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It is well established that what certain nutrients benefit our physical health. More recently there has been growing interest in the relationship between diet and brain health. The dietary pattern that has received the most interest is the Mediterranean diet. Many years have passed since the original Seven Countries study, which indicated that individuals living in the Mediterranean region had lower rates of death due to coronary heart disease compared to those from Northern Europe and the United States. This finding was ascribed to the dietary pattern that is commonly adhered to in that region. A diet high in fresh fruits, vegetables, breads, cereals, nuts, olive oil, legumes, fish, moderate consumption of dairy, poultry, red wine, and low consumption of red meat—the Mediterranean diet. Since then, adherence to this dietary pattern has been repeatedly linked to lower risk of mortality, cardiovascular disease, and the risk of developing dementia. This chapter explores the evidence for Mediterranean diet and its components in improving cognitive function and protecting against age-related cognitive decline.

Since the emblematic “Seven Countries Study” of Ancel Keys and the emergence of the Mediterranean diet (MD) as a recognized food pattern, major nutritional changes have been noted in Mediterranean populations. War-torn countries and areas afflicted by poverty and the recent economic recession have increased the prevalence of food insecurity. A negative relationship has been demonstrated between MD and food insecurity, particularly in the Mediterranean region. Furthermore, the tendency of food-insecure persons to decrease the quality of their diet and choose less nutritious foods results in micronutrient inadequacies. A negative pattern seems to emerge in the Mediterranean countries as more people abandon the MD due to economic barriers, thwarting MD adherence. Based on the economic theory, the decreased income is associated with obesogenic diets and the consumption of energy-dense food. Promotion of the MD as a sustainable diet will help reduce the prevalence of food insecurity and provide the foundations of food security for posterity.

The Mediterranean diet was first described by the Seven Countries Study in the 1960s as a cardioprotective diet, as a pattern of eating that was traditionally prevalent among residents of the Mediterranean basin countries. Since then the Mediterranean dietary pattern has been extensively described and explored with respect to its health benefits and has been identified as one of the healthier diets in the world, being associated including in some cases causally as protective against cardiovascular diseases, type 2 diabetes mellitus, some cancer, mental health issues, cognitive decline, etc. While attempts have been made to explain the protective aspects of Mediterranean diet, research groups and foundations including the United Nations Educational, Scientific, and Cultural Organization (UNESCO) have extended the definition of Mediterranean diet to be a holistic entity: the Mediterranean lifestyle. The cornerstone of the Mediterranean lifestyle not only is based upon the traditional Mediterranean diet but also extends to include food preparation, food sharing, harvesting, eating locally and seasonally, and socializing often and with all age groups and social classes while eating together. Although these behaviors are integral aspects of Mediterranean culture, the Mediterranean lifestyle requires thorough investigation to be exported outside of its Mediterranean cradle and offer its protectiveness worldwide.

The Mediterranean Adequacy Index (MAI) is an a priori dietary score created within the experience of the Seven Countries Study (SCS) of Cardiovascular Diseases, exploiting data of its feasibility study carried out in 1957–60 in Nicotera (Southern Italy). It represents the shape of typical dietary habits common in those times along the shores of several Mediterranean countries. The MAI was computed by dividing the sum of the energy percentages of typical Mediterranean food groups (bread, cereals, legumes, potatoes, vegetables, fresh fruit, nuts, fish, wine, and vegetable oils) by the sum of the energy percentages of less typical Mediterranean food groups (milk, cheese, meat, eggs, animal fats and margarines, pastries, sugar, and sugar beverages). High levels of the MAI correspond to a higher adherence to the Mediterranean dietary habits. The MAI was strongly ecologically related to the 25-year coronary heart disease death rates of the 16 cohorts of the SCS (R = − 0.84), to the 50-year death rates for the same end point (R = − 0.91), and to the 50-year all-cause mortality of the same study, after adjustment for socioeconomic status (R = − 0.62). Moreover the MAI performed satisfactorily also when applied to individual data of the SCS and other international studies.

Diet, lifestyle, and behavior are key modifiable risk factors for the primordial and primary prevention of cardiovascular diseases (CVD). Dietary guidelines and recommendations have positively moved from single-nutrient and food-based approaches and their impact on chronic disease to a whole of diet approach, recognizing that diet is the most modifiable risk factor for disease prevention. A Western dietary pattern, characterized by a high intake of red and processed meats, refined grains, processed and fried foods in unhealthy oils, sweets and desserts, etc., can influences an individual's lipid profile and related biomarkers, blood pressure, body weight, weight distribution, glucose-insulin homeostasis, oxidative stress, and inflammatory status. On the other hand, since the Seven Countries Study, several dietary patterns such as the Mediterranean diet have been recognized as major factors for lower incidences of CVD in specific populations and cultures. A significant number of studies have positively influenced guidelines that now recommend the adoption of dietary patterns such as the Mediterranean diet because of the abundance of reported beneficial outcomes in a plethora of several chronic diseases that are either directly or indirectly related to CVD risk factors (inflammation, lipid profile, BP, etc.). It is fast becoming the most globally researched and so far the healthiest dietary pattern promoted for reducing chronic diseases and promoting longevity. Within this chapter, the overall preventive and therapeutic benefits from acquiring such healthy dietary patterns will be addressed.

