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Time to get Mediterranean with our dietary advice.

The Mediterranean diet has long been considered healthy and in particular, cardioprotective. Although the association was first made by the American doctor Ancel Keys over 50 years ago,1 the diet has attracted considerable interest in the past decade or so, with a large body of observational evidence showing the potential it has to reduce chronic diseases varying from dementia to cancers.2,3 Perhaps the greatest focus, however, remains on the potential it has to reduce morbidity and mortality in cardiovascular diseases (CVD).

In April 2013, the results of the long awaited PREDIMED (Prevencion con Dieta Mediterranea) study were published.4 This large Spanish trial randomised patients at high risk of CVD to an intervention including advice about the Mediterranean diet alongside supplementation with either olive oils or mixed nuts, or to advise about a low-fat diet in the control arm. Interim analyses of results were sufficiently convincing to prompt the trial to be terminated early. In comparison to the control group, those in the intervention groups had approximately 30% reductions in their risk of developing CVD.

This level of reduction is remarkable for a dietary intervention and will undoubtedly excite many nutritionists and clinicians alike. The trial has a number of limitations, particularly the difficulty establishing the extent to which the reductions seen were due to the intensive dietary advice …