9.3.2 Production of reactive species 192
9.3.3 Effects of reactive species 193
9.3.4 Antioxidant defences 195
9.3.5 Measuring antioxidant activity 198
9.3.6 Antioxidant activity in the Mediterranean diet 199
9.3.7 Limitations of the dietary antioxidant theory 204
9.4 Inflammation 205
9.4.1 The inflammatory response 205
9.4.2 The MedDiet and inflammation 206
9.4.3 n-3 Fatty acids 207
9.4.4 Phenolics 210
9.4.5 Pro-inflammatory foods 212
9.5 Modulation of cell signalling pathways by phenolics 212
9.5.1 Cell signalling pathways in disease 212
9.6 Gene interactions 213
9.6.1 Genetic predisposition to diet ? nutrigenetics
213
9.6.2 Effects of diet on gene expression 216
9.7 Increased stress resistance 222
9.7.1 The general concept 222
9.7.2 Mechanistic basis of hormesis 225
9.8 Nutrient interactions and the Mediterranean dietary
pattern 226
9.8.1 Minimising spikes in plasma concentrations 227
9.8.2 Synergistic interactions 228
References 229
10 Metabolic Disorders 234
10.1 Introduction 234
10.2 Obesity 235
10.2.1 Introduction 235
10.2.2 Epidemiology 237
10.2.3 Mechanisms 239
10.3 Metabolic syndrome 241
10.3.1 Introduction 241
10.3.2 Epidemiology 242
10.3.3 Mechanisms 245
10.4 Type 2 diabetes 249
10.4.1 Introduction 249
10.4.2 Epidemiology 250
10.4.3 Mechanisms 252
References 254
11 Cardiovascular Diseases 258
11.1 Introduction 259
11.2 Nutrition and the biology of CVD 260
11.2.1 Atherogenesis 260
11.2.2 Cardiac arrhythmias 265
11.3 Epidemiological evidence and mechanisms 265
11.3.1 Fat and fatty acids 265
11.3.2 Plant food constituents 269
11.3.3 Whole foods 273
11.3.4 Dietary patterns 283
References 286
12 Cancers 293
12.1 Introduction 293
12.2 Nutritional factors and the biology of cancer 294
12.2.1 Introduction 294
12.2.2 Carcinogenesis 294
12.2.3 The issue of selectivity 309
12.2.4 Mediterranean dietary pattern and cancer prevention
311
12.3 Epidemiological evidence and mechanisms 316
12.3.1 Fats 316
12.3.2 Plant food constituents 318
12.3.3 Tea 322
12.3.4 Coffee 323
12.3.5 Wine and alcohol 323
12.3.6 Plant foods 327
12.3.7 Dietary patterns 330
References 334
13 Neurological and Other Disorders 343
13.1 Introduction 343
13.2 Dementias 344
13.2.1 Introduction 344
13.2.2 Epidemiology 344
13.2.3 Mechanisms 346
13.3 Parkinson's disease 349
13.3.1 Introduction 349
13.3.2 Epidemiology 349
13.3.3 Mechanisms 349
13.4 Depression 350
13.4.1 Introduction 350
13.4.2 Epidemiology 350
13.4.3 Mechanisms 350
13.5 Rheumatoid arthritis 351
13.5.1 Introduction 351
13.5.2 Epidemiology 351
13.5.3 Mechanisms 352
13.6 Age-related macular degeneration 352
13.6.1 Introduction 352
13.6.2 Epidemiology 353
13.6.3 Mechanisms 354
13.7 All cause mortality 354
13.7.1 Fruit and vegetables 355
13.7.2 Alcohol 355
13.7.3 Wine 355
13.7.4 Dietary pattern 356
13.8 General conclusions 357
References 357
14 Public Health Issues 361
14.1 Introduction 361
14.1.1 Public health and its objectives 362
14.1.2 The challenges of public health in Europe 362
14.2 Which MedDiet? 366
14.3 Which constituents are important in the MedDiet? 367
14.3.1 Olive oil 367
14.3.2 Cereals and legumes 368
14.3.3 Fruit and vegetables 368
14.3.4 Herbs and spices 369
14.3.5 Meat and dairy products 370
14.3.6 Wine and tea 370
14.3.7 How can the Mediterranean dietary pattern be implemented?
371
14.4 Transferring the Mediterranean dietary pattern 372
14.4.1 Public health recommendations and education 374
14.4.2 Governments' and communities' food policies 375
14.4.3 Individual choices and attitudes 377
References 378
SECTION 3: APPENDICES.
Appendix 1 Abbreviations 383
Appendix 2 Epidemiological Studies 385
Index 389
