Mediterranean diet boosts health, but only if you’re rich or educated

Mediterranean diet
© Kiian Oksana

Only the most advantaged people actually benefit from the Mediterranean diet, says new Italian study.

The logic is simple enough: Eat a diet rich in plant-based foods, healthy fats and fish; limit consumption of red meat, sugar and junk food – and the risk of cardiovascular disease is reduced. Abundant research has been confirming the benefits of eating in this style, known as the Mediterranean diet, for years. But according to a new study published in the International Journal of Epidemiology, the Mediterranean diet is a bit more selective than logic would suggest.

Researchers from the Institute for Research, Hospitalization and Health Care Neuromed in Italy performed a study on over 18,000 subjects and found that the Mediterranean diet does indeed reduce the risk of cardiovascular disease … but only if you are rich or highly educated.

The study, led by Giovanni de Gaetano, concluded that the benefits go hand in hand with the socioeconomic position of the diet’s followers. Basically, given the same adherence to the eating pattern, the study found that the reduction in cardiovascular risk was only seen in people with higher educational level and/or greater household income.

The most surprising part: “No actual benefits were observed for the less advantaged groups.”

What the ... ???

"The cardiovascular benefits associated with the Mediterranean diet in a general population are well known,” says Marialaura Bonaccio, first author of the study. “Yet for the first time our study has revealed that the socioeconomic position is able to modulate the health advantages linked to Mediterranean diet. In other words, a person from low socioeconomic status who struggles to follow a Mediterranean model, is unlikely to get the same advantages of a person with higher income, despite the fact that they both similarly adhere to the same healthy diet.”

It seems impossible, doesn’t it? Not to mention unfair. The researchers tried to figure out why there could be a discrepancy among groups with the same eating pattern. They came up with a few factors, including quality and diversity of food, attention to whole grains, and varying cooking methods.

"Given a comparable adherence to the Mediterranean diet, the most advantaged groups were more likely to report a larger number of indices of high quality diet as opposed to people with low socioeconomic status,” says Licia Iacoviello. “For example, within those reporting an optimal adherence to the Mediterranean diet … people with high income or higher educational level consumed products richer in antioxidants and polyphenols, and had a greater diversity in fruit and vegetables choice.”

“We have also found a socioeconomic gradient in the consumption of whole-grain products and in the preferred cooking methods," Iacoviello adds. "These substantial differences in consuming products belonging to Mediterranean diet lead us to think that quality of foods may be as important for health as quantity and frequency of intake."

I find it hard to believe that eating a Mediterranean diet, regardless of socioeconomic factors, wouldn’t have a positive effect on health. At the very least, it seems like it would have to counter the negative effects of a salt-sugar-fat-filled Western diet. And for many reasons, people should not be discouraged from eating more plant-based foods. But if Mediterranean foods with lower nutritional values are preventing some parts of the population from optimal health, it’s an issue that really needs to be addressed.

"Our results should promote a serious consideration of socioeconomic scenario of health,” says de Gaetano. “We cannot keep on saying that the Mediterranean diet is good for health, if we are not able to guarantee an equal access to it."

Mediterranean diet boosts health, but only if you’re rich or educated
Only the most advantaged people actually benefit from the Mediterranean diet, says new Italian study.

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