As fruits and vegetables have partially different nutritional attributes, I think it appropriate, from a health point of view, to segregate the recommendations concerning the two food groups. Targeted interventions that focus specifically on vegetables may have to take priority, because it is with respect to vegetables that the benefit is more substantial. The "more than 400g a day", the "5 servings" and the "eating more fruit and vegetables" recommendations are open to different interpretations. Agreement is further required with respect to foods such as pulses, potatoes and nuts, the classification of which is ambiguous.
Pulses are rarely consumed and rarely independently considered in FBDG of most countries. In Greece, however, olive oil allows the preparations of delightful dishes with pulses that share some of the health attributes of vegetables and also provides protein, albeit of moderate quality. Consumption of an average of one serving every other day is advised, and higher consumption should not be discouraged.
Are potatoes cereals?
Potatoes in the Greek guidelines are not included to the cereal food group and their consumption is recommended not daily but only a few times per week. Potatoes provide as much percentage energy from protein as do wheat and rice, and are a good source of vitamin C. Like white bread, however, potatoes have a high glycaemic index because they are rapidly converted to glucose after being consumed. Potato consumption has been found to be positively associated with the risk of type 2 diabetes in men and women.
Two additional questions should be addressed at this time: Is the Mediterranean diet an integral entity, or the sum of identifiable components that can and should be separately considered in the development of guidelines? Is the Mediterranean diet or its major components transferable to populations living far from the Mediterranean region? Answers to these questions would be important for policy formulation, if and when such a policy were desirable.
An attempt to conceptualise and operationalise the proper diet has been reported and a score has been developed and evaluated. Studies among elderly in Greece, Denmark, Austalia and Spain has shown that the overall Mediterranean dietary pattern was more important for longevity than individual nutrition components.
There has been much interest regarding the components that contribute to the beneficial health effects of the Mediterranean diet. So far they have been attributed, mostly to its unique lipid profile, but the contribution of additional components such as the consumption of vegetables, should also be taken into consideration. In practical terms, more attention to the dietary practices of the Mediterranean people might contribute to the increase of pulse and vegetable consumption in North America as well as in northern and central Europe.
University of Athens Medical School, Greece