Elsevier

Nutrition

Volume 16, Issues 7–8, July–August 2000, Pages 528-531
Nutrition

Nutrition, Life Cycle, and Lifestyle
From research to education: the greek experience

https://doi.org/10.1016/S0899-9007(00)00346-4Get rights and content

Introduction

The realization that diet is an important determinant of human health is not new. What is new is 1) the documentation of our knowledge about what is and what is not healthy in diet, 2) the semiquantification of our understanding, and 3) the realization that changes can be successfully implemented at either the individual or the population level.

These facts impose on us, nutrition scientists and public-health officials, an obligation to act. As a first step toward meeting this obligation, we have developed food-based dietary guidelines (FBDGs), and we have asked conscientious citizens to adopt them toward a better nutrition for a better life.

Several countries have formulated their own national FBDGs:1 The United States FBDGs (http: //www.pueblo.gsa.gov/cic−text/food/dietgd/dietgd.html>), depicted in the form of a food pyramid, have been widely publicized and can be accessed through the internet.2 A Harvard-led group, with substantial input from Greek scientists, has also developed an alternative pyramid based on the principles of the traditional Mediterranean diet.2 Within Europe, several countries have developed their own FBDGs. A report to the European Parliament3 has pointed out that the traditional Mediterranean diet has several advantages over other traditional healthy dietary patterns. The development of FBDGs for Europe is currently the objective of a large European Union–funded project. In Greece, the Ministry of Health has issued a poster depicting a Greek version of the Harvard-developed Mediterranean diet pyramid, thus acknowledging the importance of this pattern for the health of the Greek population. Moreover, the Hellenic Supreme Scientific Health Council has recently called for the development of a document summarizing FBDGs for the Greek population, taking into account evidence from studies in this population4 (Fig. 1).

Current scientific evidence is altering our perceptions on nutrition and health and tends to transform nutrition guidelines. In this context, I comment on some elements of several FBDGs from the point of view of the Mediterranean diet.

Section snippets

What is meant by fat

Dietary guidelines have been widely perceived as indicating that total fat should be reduced. However, total fat is not a very useful term because fats and oils are distinct categories in the broad group of lipids. For southern Europe, fat means mainly olive oil; for north and central Europe, the word fat is associated with animal fat. By recommending fat reduction, we may have had, as a result, the reduction of olive-oil consumption in southern Europe and the concomitant reduction of vegetable

Fat and obesity

Another argument allegedly in support of low-fat intake is that fat is conducive to obesity. For several decades, it has been recommended that a healthy diet provides less than 30% of total energy from fat. Two schools of thought have expressed different views concerning the optimal level of overall lipid intake.10, 11 However, there are no conclusive findings from controlled studies on the appropriate amount of fat in the diet to promote long-term weight reduction and maintenance. Although

Vegetables and fat

There is strong evidence that antioxidants, largely derived from vegetables and fruits, contribute to the protection against coronary heart disease and, probably, cancer and other diseases. Recent findings suggest that polyphenolic compounds in vegetables are endowed with several beneficial biologic activities.15, 16, 17, 18

The campaigns to increase fruit consumption have been relatively successful, but only a minority of people in developed countries consume adequate quantities of vegetables.19

Fruits and vegetables in the same basket?

Because fruits and vegetables have partly different nutritional attributes,17, 18 I think it appropriate, from a health point of view, to segregate the recommendations concerning the two food groups.

Targeted interventions that focus specifically on vegetables may have to take priority because it is with respect to vegetables that the deficit is more substantial. The “more than 400 g a day,” the “five servings,” and the “eating more fruit and vegetables” recommendations are open to different

Pulses

Pulses are rarely consumed and rarely are considered independently in FBDGs of most countries. In Greece, however, olive oil allows the preparation of delightful dishes with pulses that share some of the health attributes of vegetables and also provide protein, albeit of moderate quality. Consumption of an average of one serving every other day is advised, and higher consumption should not be discouraged.

Are potatoes cereals?

Potatoes in the Greek guidelines are not included in the cereal food group and their consumption is recommended, not daily, but only a few times per week.

Potatoes provide as much percentage of energy from protein as do wheat and rice and are a good source of vitamin C. Like white bread, however, potatoes have a high glycemic index because they are rapidly converted to glucose after being consumed. Potato consumption has been found to be positively associated with the risk of type-2 diabetes in

Practical implications

Two additional questions should be addressed at this time: Is the Mediterranean diet an integral entity or the sum of identifiable components that can and should be considered separately in the development of guidelines? Is the Mediterranean diet or its major components transferable to populations living far from the Mediterranean region? Answers to these questions would be important for policy formulation, if and when such a policy were desirable.

An attempt to conceptualize and operationalize

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