Lessons from Studies in Middle-Aged and Older Adults Living in Mediterranean Islands: The Role of Dietary Habits and Nutrition Services

Table 1

A summary of studies that evaluated the role of diet on CVD risk in populations living on Mediterranean islands.

Study	Design	Sample	Main findings
The Seven Countries Study [17–19].	Cohort.	Of the total Study’s sample, 1,200 middle-aged men (40–59 years old) were living in Crete and Corfu islands.	Saturated fat associated with increased CHD mortality rates. Mediterranean diet appeared a cardio-protective effect.
MEDIS Study [20–29].	Cross-sectional.	553 men and 637 women (>65 years) living in Cyprus republic, and in 7 Greek islands (Mitilini, Samothraki, Cephalonia, Crete, Corfu, Lemnos and Zakynthos).	The level of adherence to the traditional Mediterranean diet was moderate in the elderly inhabitants of these insular areas. Adherence to this dietary pattern was associated with lower likelihood of diabetes and obesity, as well as overall CVD risk.
‘Ventimiglia di Sicilia’ project [30–33].	Prospective.	363 males and 472 females (20–70 years) living in Sicilia island.	Lower CVD mortality in persons of ages 40 to 64 years old. Increase of total and complex carbohydrates intake and significant decrease of the consumption of total, saturated and polyunsaturated fats with increment of age.
‘Spili’ study [30].	Cross-sectional.	445 males and females (15–79 years) living in rural area of Crete island.	Appeared high prevalence in many CVD risk factors. However there were no signs of postmyocardial infarction in men aged 63 and under.
“Messara” study [31].	Cross-sectional.	502 (15–79 years) male farmers living in rural area of Crete island.	The level of adherence to the traditional Mediterranean diet was moderate in the inhabitants of these insular areas. The lack of adherence to this traditional dietary pattern have led to the fact that the rural inhabitants from Crete are likely to be at a higher risk for developing CVD in comparison with earlier generations.
“Balearic Islands” study [34, 35].	Cross-sectional.	498 males and 702 females (16–70 years) living in Balearic islands.	The elders seem to better hold the traditional Balearic Mediterranean dietary habits, than younger ones. However, Mediterranean diet appeared to being lost in the Balearic Islands, mainly in the younger generations.
“Sardinia and Malta Islands” study [36].	Cross-sectional.	30 mother-daughter pairs were interviewed in Sardinia and Malta islands.	The Sardo-Mediterranean dietary model is evolving under the impact of modernization - globalisation, but it is not disappearing. In Malta, the western modernity has led to a more sudden shift where the local nutrition identity is no longer Mediterranean.