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LETTER TO THE EDITOR |
Division of Metabolic Diseases
Second University of Naples
Piazza L Miraglia 2
80138 Naples
Italy
E-mail: dario.giugliano{at}unina2.it
Dear Sir:
We read with interest the recent report of Brunner et al (1) in the Journal, which described the prospective relation between habitual diet and the incidence of diabetes or coronary heart disease in the 15-y follow-up of the Whitehall II study. The finding that healthy dietary patterns offer protection against the burden imposed by chronic diseases in the Western world is in line with current scientific information (2-4) and is reassuring. We would like to focus on the estimated macronutrient intake that Brunner et al described in Table 2, in which the value of carbohydrates/d across the dietary clusters is quite similar, ranging from a minimum mean value of 40.4% (Mediterranean-like dietary pattern) to a maximum mean value of 43.4% (Healthy dietary pattern); the other values (Unhealthy and Sweet dietary patterns) had intermediate positions. It seems quite strange that the Mediterranean-like pattern, which in theory would have had the maximal intake of estimated carbohydrates (higher than average consumption of whole-meal bread, fruit, vegetables, rice, and pasta and average consumption of white bread, as shown in Table 1), in practice had the lowest intake, whereas the Unhealthy dietary pattern had higher than average consumption of bread and very low consumption of fruit and vegetables (as Brunner et al showed in Table 1). The mean intake of daily carbohydrates, <50% across the dietary clusters, may in fact reflect the country in which the study was conducted; however, the sum of energy distribution in each pattern (protein, carbohydrates, alcohol, and total fat) gave values consistently <100% (94.7–96.2%). Is there any particular reason for this?
Another aspect of the article that left us puzzled was the use of the term "Mediterranean-like" to describe a dietary pattern that, in theory, should conform to what a Mediterranean-style diet is thought to be; the calculated Mediterranean score is also unclear. The Mediterranean dietary pattern emphasizes a consumption of fat (30–40% of daily energy intake), primarily from foods high in monounsaturated fatty acids, and encourages the consumption of fruit, vegetables, tree nuts, legumes, whole grains, and fish and a moderate consumption of alcohol (5). Thus, the main characteristics of the Mediterranean-style diet are an abundance of plant food, olive oil as the principal source of fat, consumption of fish and poultry in low-to-moderate amounts, relatively low consumption of red meat, and moderate consumption of wine, normally with meals. Quite paradoxically, in the description of dietary clusters (Table 1) and in the method given for calculating the Mediterranean diet score (Table 2, footnote), there is no mention of olive oil or other vegetable oils. Curiously, the reader is told that the Mediterranean-like dietary cluster is characterized by a high intake of butter (Table 1), which seems to be the negation of most scientific evidence about the health benefits of Mediterranean diets (6).
Thus, our concern relates to the improper use of the term Mediterranean-like as applied to a dietary cluster that was misconstrued by Brunner et al as having the full characteristic of a Mediterranean-style diet. For example, most of the attributes of the Mediterranean-style diet are split between the 2 healthy clusters (Mediterranean-like and Healthy; Table 1), which may account for the nonsignificant reduction found in the risk of diabetes and CHD (see Table 5). Unifying the 2 healthy clusters would, of course, have provided further support for the holistic concept of nutrition. Mediterranean diets, which are known to be safe and beneficial for a number of cardiovascular endpoints (7), are gaining popularity as individual persons and healthcare professionals seek diets that improve the quality of life and promote longevity (8).
ACKNOWLEDGMENTS
Neither of the authors had a personal or financial conflict of interest.
REFERENCES
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