¹National Institute for Food and Nutrition Research, Rome, Italy

²Public Health Policy Group, IASO/IOTF, London, UK

³Preventive Medicine and Nutrition Clinic, Department of Social Medicine, Medical School, University of Crete, Crete, Greece

Correspondence to: A Ferro-Luzzi, Human Nutrition, National Institute of Food and Nutrition Research, Via Ardeatina 546, Rome 00178, Italy. E-mail: afl@inran.it

^aGuarantor: A Ferro-Luzzi.

^bContributors: AFL provided the initial idea, searched the literature and re-analysed the collated data; WPTJ and AFL wrote the drafts of the paper. AK provided recent published and unpublished Greek data and reviewed the text. All three investigators discussed the validity and the interpretation of the data.

Objective: To examine critically the published results of dietary surveys on the fat content of the Greek diet, and to assess its evolution and its relationship to the health of the Greeks. To consider the implications of these findings for current views on the nature and health implications of the traditional Mediterranean diet and how best to define it for use in modern policy making.

Design: A systematic review of the literature on food consumption in Greece.

Setting: Greece.

Results: The first fully published data on the fat content of the Greek diet¾the Seven Countries Survey¾relates only to a small number of adult males in Crete and Corfu; the legitimacy of extrapolating these results to the rest of Greece is questioned. Earlier studies and chemical validation of intakes point to a lower fat content of the traditional diet than that inferred for Crete. Nearly all later surveys relate only to urban groups in Athens (mostly case-control hospital-based samples) and a variety of non-representative Cretan groups. Only two studies are larger and more representative, but one uses FAO food balance-sheets to reflect the national diet, and the other surveyed school-age children in three out of the 52 Greek counties. Unfortunately recent dietary studies have proved unreliable, given the continuing lack of national food composition tables with survey methods which proved inaccurate for dietary fat content. A progressive upward trend in total and saturated fat intake appears to have occurred with all health indicators in relation to fat indicating remarkable increases in adult and childhood obesity with attendant progressive deterioration in cardiovascular mortality and its risk factors, ie hypertension and diabetes. These data emphasise the need to alter current nutritional advice in Greece, particularly when it focuses on the promotion of olive oil and a high-fat diet.

Conclusions: The findings reaffirm low-moderate fat policies for optimum health, within which olive oil can be an important component of the diet.

European Journal of Clinical Nutrition (2002) 56, 796-809. doi:10.1038/sj.ejcn.1601393

Mediterranean diet; Greece; dietary fat; nutritional goals