The Mediterranean pyramid: 30 years later, still relevant

Abstract Purpose The Mediterranean diet, which has its roots in the traditional eating habits of olive-growing regions, is widely recognized for its health benefits. Methods Originally described by Ancel Keys and formalized in the 1990s by the Mediterranean Diet Pyramid, this plant-based diet has consistently shown protective effects against cardiovascular disease, type 2 diabetes, various cancers, and cognitive decline. In recent decades, a growing body of evidence — including large randomized controlled trials such as PREDIMED and CORDIOPREV — has further demonstrated the effects on chronic disease prevention and longevity. Results In addition to these classic findings, there is growing evidence that the Mediterranean diet is also beneficial in areas such as liver health, particularly steatotic liver disease associated with metabolic disorders, chronic kidney disease, and mental health. Mechanistic studies highlight the role of (poly)phenols, other micronutrients, and fiber in regulating inflammation, oxidative stress, metabolic pathways, and the microbiota. The cultural appeal and palatability of the Mediterranean diet also encourage long-term adherence to the diet. Conclusions Overall, this review examines whether the health effects of the Mediterranean diet go beyond the established areas and may represent a holistic strategy for the prevention of a wider range of chronic diseases.