Mediterranean diet and cardiovascular diseases in an Israeli population Natalya Bilenko, M.D, M.P.H. a,b , Drora Fraser, Ph.D. a,b, * , Hillel Vardi, M.A. b , Iris Shai, Ph.D. a,c , Danit R. Shahar, Ph.D. a,b a The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer-Sheva, Israel b Epidemiology and Health Services Evaluation Department, Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel c Harvard School of Public Health Department of Epidemiology, Boston, MA, USA Available online 25 July 2004 Abstract Background. Israel is in the Mediterranean basin, but its population immigrated mostly from Europe, Asia, and Africa. We surveyed the adherence of the Israeli Jewish population to Mediterranean Diet (MD) and its association with cardiovascular disease. Methods. We studied a random sample of Jewish adults, aged 35+ using a 24-h recall questionnaire. A MD score (scale 0–8) was computed reflecting high ratio of monounsaturated to saturated fat; high intake of alcohol, legumes, cereals, vegetables, and fruits; low intakes of meat and it’s products, milk and dairy products. Scoring <5 was defined as Low-MD consuming, while 5+ as High-MD consuming. Results. Five hundred twenty men and 639 women participated in the study, with High-MD consumers constituting 19% and 17% by sex, respectively. The risk for myocardial infarction, coronary bypass, angioplasty, and any cardiovascular disease in men increased by 1.2 (P = 0.04), 1.6 (P = 0.01), 1.4 (P = 0.003), and 1.3 (P = 0.01), respectively, for each MD score decrease. In women, crude odds ratios ranged from 1.4 to 1.9 but were not statistically significant. Conclusions. The current rate of MD in Israel is fairly low. Given the MD’s proven preventive effect and local availability of foods, a reasonably priced MD diet can be devised and recommended widely in our population. D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. Keywords: Mediterranean diet; Cardiovascular diseases; Prevention; Chronic disease; Dietary pattern Background The Mediterranean diet (MD), representing the dietary pattern among populations of the Mediterranean area, is a model for a healthy diet [1–5]. This eating pattern refers to a diet with increased consumption of olives, fruits and vegeta- bles, nuts and cereals, and increased intake of legumes in cooked foods. Furthermore, this diet includes a low intake of dairy and meat products as well as moderate consumption of alcohol, mostly wine. The diet has been shown to have implications for diseases other than coronary heart disease and is believed to achieve its effects not only via the low- saturated fat composition [5]. Components of MD such as selenium, glutathione, a balanced ratio of essential fatty acids, high amounts of fiber, antioxidants (especially from wine and polyphenols from olive oil) are all believed to be protective [1]. There are several variations in the MD. For example, the Greek variant has more total fat, the Italian variant has higher consumption of pasta, and the Spain variant has higher fish intake. However, all variants of MD share common features, which were used in creating the diet’s score [5]. Several studies have described that various types of MD (or most of its components) in different populations lower the risk of cardiovascular diseases [6–8], decreases cancer rates [9], and even affect overall mortality [10–14]. Israel is a typical immigrant country with a wide variety of dietary patterns due to the diversity of countries of origin, including the Americas, Asia, Africa, and Europe. As Israel is geographically located on the Mediterranean coast, it has the appropriate agricultural and climatic conditions for crops such as olives and grapes. While the rank of the major causes of mortality have changed in the population over the past 50 years, the major cause of death in the Israeli population remains cardiovascular disease, accounting for 26.2% of deaths in men and 25.9% in women [15]. 0091-7435/$ - see front matter D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2004.06.004 * Corresponding author. The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, PO Box 653 Beer Sheva 84105, Israel. Fax: +972-8-647-7637. E-mail address: fdrora@bgumail.bgu.ac.il (D. Fraser). www.elsevier.com/locate/ypmed Preventive Medicine 40 (2005) 299 – 305