Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The high-fat Greek diet: a recipe for all?


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 diet—the Seven Countries Survey—relates 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.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3
Figure 4


  • Allbaugh LG . 1953 Crete: a Case Study of an Underdeveloped Area Princeton, NJ: Princeton University Press

    Book  Google Scholar 

  • Aravanis C, Mensink RP, Karalias N, Christodoulou B, Kafatos A, Katan MB . 1988 Serum lipids, apoproteins and nutrient intake in rural Cretan boys consuming high-olive-oil diets J. Clin. Epidemiol. 41: 1117–1123

    CAS  Article  Google Scholar 

  • Buzina R, Keys A, Brodarec A, Fidanza F . 1968 Dietary surveys in rural Yugoslavia. III. Comparison of three methods Dietary Studies and Epidemiology of Heart Diseases ed. C Den Hartog, K Buzina, F Fidanza, A Keys & P Roine, pp 129–135 The Hague: The Stichting

    Google Scholar 

  • Christakis G, Severinghaus EL, Maldonado Z, Kafatos FC, Hashim SA . 1965 Crete: a study in the metabolic epidemiology of coronary heart disease Am. J. Cardiol. 15: 320–332

    CAS  Article  Google Scholar 

  • Den Hartog C, Buzina K, Fidanza F, Keys A, Roine P . 1968a Dietary Studies and Epidemiology of Heart Diseases The Hague: The Stichting

    Google Scholar 

  • Den Hartog C, Van Schaik ThFSM, Dalderup IM, Drion EF, Mulder T . 1968b The diet of volunteers participating in a long term epidemiological field survey on coronary heart disease at Zutphen the Netherlands In: Dietary Studies and Epidemiology of Heart Diseases ed. C Den Hartog, K Buzina, F Fidanza, A Keys & P Roine, pp 87–110 The Hague: The Stichting

    Google Scholar 

  • Detorakis TE . 1994 History of Crete ed. TE Detorakis. Iraklion

  • Dontas AS, Menotti A, Aravanis C, Ioannidis P, Seccareccia F . 1998 Comparative total mortality in 25 y in Italian and Greek middle aged rural men J. Epidemiol. Community Health 10: 638–644

    Article  Google Scholar 

  • EURODIET. 2001a Nutrition and diet for healthy lifestyles in Europe: science and policy implications Public Health Nutr. 4: 1–75

  • EURODIET. 2001b Working party 1 final report Public Health Nutr. 4: 11–29

  • Euronut SENECA investigators. 1991 Nutritional status: serum lipids Eur. J. Clin. Nutr. 45: 53–61

  • FAO. 2000 Food Balance Sheets: FAOSTAT Database Rome: FAO

  • FAO/WHO. 1997 Carbohydrates in Human Nutrition Vol 66: pp 1–140 Rome: FAO

  • Fidanza F, Fidanza Alberti A . 1968 Dietary surveys in connection with the epidemiology of heart disease: reliability, sources of variation and othe data from 9 surveys in Italy In: Dietary Studies and Epidemiology of Heart Diseases ed. C Den Hartog, K Buzina, F Fidanza, A Keys & P Roine, pp 77–86 The Hague: The Stichting

    Google Scholar 

  • Fodor JG, Whitmore B, Leenen F, Larochelle P . 1999 Recommendations on Dietary Salt Can. Med. Assoc. J. 160: S29–S34

    CAS  Google Scholar 

  • Hulshof KFAM, van Erp-Baart MA, Anttolainen M, Becker W, Church SM, Couet C, Hermann-Kunz E, Kesteloot H, Leth T, Martins I, Moreiras O, Moschandreas J, Pizzoferrato L, Rimestad AH, Thorgeirsdottir H, van Amelsvoort JMM, Aro A, Kafatos AG, Lanzmann-Petithory D, Van Poppel G . 1999 Intake of fatty acids in Western Europe with emphasis on trans fatty acids: the TRANSFAIR Study Eur. J. Clin. Nutr. 53: 143–157

    CAS  Article  Google Scholar 

  • International Task Force for Prevention of Coronary Heart Disease. 1998 Coronary Heart Disease: Reducing the Risk Medikal Press

