Developing Critical Appraisal Criteria for Mediterranean Diet Studies

The Mediterranean Diet has been intensively researched and there are various health associations that have been identified, published and disseminated. Nevertheless both the diet itself and the measurement of adherence are complicated by many factors. After looking at a number of papers on this theme, I have collected a number of the considerations written about previously.

1. The original Mediterranean Diet was described in publications from the Seven Countries study and epitomised by the dietary habits of a cohort from Crete. It would be useful to understand whether any subsequent studies reference these earlier habits or else variations of the original dietary habits.
2. The Mediterranean Diet has been used outside of the research setting to describe the diet of countries bordering the Mediterranean. Individual countries feature unique foods in their variations of the Mediterranean Diet. Thus it can be argued that there is no single Mediterranean Diet. However amongst these countries, shared dietary patterns have been described.
3. Mediterranean Diet pyramids have been published and refined. The New Italian Mediterranean Diet Pyramid is one example. Thus the practice or recommended practice of the diet may be expected to change with time. The interaction between specific research findings and changing dietary patterns or ideal dietary patterns would need clarification.
4. The cohorts in the original seven countries study were chosen for their characteristics (e.g. rail workers or farmers). These characteristics may limit generalisations about the research findings.
5. The Mediterranean Diet was associated with other lifestyle factors which may impact on health and these have been included in recommendations about the practice of the Diet. These lifestyle factors may be confounders for research findings.

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