Evolution of Mediterranean Diet: Facts, Causes, Effects

Evolution of Mediterranean Diet: Facts, Causes, EffectsM. PadillaCMEAMAAM Montpellier, F-34093 Montpellier Cedex 3, FranceWe will first go back several centuries in order to understand the historical characteristicsof Mediterranean food availabiiities. We will then consider the diversity of Mediterraneanfood and finally present an overview of the recent evolutions.1- FactsI.1. Hktorical EvolutionWe can characterise five main historical periods which have influenced Mediterraneanfood :Years BCTrading traffics and great civilisations, which mixed a lot of people, have allowed thespreading of Mediterranean food products: Mesopotamian, Aegean, Phoenicians and later,Carthaginians have exported olive trees, vine, fig trees and almond trees, they have brought tothe West (Rome) pepper and spices from Asia (India). These diverse colonisations have alsointroduced wheat, barley, oats, ciaus fruits, sheep, goats and oxen in the Mediterraneancountries.RomansThey have deeply modified production bases by colonisation: every conquered tenitory hadto cultivate vine and olive trees. This way, Romans marked the limits of their power. Theyimposed wheat in Turkey, Egypt, Greece, Sicily, Andalusia and Languedoc; they spreadgarden peas, beans, lentils, chickpea and green vegetables, al1 of them issued from Easternareas of the Roman Empire.The last food conquests from tbe eastern worldArabians spread ciaus fruits dl around the Mediterranean area. Byzantines and especiallyOttomans had a significant influence on food practices in the 1 2 and ~ 13" century. Crusadesbrought rice and cane sugar. The discovery of China in 1298 has allowed the consumption ofpasta and vegetables from the gourd family (like cucumber and marrow).It is sometimes said that Mediterranean diet has been formed during two essential periods:Classical Antiquity and Arabian Empire. During the Classical Antiquity, the internationaltrade was developed. This allowed the Roman Empire to strongly modify dietary habits.Conversely, Arabians protected diversity and spread agronomic and technical knowledge.Cities were in symbiosis with their couniries. These practices contributed to the developmentof regional cooking.Discovery of the AmericasDuring the new wave, some products, which were introduced via Spain and Portugal,became staple food in the Mediterranean ara, such as corn, potatoes, tomatoes, sweetpeppers, gourd and chocolate and finally, the last colonisation ( 19~ and 2oLh century) hasbrought tender wheat, lentils, corn, tomatoes, salad, artichokes, asparagus, chestnuts andacorns into the Maghreb

NEAR EASTand MlMKE EASTw w 9Figure 1. Origm of Mediterranean productsin figure 1, we can see the principal borrowings by the Mediterranean from other regionsof the world. There is no food nowadays which can be considered typical regional in a strictsense.1.2. Regional characteristicsEven if the major changes in staple production has been achieved, we wonder how a singleMediterranean food model could be bom out of the diversity of people, cultures and foodacquisition disparities in this area. From the middle of the 19" century, the major economicchanges, characterised by a standardisation of food practices on a national and intemationalscale, with the development of intemational vast agricultural markets, and the increasingmobility of the populations, could have lead to a uniformity of food habits among nations.Mter analysis we found that different food models between the North and the SouthMediterranean counmes are still observed, and also between the different counmesencompassing the referent model, which made up the European Mediterranean countries(Figure 2).Contrast in food intake structure between northem and southern Mediterranean countrieswas and remains still strong (Figure 3). in the South, food intake is above al1 vegetal (lessthan 10 % of the total calorie intake is of animal origin because of lacking availabilities andhigh prices) and made up of carbohydrates (65-70 % of the total calorie intake). Cereals,together with pulses, are the basis of food. The gap conceming the part of animal products inthe food intake between the North and the South is increasing. We are attending a real fooddrift in the Mediterranean countries; the South remains very traditional in spite of adoption ofmodemity in their food practices in urban areas. The North looses its identity and the imageof health diet that it generated.

CerealsSugarFruits' vegetablesFatsIiIVieat, eygçFishFigure 2. Cornparison of north and south-mediterranean diets relatively to occidental diet in1995 (Source : FAOIAGROSTAT)Figure 3. Food availabilities (Kgkaplyear) 1996 (Source : FAOIAGROSTAT)

