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Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes (MGSD)

European Journal of Clinical Nutrition volume 56, pages 983–991 (2002)Cite this article

Abstract

Objective: To compare the nutritional habits among six Mediterranean countries and also with the various official recommendations and the ‘Mediterranean diet’ as originally described.

Design: Cross-sectional study.

Settings: Three centres in Greece, two in Italy and one in Algeria, Bulgaria, Egypt and Yugoslavia.

Subjects: Randomly selected non-diabetic subjects from the general population, of age 35–60, not on diet for at least 3 months before the study.

Interventions: A dietary questionnaire validated against the 3-Day Diet Diary was used. Demographic data were collected and anthropometrical measurements done.

Results: All results were age adjusted. Energy intake varied in men, from 1825 kcal/day in Italy–Rome to 3322 kcal/day in Bulgaria and in women, from 1561 kcal/day in Italy–Rome to 2550 kcal/day in Algeria. Protein contribution (%) to the energy intake varied little, ranging from 13.4% in Greece to 18.5% in Italy–Rome, while fat ranged from 25.3% in Egypt to 40.2% in Bulgaria and carbohydrates from 41.5% in Bulgaria to 58.6% in Egypt. Fibre intake, g/1000 kcal, ranged from 6.8 in Bulgaria to 13.3 in Egypt and the ratio of plant to animal fat from 1.2 in Bulgaria to 2.8 in Greece. The proportion of subjects following the WHO and the Diabetes and Nutrition Study Group (DNSG) of the EASD recommendations for carbohydrates, fat and protein ranged from 4.2% in Bulgaria to 75.7% in Egypt. Comparison with the Mediterranean diet, as defined in the seven Country Study, showed significant differences especially for fruit, 123–377 vs 464 g/day of the Mediterranean diet, meat, 72–193 vs 35 g/day, cheese, 15–79 vs 13 g/day, bread, 126–367 vs 380 g/day.

Conclusions: (a) Dietary habits of the ‘normal’ population vary greatly among the Mediterranean countries studied. (b) Egypt is closest to the DNSG recommendations. (c) Significant differences from the originally described Mediterranean diet are documented in most Mediterranean countries, showing a Westernization of the dietary habits.

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Acknowledgements

We thank all the subjects who took part in this study. The study is part of the Multicenter Nutritional Study of the Mediterranean Group for the Study of Diabetes (MGSD) and it was financially supported by (a) the MGSD, (b) Novo Nordisk A/S and (c) Farmaserve Hellas. We would like also to thank Ms Elli Antoniadou and Ms Martha Panagiotopoulou for secretarial support, Ms Petroula Maraki for laboratory assistance and Ms Christina Leoussi for statistical help.

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Author notes

  1. B Karamanos: Guarantor: B Karamanos.

  2. B Karamanos, A Thanopoulou, F Angelico, S Assaad-Khalil, A Barbato, M Del Ben, V Dimitrijevic-Sreckovic, P Djordjevic, C Gallotti, N Katsilambros, I Migdalis, M Mrabet, M Petkova, D Roussi and MT Tenconi: Contributors: BK was principal investigator, secured the funding, collaborated in the protocol design, supervised the statistical analysis and wrote the manuscript. AT did the statistical analysis and wrote the manuscript. DR was responsible for analyzing the data from the dietary questionnaire, collaborated in the protocol design, contributed to data collection. FA, SAK, PD, CG, NK, IM, MM, MP, MTT collaborated in the protocol design and were involved in data collecting and in editing the manuscript. AB, MDB, VDS were involved in data collecting and in editing the manuscript.

Authors and Affiliations

  1. 2nd Medical Department, Diabetes Center, Athens University Medical School, Hippokration Hospital, Athens, Greece

    B Karamanos, A Thanopoulou & D Roussi

  2. Dipartimento di Terapia Medica, University ‘La Sapienza’, Rome, Italy

    F Angelico, A Barbato & M Del Ben

  3. Department of Internal Medicine, Alexandria Faculty of Medicine, Alexandria, Egypt

    S Assaad-Khalil

  4. Diabetes Center, Institute for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Yugoslavia

    V Dimitrijevic-Sreckovic & P Djordjevic

  5. 1st Department of Propedeutic Medicine, Diabetes Center, Athens University School of Medicine, Laiko General Hospital, Athens, Greece

    N Katsilambros

  6. Diabetes Center, ‘NIMTS’ Hospital, Athens, Greece

    I Migdalis

  7. Service de Medicine Interne ‘A’ C.H.U, Oran, Algeria

    M Mrabet

  8. Diabetes Center ‘St Luca’, Sofia, Bulgaria

    M Petkova

  9. Dipartimento di Medicina Preventiva, Occupazionale e di Communita. Sezione di Igiene, Universita degli studi di, Pavia, Italy

    C Gallotti & MT Tenconi

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  1. B Karamanos
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Correspondence to B Karamanos.

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Karamanos, B., Thanopoulou, A., Angelico, F. et al. Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes (MGSD). Eur J Clin Nutr 56, 983–991 (2002). https://doi.org/10.1038/sj.ejcn.1601413

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