A study by a group of Italian researchers published in the International Journal of Epidemiology has concluded that those who are well off or highly educated are more likely to reap the health benefits of the Mediterranean diet.

We cannot keep saying that the Mediterranean diet is good for health if we are not able to guarantee an equal access to it.- Giovanni de Gaetano

As part of the study, the researchers from IRCCS Istituto Neurologico Mediterraneo Neuromed, an Italian research institute, tracked a group of 18,991 men and women over the age of 35 for a period of four years and four months.

The Mediterranean Diet Score (MDS) was used to assess the participants’ compliance to the diet while data on their annual household income and educational levels were collected as indicators of their socio-economic status. Each of the study participants was also monitored for total physical activity, tobacco use, body mass index, health history, and incidence of cardiovascular disease, diabetes and cancer.

The researchers assessed the participants’ food intake, taking note of the foods they consumed as well as factors determining food quality: for example, whether foods were organic or not, and if bread consumed was whole-grain or refined. At the same time, they examined the cooking methods used and specifically whether foods were prepared by boiling, stewing, frying, roasting or grilling.

The results revealed that for every two-point increase in MDS, there was a 15 percent reduced risk of cardiovascular disease. However, this result was only evident in those with a higher income or level of education compared to participants of lower socioeconomic status.

According to the research analysis, this difference was attributed to “different intakes of antioxidants and polyphenols, fatty acids, micronutrients, dietary antioxidant capacity, dietary diversity, organic vegetables and whole grain bread consumption.”

Marialaura Bonaccio, the lead author of the study told CNN that the higher-income group consumed more fish and a higher quality diet that included organic and whole grain foods. She also pointed out that the quality of products like olive oil may make a difference.

“Let’s give that two persons follow the same diet, that is equal amounts of vegetables, fruits, fish, olive oil etc. every day so that they report the same adherence score to the Mediterranean diet,” she told CNN. “It might be that, beyond quantity, differences in quality may exist. For example, in olive oil… our hypothesis is that differences in the price may yield differences in healthy components and future health outcomes.”

Speaking to Science Daily, Giovanni de Gaetano, another member of the research team, highlighted the impact of socioeconomic status on healthy food choices that the study has brought to light:

“Our results should promote a serious consideration of socioeconomic scenario of health. Socioeconomic disparities in health are growing also in access to healthy diets. During the very last years, we documented a rapid shifting from the Mediterranean diet in the whole population, but it might also be that the weakest citizens tend to buy ‘Mediterranean’ food with lower nutritional value. We cannot be [keep saying] that the Mediterranean diet is good for health if we are not able to guarantee an equal access to it.”

The Mediterranean diet is characterized by a high consumption of fruits, vegetables, legumes, cereals and nuts, a moderate intake of fish, and small quantities of meat, poultry and dairy products. Also, monounsaturated fats like olive oil are favored instead of saturated ones like butter and lard, and alcohol consumption is limited.

This was the first study to link the health benefits of the Mediterranean diet to socio-economic status.

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