In the Northem Mediterranean area, some regional differences still appear. Spain andPortugal are characterised by a greater consumption of potatoes, fish and seafood; Italy differsby cereals and dairies. In Greece more cereals, vegetables, fruits and intemationally wellknown« feta » is consumed than in other countries. It is not surprising that France is above al!the most « westernised~ Mediterranean country, with a great relative consumption of mearand rnilk. Pulses, sugar, oils and fats are uniformly distributed, Portugal and France aredistinguishable from other countries by a high consumption of alcoholic beverages, mainlywine. Analysis at local level should be done for more precise regional differentiation ofproducts and cooking. Cooking is an illustration of history of populations and does not respectgeographical frontiers: Greeks are highly influenced by oriental and Ottoman's cooking,Spain, and also Sicily, by Moorish, and Provence (Southem France) by Italian cooking.I.3 Recenr evoluîionsThis healthy mode1 took serveral cnturies to develope and still had just an phemeral life; itis currently undergoing a profound change. Globally we are moving towards over-eating andboth food and nutritional balances are broken. An increase of quatities cosumed is observed,up to a level which must be judged as immoderate.The average energy intake in the nineties amounted to 3450 kcaiicapitdday, whereas in thesixties it was 2900 kcalCerealsSugar 150200 IFruits, vegetablesFatsPulses~eat; eggsFigure 4. Evolution of Mediterranean diet versus western diet 1 1960 - 1995(Source : FAO/AGROSTAT)We can observe an immoderate consumption of animal products with 30% of the totalcalorie intake in 1995, whereas it amounted to 23% in the sixties.The proportion of added fats inîake has also strongly increased: from 25% in 1%3, tonearly 40 %, 30 years later.

Nature of consumed iipids has changed, especially in Portugal, Spain and Italy, where theincrease of animal fats is high. In France and Greece, however, the increase of vegetable fat ishighe:. glucidr.C..-.>M- Greece ' 1protida 1Figure 5. Evolu tion of the nutritional structure of diet (1 963 and 1996)(Source FAOJAGROSTAT)II - CausesSocio-economists explain this development by a change of the consumer's social andeconomic environment. 1 have selected three of the main reasons.ILI Constitution of Europe and broadened marketsReasons of this development can be explained by a phenomenon of imitation ofeconomically important countries such as Northem Europe and The United States.Transformation of way of iife and their corollaries - disruption of food patterns andindustrialisation of consumption - appeared with the constitution of the European Community.The first signs were observed in 1975, with the beginning of a probation of the Mediterraneancountries candidates to adhesion to E.E.C Spain, Greece, Portugal. European harmonisationand necessity of applicant countries to integrate into the European organisation system had animportant repercussion in the society: multiple contacts between countries, more and moremigrations and exchanges of population, competitiveness, implantation of Northern agro-foodindustries and distribution lines, al1 factors favounng the implementation of a Northernconsumption model. Besides, there was a change from

~p11.2 Food representationsTable 1. Food representation steps in occidental countries, . *+TV-After 1992Decrease ofcondemnedproductsChasing calories.Sugar, fatThinnessfrom foodNew practicesFrozen food,Ready-madeproductsdisruption . ofmeals structuresocial issuewithout)Traditional disheslifeChoice aniongproductsExplorationRehabiliiationIndividualbiologicalrhythmLessMinimalismErsatzQuality, TasteTO EAT LESSTO EATQUICKLYTO EATW ITHOUTï0 EAT WELLSource: A Defrance (2)We can characterise five main periods after the second world war (Table 1) According tothe symbol attached to an « ideal >> society (safety, thinness, social issue, balance...), thestrong recommendation in the food field (eat more, eat less, eat quickly, eat without, eatwell) will have repercussions on expectations of consumers and food products from industrialinnovation.11.3 Socio-economic mutations of society contributed to the evolution of the representationsChanges of lifestyles are detectable at six levels:De-cohabitation of the members of households: The size of the households is rapidlydecreasing and single-households are not anymore rare (10 to 30% of households). Decohabitationfavours consumption of ready-to-eat food and served food.Professional life is attracting more and more women: 30 to 40% of women are nowworking out of home (Figure 6). Time constraints become as strong as income constraintsto explain consumption choices.

4035 - - SpainIFranceAmGreecea' Italy105 6 PortugalO. I II 11960's 1970's 1980's 1990'sFigure 6. Evolution of employed women in the total of women - 196011990Organisation of work: Generalisation of working al1 day induces improvement ofcatering industry and fast food. This situation favours an Anglo-saxon dietary modelrather than a Mediterranean model.Evolution of consumption sequences: Conception of three daily meals disappears andthe number of food intake in a day increases. From another source, moreover, the changefrom kitchen to « laboratory » has changed conviviality of the evening meal. In Spain,e.g.. dinner is often fast food, eaten in the living room while watching television.Historical and cultural components. For example, the Spanish were still living understarvation and had an isolated regime fifty years ago. As a reaction, there was an excessivedesire for affluence to privilege quantity as opposed to quality and rejecting foodsreminding of the poor period, such as bread, potatoes, cd, offal and legumes.More and more, collective environment substitutes family groups. Tastes of youngpeople are developed essentially out of the family by means of symbolisation of powers.Food, just like language, is an element to protest, to agree, to take revenge, to get power ata group level(3).III- EffectsIII.1 International spreading of Mediterranean dietThe European Union that perverted the Mediterranean model might now rehabilitate it. Itmight do large-scale promotion for it, due to the phenomenon of spreading-imitation. In fact.on the spur of medical profession, Anglo-saxon countries are developing informationcampaigns, giving the Mediterranean model as exemplary. Americans, English andAustralians have put the « Mediterranean Diet Pyramid » in their officia1 foodrecommendations. This model aims to increase consumption of specific foodstuffs and toencourage ethnic and food diversity. Recommendations are based on a diet of the sixtiesprevailing in Crete and South Italy. The Mediterranean pyramid does not constitute the solerecommendation at the world level. Indeed, Latino-American, Asian, Vegetarian and the onearising from USDA (4) are also sources of recommendation, but only the Mediterranean isapproved by the World Health Organisation.

