For years, serum cholesterol has been accepted as a major risk factor for coronary artery disease (CAD).1 This view led to the hypothesis that reduction of plasma cholesterol by dietary means might reduce cardiovascular risk. It must be noted, however, that among all the many dietary trials conducted, only those reproducing Mediterranean or Asian-vegetarian types of diets have shown significant reduction of CAD morbidity and mortality.2 The phenomenon occurred independent of dietary effects on plasma cholesterol.3-5
Typical traditional diets in Mediterranean countries (Table 12.1) are characterized by large intakes of cereals, vegetables, and vegetable-derived foods rich in complex carbohydrates and fiber, fresh fruit rich in natural antioxidants, and marine foods rich in polyunsaturated omega-3 fatty acids; moderate wine consumption; very small intakes of meat, dairy foods, eggs and sweets; and high consumption of olive oil rich in omega-9 monounsaturated fatty acid oleate and antioxidant polyphenols as the main source of fat.6-7
The basic observation that spurred interest in the Mediterranean dietary style, at least until the early 1960s, was that adults living in certain regions around the Mediterranean Sea had rates of chronic diseases among the lowest in the world and life expectancies among the highest. Such favorable statistics could not be
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