Mediterranean diet and beyond: an Italian perspective

The health benefits associated with the Mediterranean diet have been well established by several epidemiological studies consistently showing that adherence to this dietary pattern is associated with a significant reduction in the risk of developing chronic diseases, as well as all-cause mortality. Nevertheless, the dietary behaviors of many populations have been radically changing since the original definition of this eating pattern and many problematic nutritional aspects emerged, especially within a context of global industrial food system that favors food exchanges from one country to another across the globe. The Mediterranean Diet Score is the most extensively used index to measure adherence to the Mediterranean diet in epidemiological studies but, although including the key food groups, it leaves out other foods and beverages, some of which might be positively associated with advantageous health outcomes. This thesis confirmed the health benefits of the traditional Mediterranean diet and its major determinants, such as socio-economic factors and education. Moreover, it addressed the question whether some foods and beverages, (Italian-style coffee, chili pepper and eggs) neither presently included in the traditional Mediterranean Diet Score, nor in the majority of its modified versions, were associated with health outcomes in a population with typical Mediterranean dietary habits. The thesis concluded however that the inclusion of these foods and beverages did not improve risk prediction beyond a traditional Mediterranean Diet Score.