The Mediterranean diet score

The study, known as the Northern Manhattan Study or NOMAS, included more than 2,500 adults, of whom 64% were women, 55% were Hispanic, 24% were black, and 21% were white. Each participant answered a diet questionnaire upon enrolling in the study and was given a score to indicate how closely their diet resembled the Mediterranean diet. These scores were based on adherence to the following dietary characteristics:

• High in fruits and vegetables
• High in pulses and cereal grains
• High in fish
• Low in meat and dairy products
• High ratio of monounsaturated to saturated fats (monounsaturated fats are found in olive oil and some nuts, while saturated fats are primarily animal fats)
• Mild to moderate alcohol consumption

Eating Mediterranean-style is good for everyone

After an average of nine years of monitoring, the following relationships were seen:

• A high Mediterranean diet score was associated with a low risk of stroke, heart attack, and cardiovascular death.
• The risk of cardiovascular death in particular was reduced in people with high Mediterranean diet scores: people with the highest scores were 33% less likely to die from cardiovascular causes than people with the lowest scores.
• Greater consumption of fish and pulses and moderate consumption of alcohol were individually linked to lower risk of cardiovascular death.
• All ethnicities benefited equally from a Mediterranean diet pattern.

“Higher consumption of a Mediterranean diet was associated with decreased risk of vascular events,” the study’s authors said. “[These] results support the role of a diet rich in fruit, vegetables, whole grains, fish, and olive oil in the promotion of ideal cardiovascular health.”

Making the switch

Here are some tips to help you eat more like a Mediterranean native:

• Include vegetables and fruits at every meal. An average of nine servings of fruits or vegetables per day is typical in the Mediterranean.
• Switch to whole grains and whole grain products. Whole grain breads are an important part of a Mediterranean diet.
• Use olive oil instead of butter. In the Mediterranean, bread is more often dipped in olive oil than slathered in butter. Drizzle it on pasta and vegetables, and add some crushed garlic for extra flavour.
• Choose nuts for a healthy satisfying snack. Nuts are a far better choice than sweets or chips, and can also be added to cereals, pastas, and vegetable dishes to add a flavourful crunch.
• Try hummus instead of cheese. Hummus, a spread made from blended chickpeas, sesame tahini, olive oil, and garlic, is great on biscuits and in sandwiches.
• Get your protein from pulses and fish. Whether in soups, salads, or stews, used in falafel or lentil loaf, or simply spiced and eaten with a whole grain, beans and lentils provide plenty of protein and are fibre-dense.
• Fish, twice a week. Sardines, mackerel, anchovies, cod, sea bass, and tuna are all popular in the Mediterranean.

(Am J Clin Nutr 2011;94:1458–64)