Seven Countries Study in the 1950s by Ancel Keys

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Since Ancel Keys introduced the Seven Countries Study in the 1950s, the Mediterranean diet has been considered a model of healthy eating pattern for its contribution to a favourable health status and a better quality of life.1,2 Several studies in different populations have indicated that the main components of Mediterranean diet have a beneficial role in the prevention of cardiovascular diseases and chronic degenerative diseases.2,3 High olive oil (not necessarily extra-virgin olive oil) intakes are considered a trademark of the traditional Mediterranean diet, along with a high consumption of monounsaturated fat, plant proteins, wholegrain, and fish; a moderate intake of wine; and a low intake of red meat and sweets.4
A study by Estruch, et al. found that an energy-unrestricted Mediterranean diet supplemented by extra-virgin olive oil or nuts substantially reduced the occurrence of cardiovascular disease.5 In brief, the Prevención con Dieta Mediterránea (PREDIMED) trial was a large (7,447 participants), multi-centre, randomised control trial conducted in Spain, which aimed to investigate the primary prevention of cardiovascular disease solely with diet. Participants with a high risk of cardiovascular disease were assigned to one of three groups: those who received provision of extra-virgin olive oil, those who received provision of nuts, and those who were advised to reduce dietary fat. The primary end point was a composite of major cardiovascular events (myocardial infarction, stroke, and death from cardiovascular causes). After a median follow-up of 4.8 years, the results of multivariate analyses presented a protective effect from olive oil and nuts supplementation versus the control diet by reducing the risk of cardiovascular...

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...e diets is that the Mediterranean diet consists of higher total calories from fat (roughly 35%) and specifically uses olive oil as the main source of fat.3
There are still many unanswered questions about the benefits of the Mediterranean diet. The recent finding by Estruch, et al. has not given enough proof either olive oil and nuts alone or the combination of a low-saturated fat and plant-based diet components are effective in reducing the risk of cardiovascular disease. Likewise, the long-term effect of olive oil supplementation, which provides ta significant amount of empty calories, has not been documented. Given this limited information, a new recommendation about olive oil and nuts supplementation relies on a future randomised control trial of the same size as the PREDIMED study, which tests the real Mediterranean diet as a whole and lasts more than five years.

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