  • Jackson KG, Zampelas A, Knapper JME, Roche HM, Gibney MJ, Kafatos A, Gould BJ, Wright JW, Williams C . 2000 Differences in glucose-dependent insulinotrophic polypeptide hormone and hepatic lipase in subjects of Southern and Northern Europe: implications for postprandial lipemia Am. J. Clin. Nutr. 1: 13–20

    Article  Google Scholar 

  • Kaaks R, Slimani N, Riboli E . 1997 Pilot phase studies on the accuracy of dietary intake measurements in the EPIC project: overall evaluation of results Int. J. Epidemiol. 26: S26–S36

    Article  Google Scholar 

  • Kafatos A, Kouroumalis I, Vlachonikolis J, Theodorou C, Labadarios D . 1991 Coronary-heart-disease risk-factor status of the Cretan urban population in the 1980s Am. J. Clin. Nutr. 54: 591–598

    CAS  Article  Google Scholar 

  • Kafatos A, Diacatou A, Labadarios D, Kounali D, Apostolaki J, Vlachonikolis J, Mamalakis G, Megremis S . 1993 Nutrition status of the elderly in Anogia, Crete, Greece J. Am. Coll. Nutr. 12: 685–692

    CAS  Article  Google Scholar 

  • Kafatos A, Diacatou A, Voukiklaris G, Nikolakakis N, Vlachonikolis J, Kounali D, Mamalakis G, Dontas AS . 1997 Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Country Study Am. J. Clin. Nutr. 65: 1882–1886

    CAS  Article  Google Scholar 

  • Kafatos A, Verhagen H, Moschandreas J, Apostolaki I, Van Westerop JM . 2000 Mediterranean diet of Crete: foods and nutrient content J. Am. Diet. Assoc. 12: 1487–1493

    Article  Google Scholar 

  • Katsouyanni K, Skalkidis Y, Petridou E, Polychronopou-Trichopoulou A, Willett W, Trichopoulos D . 1991 Diet and peripheral arterial occlusive disease: the role of poly-, mono-, and saturated fatty acids Am. J. Epidemiol. 1: 24–31

    Article  Google Scholar 

  • Katsouyanni K, Rimm EB, Gnardellis C, Trichopoulos D, Polychronopoulos E, Trichopoulou A . 1997 Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers Int. J. Epidemiol. 26: S118–S127

    Article  Google Scholar 

  • Keys A . 1970 Coronary heart disease in Seven Countries Circulation (Suppl. I) 41–42: 1–211

    Google Scholar 

  • Keys A . 1980 Seven Countries: a Multivariate Analysis of Death and Coronary Heart Diseases Cambridge, MA: Harvard University Press

  • Keys A, Aravanis C, Sdrin H . 1968 The diets of middle-aged men in two rurals areas of Greece In: Dietary Studies and Epidemiology of Heart Diseases ed. C Den Hartog, K Buzina, F Fidanza, A Keys & P Roine, pp 57–68 The Hague: The Stichting

    Google Scholar 

  • Khaw K-T, Bingham S, Welch A, Luben R, Wareham N, Oakes S, Day N . 2001 Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study The Lancet 357: 657–663

    CAS  Article  Google Scholar 

  • Kromhout D, Keys A, Aravanis C, Buzina R, Fidanza F, Giampaoli S, Jansen A, Menotti A, Nedeljkovic S, Pekkarinen M, Simic BS, Toshima H . 1989 Food Consumption patterns in the 1960s in Seven Countries Am. J. Clin. Nutr. 49: 889–894

    CAS  Article  Google Scholar 

  • Law M, Wald N . 1999 Attribution of time lag theory to explain French paradox Br. Med. J. 319: 1073

    CAS  Article  Google Scholar 

  • Linos A, Kaklamani E, Koumantaki Y, Giziachi E, Papazoglou S, Mantzoros CS . 1999 Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables? Am. J. Clin. Nutr. 6: 1077–1082

    Article  Google Scholar 

  • Mamalakis G, Kafatos A . 1996 Prevalence of obesity in Greece Int. J. Obes. Relat. Metab. Disord. 20: 488–492