Paradoxically, it is in the North that the Mediterranean model makes up for lost ground. Itlooks like Mediterranean food is on its way to become a real phenomenon of society. Anumber of big agro-food companies use the Mediterranean image in their marketingpromotion, even the leader of food uniformity, McDonalds.111.2 Re-appropriation of the Mediterranean diei under modern fomtsWe carried out a pilot European study CO-ordinated by M. Gerber and myself in France,Italy, Spain, England and Belgium in 1998. The aim of this study was to analysecharacteristics of the Mediterranean food and its impact on Northem populations. This studyhas verified that Mediterranean diet is persisting. It has even been re-appropnated byconsumers with adaptations to their new iifestyle and expectations.in the Mediterranean ara, contrary to the current Western habits, women usually prepare awarm meal every day. in addition, the young generation adapt mother's recipes bysimpiifying the mals and by integrating less fat, less meat and less sugar. They diversify theirfood repertory by integrating news dishes (couscous, tajine), often from the Mediterraneanarea. Implications in food are strong. Knowledge is often transrnitted between generations andin particular between mothers and daughters. In France, 41 % of food specialities have beentransmitted this way, and only 20 % by cooking books.ConclusionThe use of Mediterranean image in marketing suggests that we can find the stake thatmobilises consumers, and use it to extend the model. The more this stake requests « stronglyincentive approaches », the more its use in marketing has chances to be performed.This stake is distributed along four identity-related axes, which give their power to thepromises possibly carried by Mediterranean diet.Combination of pleasure and health: renewal with nourishing food, taking distance to"hygienist" American food culture, valorising sensorial aspects, making a dichotomybetween the good and the bad.Emphasising European culture, with its diversified tastes and colours as a base forMediterranean identity: After integration and mixture of different culinarycontributions, the Mediterranean cuiinary identity is now becorning a reference that isexported everywhere.Mobilising a desire of rebirth and « re-assurance » by a return to the sources: Thistrend is explainable by the rupture between production iine and consumption chain. Thisrupture creates an anxiety on the consumer who can no more clearly identify his food. Itinvolves request for regional and authentic food products, traditional recipes and naturalfood products.The consumer is more concerned about health, food security and nutritional balance:Consumers are also more attentive to environment problems, conditions of production,food products development and companies which are « politically correct ». A newmedical reading has contributed to a revival of Mediterranean food, and allowsrecognition through the eiite of ancestral and popular knowledge about the Mediterraneandiet.

References(1) Cresta M. and Teti V. The road of foods habits in the Mediterranean area betweenbiology and culture.(2) Defrance A. (1994). "To eat or not to eat, 25 ans de discours alimentaire dans la presse".Les Cahiers de I'OCHA, n04, CIDIL, Paris.(3) Fidanza A. (1990). Mediterranean Meal Patterns. in: Nuiritional adptation to new lijésoles,(Somogyi JC, Koskinen EH. eds)., N045, pp 59-71. Bibl Nutr Dieta. Basel,Karger.(4) Barone J. (1998). Up and down the food pyramids.(5) http://onhealthnetworkcompany.com.Further readingBarrau J (1983). Les hommes et leurs aliments, Temps Actuels, , 378p.Grivetti L (1997). Morning meals. North American and Mediterranean Breakfastpatterns. Part 3. Mediterranean patterns and surnrnary. Nuirition today 32, N04,Julylaugust.Haber B. (1997). The mediteranean diet: a view from history. Am J Clin Nutr. 66(suppl), 1053s-7s.Harlan Jr, (1987). Les plantes cultivées et l'homme, ACCT, ,410~.Malassis L,. Padilla M. (1986). Traite d'économie agro-alimentaire - Tome IiI :« 1'Cconomie mondiale ». Editions Cujas, 449 p.Malassis L, (1994). Noumr les hommes, Ed. Flammarion, Collection Dominos, 126p.Padilla M. (1996). Trait6 d'économie agro-alimentaire, Tome IV : "Les politiquesalimentaires". Editions Cujas, 255 p.Padilia M. and Le Bihan G., (1997). « La dynamique internationale de la consommationalimentaire ». in : Economies et sociétés, SCrie AG n023, , p.11-25.Padilia M., Allaya M., Malassis L, (1997). «Que mangeons-nous?», AgropolisMuseum /Ciheam-Iam, Montpellier.Padilla M., Gerber M. (Coord) (1998). «Consommer mCditerranCen, une attitudeprCventive au cancer B. Rapport$nalprojet européen, Commission EuropCenne, DG V.Trichopoulou A, Lagiou P (1997) Healthy traditional mediterranean diet: an expressionof culture, history and filfe-style. Nutrition Reviews 55,383-389.Volatier JL (1999). Le repas traditionnel se porte encore bien, CREDOC consommationet modes de vie. N0132.