Despite more than a century of research, cardiovascular disease (CVD) and coronary heart disease (CHD) are the leading causes of death in the developing world. Since the early days of CVD research, the underlying cause and putative prevention strategies remain elusive. This chapter discusses the history of the lipid hypothesis, from the initial observations of Anitschkow and Chalatow to the industrious work of Gofman and the further studies of Ancel Keys, who endeavored to discover the role of cholesterol and saturated fat in CVD. The Seven Countries Study identified diet, saturated fat, and cholesterol as the underlying causes of CVD development. This chapter delivers an overview of the early research that formed the “lipid hypothesis,” which led to the development of modern treatment and prevention strategies for CVD.

Mediterranean Diet refers to dietary patterns found in the olive tree-growing areas of the Mediterranean basin before the mid-1960s. The main characteristics of this pattern are: the high consumption of abundant plant foods; fresh and varied fruits as the main and usual dessert; olive oil as the main source of fat and commonly used for salads and cooking; frequent consumption of fish; moderate wine consumption with meals; low amounts of meat; and low to moderate consumption of dairy products. Over the last few decades, the Mediterranean Diet has been recognized for its nutritional composition and effects on human health because it shows an excellent profile of macronutrients and essential micronutrients. Several observational studies with longitudinal design as well as two important clinical trials (PREDIMED and Lyon Hearth Study) have demonstrated the favorable role of this dietary pattern in the primary and secondary prevention of cardiovascular disease.

Objectives Investigate the relationship of some behavioural characteristics of a male population with lifetime incidence of heart diseases. Material and methods In the Italian Rural Areas of the Seven Countries Study of Cardiovascular Diseases, 1677 heart disease-free men aged 40–59years were followed up during 50years for lifetime incidence of heart disease up to the age of 90years. They were classified as coronary heart disease (CHD) and heart diseases of uncertain etiology (HDUE). Baseline cigarette smoking habits (non-smokers and ex-smokers, moderate smokers, heavy smokers), physical activity (sedentary, moderate, vigorous) and eating habits (non-Mediterranean Diet, Prudent Diet and Mediterranean Diet) were related to incidence of heart disease. Results Incidence of CHD and HDUE up to the age of 90years was 28.8 and 17.7%, respectively. Univariate and multivariate analyses showed strong association of behavioural characteristics with CHD incidence, but not with HDUE incidence. Cox proportional hazard rates for CHD were 1.45 (95% confidence intervals, CI: 1.11–1.90) for heavy smokers versus non-smokers; 0.67 (CI 0.50–0.89) for vigorous activity versus sedentary habits and 0.62 (CI 0.47–0.83) for Mediterranean Diet versus non-Mediterranean Diet. Combining CHD cases with HDUE cases made the predictive picture similar to that of CHD. When some basic risk factors were added to the model results remained substantially unaltered, despite the existence of some correlations of behaviours with risk factors. Conclusions Behavioural factors including cigarette smoking, physical activity and diet are strong predictors of lifetime incidence of common heart diseases even adding other traditional risk factors.

Extended Abstract Unquestionably, cigarette smoking is the dominant risk factor for lung cancer. In addition, epidemiological studies consistently show an inverse association between fruit and vegetable consumption and lung cancer risk.1,2,3However, critics point at the possible role of residual confounding by smoking, and suggest that results from cohort studies may be less consistent compared with those from case-control studies.4Therefore, we examined the relationship between plant food consumption and lung cancer mortality in a cohort of men, focusing on smokers at baseline. Around 1970, dietary intake of Finnish, Italian and Dutch middle-aged men participating in the Seven Countries Study was assessed using a cross-check dietary history. Smoking habits and other lifestyle factors were determined by a standardised questionnaire. For 3108 men complete baseline information was available, of which 1578 were baseline smokers. During 25 years of follow-up, 187 lung cancer deaths occurred, of which 149 were smokers at baseline. Relative risks and 95% confidence intervals for consumption in country-specific tertiles were estimated by Cox proportional hazard analyses, and statistical significance was determined by two-sided tests. Risk estimates were calculated for the total study population and per country, both univariately and adjusted for potential confounders, including pack-years of smoking. Fruit consumption was inversely associated with lung cancer mortality in the total group of baseline smokers. Among Finnish smokers, lung cancer risk tended to be reduced in men with a medium or high fruit intake compared with those with the lowest fruit intake; however, estimates were not statistically significant. In Italian smokers, fruit consumption and lung cancer mortality were not related. Fruit consumption was only statistically significant inversely associated in the Dutch cohort. Stratifying the total cohort of smokers according to intensity of smoking, revealed the most pronounced relationship among the heaviest smokers. Vegetable intake and lung cancer mortality were not statistically significant related, neither in the total study population nor in the countries separately. In conclusion, this study shows a lower lung cancer risk among heavier smokers consuming more fruits. For vegetable consumption no such relationship was observed.