    CAS  PubMed  Google Scholar 

  • Mamalakis G, Kafatos A, Tornaritis M, Alevizos B . 1998 Anxiety and adipose essential fatty acid precursors for prostaglandin E1 and E2 J. Am. Coll. Nutr. 17: 239–243

    CAS  Article  Google Scholar 

  • Mamalakis G, Kafatos A, Manios Y, Anagnostopoulou T, Apostolaki I . 2000 Obesity indices in a cohort of primary school children in Crete: a six year prospective study Int. J. Obes. Relat. Metab. Disord. 24: 765–771

    CAS  Article  Google Scholar 

  • Manios Y, Kafatos A . 1999 Health and nutrition education in elementary schools: changes in health knowledge, nutrient intakes and physical activity over a six year period Public Health Nutr. 2: 445–448

    CAS  Article  Google Scholar 

  • Menotti A, Kromhout D, Blackburn H, Fidanza F, Buzina R, Nissinen A . 1999 Food Intake patterns and 25-years mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study Eur. J. Epidemiol. 15: 507–515

    CAS  Article  Google Scholar 

  • Moschandreas J, Kafatos A . 1999 Food and nutrient intakes of Greek (Cretan) adults. Recent data for food-based dietary guidelines in Greece Br. J. Nutr. 81: S71–S76

    Article  Google Scholar 

  • Paul AA, Southgate DAT . 1978 McCance and Widdowson's The Composition of Foods London: The Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food

  • Pekkarinen M . 1968 Chemical analysis in connection with dietary surveys in Finland In: Dietary Studies and Epidemiology of Heart Diseases ed. C Den Hartog, K Buzina, F Fidanza, A Keys & P Roine, pp 49–56 The Hague: The Stichting

    Google Scholar 

  • Petridou E, Malamou H, Doxiadis S, Pantelakis S, Kannellopoulu G, Toupadaki N, Trichopoulou A, Flytzani V, Trichopoulos D . 1995 Blood lipids in Greek adolescents and their relation to diet, obesity, and socio-economic factors Ann. Epidemiol. 5: 286–291

    CAS  Article  Google Scholar 

  • Polychronopoulou-Trichopoulou A . 1982 Composition of Greek Foods and Recipes Athens: Parisianos

  • Roine P, Pekkarinen M, Karvonen MJ . 1964 Dietary studies in connection with epidemiology of heart diseases: results in Finland Voeding 25: 383–393

    CAS  PubMed  Google Scholar 

  • Roma-Giannikou E, Adamidis D, Gianniou M, Nikolara R, Matsaniotis N . 1997 Nutritional survey in Greek children: nutrient intake Eur. J. Clin. Nutr. 51: 273–285

    CAS  Article  Google Scholar 

  • Sandker GW, Kromhout D, Aravanis C, Bloemberg BPM, Mensink RP, Karalias N, Katan MB . 1993 Serum cholesteryl ester fatty acids and their relation with serum lipids in elderly men in Crete and The Netherlands Eur. J. Clin. Nutr. 47: 201–208

    CAS  PubMed  Google Scholar 

  • Serra-Majem L, La Vecchia C, Ribas-Barba L, Prieto-Ramos F, Lucchini F, Ramon JM, Salleras L . 1993 Changes in diet and mortality from selected cancers in Southern Mediterranean Countries, 1960–1989 Eur. J. Clin. Nutr. 47: S25–S34

    PubMed  Google Scholar 

  • Slimani N, Ferrari P, Ocké M, Welch A, Boeing H, van Liere M, Pala V, Amiano P, Lagiou A, Mattisson I, Stripp C, Engeset D, Charrondière R, Buzzard M, Van Staveren W, Riboli E . 2000 Standardization of the 24-hour recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results Eur. J. Clin. Nutr. 12: 900–917

    Article  Google Scholar 

  • Societé Francaise de Santé Publique. 2000 Health and Human Nutrition. Elements for European Action/10 pp 1–42 Nancy: Collection Santé et Société

