Public Health Nutrition

Research paper

Mediterranean diet pyramid today. Science and cultural updates

Anna Bach-Faiga1, Elliot M Berrya2, Denis Lairona3, Joan Reguanta1, Antonia Trichopouloua4, Sandro Derninia5a6, F Xavier Medinaa7, Maurizio Battinoa8, Rekia Belahsena9, Gemma Mirandaa1 and Lluís Serra-Majema1a10 c1 on behalf of the Mediterranean Diet Foundation Expert Group

a1 Mediterranean Diet Foundation, Barcelona, Spain

a2 Department of Human Nutrition and Metabolism, Braun School of Public Health, Hebrew University-Hadassah Medical School, Jerusalem, Israel

a3 Research Unit 1025 Inserm/1260 Inra/“Human Nutrition and Lipids: Bioavailability, Metabolism and Regulations”, Faculté de Médecine, Université de la Méditerranée, Marseille, France

a4 Hellenic Health Foundation, Athens, Greece

a5 Forum on Mediterranean Food Cultures, Rome, Italy

a6 Interuniversity International Center for Mediterranean Food Cultures Studies (CIISCAM), Sapienza University of Rome, Italy

a7 Department of Food Systems, Culture and Society, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain

a8 Department of Biochemistry, Università Politecnica delle Marche, Ancona, Italy

a9 Department of Biology, Faculty of Sciences, Chouaïb Doukkali University, El Jadida, Morocco

a10 Department of Clinical Sciences, University of Las Palmas de Gran Canaria, PO Box 550, 35080, Las Palmas de Gran Canaria, Spain


Objective To present the Mediterranean diet (MD) pyramid: a lifestyle for today.

Design A new graphic representation has been conceived as a simplified main frame to be adapted to the different nutritional and socio-economic contexts of the Mediterranean region. This review gathers updated recommendations considering the lifestyle, dietary, sociocultural, environmental and health challenges that the current Mediterranean populations are facing.

Setting and Subjects Mediterranean region and its populations.

Results Many innovations have arisen since previous graphical representations of the MD. First, the concept of composition of the ‘main meals’ is introduced to reinforce the plant-based core of the dietary pattern. Second, frugality and moderation is emphasised because of the major public health challenge of obesity. Third, qualitative cultural and lifestyle elements are taken into account, such as conviviality, culinary activities, physical activity and adequate rest, along with proportion and frequency recommendations of food consumption. These innovations are made without omitting other items associated with the production, selection, processing and consumption of foods, such as seasonality, biodiversity, and traditional, local and eco-friendly products.

Conclusions Adopting a healthy lifestyle and preserving cultural elements should be considered in order to acquire all the benefits from the MD and preserve this cultural heritage. Considering the acknowledgment of the MD as an Intangible Cultural Heritage of Humanity by UNESCO (2010), and taking into account its contribution to health and general well-being, we hope to contribute to a much better adherence to this healthy dietary pattern and its way of life with this new graphic representation.

(Received May 13 2011)

(Accepted September 07 2011)

(Online publication December 13 2011)


c1 Corresponding author: Email