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expert reaction to Mediterranean diet only works for wealthy people

Researchers publishing in the International Journal of Epidemiology state that mediterranean diet is associated with lower cardiovascular disease risk but this relationship is confined to higher socioeconomic groups.


Dr Amitava Banerjee, Senior Clinical Lecturer in Clinical Data Science and Honorary Consultant Cardiologist, Farr Institute of Health Informatics Research, UCL, said:

“The benefits of a Mediterranean diet in reducing the risk of cardiovascular disease are not in question. This well-conducted observational study of 24,000 men and women in Southern Italy over a 5-year period confirms this reduction in risk. The novelty of the study is that this benefit is restricted to people of high socioeconomic status as measured by self-reported education and income.

“There are two implications. First, a higher quality Mediterranean diet may be more readily accessible to higher socioeconomic status groups due to the higher cost of the best food types or because their education makes them more likely to adhere to the healthier components of this diet. Second, socioeconomic gradients are well described for cardiovascular disease, but this is the first study to show an attenuation of the benefit of a Mediterranean diet in lower income individuals.

“We need a holistic and societal view of heart disease and stroke, recognising the role of poverty reduction and reducing social gradients. Moreover, the Mediterranean diet is neither accessible to all nor works the same in all.”


Dr Tim Chico, Reader in Cardiovascular Medicine, University of Sheffield, said:

“Although it is very hard to know exactly what the most healthy diet is, studies have repeatedly shown that the Mediterranean diet (which is a broad category but is generally high in vegetables, nuts, seeds, fruit, olive oil, fish and low in red meat and very low in processed food) is able to reduce the risk of heart disease compared with the usual diet in the Western world.

“This study confirms a well-known but depressing fact; people of lower education or income have almost double the risk of heart disease compared with those who are better off.

“Although the authors of this study suggest that the Mediterranean diet may be less effective in reducing heart disease in less well-off people, this is likely to be due to other differences between low and high income groups, rather than the diet not being effective. The authors suggest that there are some elements of the Mediterranean diet that are eaten more often by high rather than low income groups, but there are other possible explanations for these findings.

“These findings should not put anyone off a Mediterranean diet; this is still the best option for reducing risk of heart disease. However, there is no quick-fix diet; a healthy diet has to be a part of an overall heart-healthy lifestyle that includes not smoking, taking regular exercise, and maintaining a healthy weight.”


* ‘High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups: prospective findings from the Moli-sani study’ by Bonaccio et al. published in International Journal of Epidemiology on Tuesday 1st August.


Declared interests

Dr Banerjee: “I have no conflicts of interest.”

Dr Chico: “I am a committee member and Treasurer of the British Atherosclerosis Society, a charity established in 1999 to promote UK atherosclerosis research.”

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