  • Supreme Scientific Health Council. 1999 Dietary Guidelines for Adults in Greece Athens: Ministry of Health and Welfare

  • Trichopoulou A . 1982 Food Composition Table Athens: Lenis

    Google Scholar 

  • Trichopoulou A . 2000 From research to education: the Greek experience Nutrition 16: 528–531

    CAS  Article  Google Scholar 

  • Trichopoulou A, Efstathiadis PP . 1989 Changes of nutrition patterns and health indicators at the population level in Greece Am. J. Clin. Nutr. 49: 1042–1047

    CAS  Article  Google Scholar 

  • Trichopoulou A, Lagiou P . 1997 Healthy traditional Mediterranean diet: an expression of culture, history and lifestyle Nutr. Rev. 55: 383–389

    CAS  Article  Google Scholar 

  • Trichopoulou A, Lagiou P . 1998 Methodology for the Exploitation of HBS Food Data and Results on Food Availability in Six European Countries DAFNE II Food Data Networking Luxembourg: Office for Official Publications of the European Communities

    Google Scholar 

  • Trichopoulou A, Tzonou A, Hsieh CC, Toupadaki N, Manousos O, Trichopoulos D . 1992 High protein, saturated fat and cholesterol diet, and low levels of serum lipids in colorectal cancer Int. J. Cancer 51: 386–389

    CAS  Article  Google Scholar 

  • Trichopoulou A, Toupadaki N, Tzonou A, Katsouyanni K, Manousos O, Kada E, Trichopoulos D . 1993 The macronutrient composition of the Greek diet: estimates derived from six case–control Studies Eur. J. Clin. Nutr. 47: 549–558

    CAS  PubMed  Google Scholar 

  • Trichopoulou A, Gnardellis C, Lagiou A, Benetou V, Trichopoulos D . 2000 Body mass index in relation to energy intake and expenditure among adults in Greece Epidemiology 11: 333–336

    CAS  Article  Google Scholar 

  • Tzonou A, Hsieh C-C, Polychronopoulou A, Kaprinis G, Toupadaki N, Trichopoulou A, Karakatsani A, Trichopoulos D . 1993 Diet and ovarian cancer: a case–control study in Greece Int. J. Cancer 55: 411–414

    CAS  Article  Google Scholar 

  • Van de Vijver LP, Kardinaal AF, Couet C, Aro A, Kafatos A, Steingrimsdottir L, Amorim Cruz JA, Moreiras O, Becker W, van Amelsvoort JM, Vidal-Jessel S, Salminen I, Moschandreas J, Sigfusson N, Martins I, Carbajal A, Ytterfors A, Poppel G . 2000 Association between trans fatty acid intake and cardio-vascular risk factors in Europe: the TRANSFAIR Study Eur. J. Clin. Nutr. 54: 126–135

    CAS  Article  Google Scholar 

  • WCRF, AICR. 2000 Food, Nutrition and the Prevention of Cancer: a Global Perspective Washington, DC: WCRF/AICR

  • WHO. 1998a Obesity: Preventing and Managing the Global Epidemic Geneva: WHO

  • WHO. 1998b Preparation and Use of Food-based Dietary Guidelines Geneva: WHO

  • WHO. 2000 Health for All Statistical Database Copenhagen: WHO

  • WHO Expert Consultation. 1985 Energy and Protein Requirements Geneva: WHO

  • Willett WC . 1994 Diet and health. What should we eat? Science 264: 532–537

    CAS  Article  Google Scholar 

  • Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyorala K . 1998 Prevention of coronary heart disease in clinical practice. Task force report Eur. Heart J. 19: 1434–1503

    Article  Google Scholar 

Download references


We would like to thank Ms Elisabetta Toti and Noemi Bevilacqua for their valuable assistance in tracking the literature and in preparing the tables.

Author information

Authors and Affiliations


Corresponding author

Correspondence to A Ferro-Luzzi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ferro-Luzzi, A., James, W. & Kafatos, A. The high-fat Greek diet: a recipe for all?. Eur J Clin Nutr 56, 796–809 (2002).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Mediterranean diet
  • Greece
  • dietary fat
  • nutritional goals

Further reading


Quick links