Modified Mediterranean diet
The SMILES trial used the ModiMed diet, based on the traditional Mediterranean diet.
The traditional Mediterranean diet is one of the most researched dietary styles, consistently demonstrating numerous health benefits, including an association with a reduced risk of depression.
Developing the ModiMed diet
The ModiMed diet also used recommendations from the Dietary Guidelines for Adults in Greece and the Australian Guide to Healthy Eating to make the diet relevant and easy to maintain for Australian participants.
As the study took place in Australia, traditional Australian food products, such as Australian versions of wholegrain cereals or kangaroo meat, were included in the recommendations.
Modifying the traditional mediterranean diet
Additionally, the ModiMed diet included a slightly greater intake of red meat than traditional Mediterranean diets. This amendment was due to the previous research indicating that:
- a large proportion of Australian women do not habitually consume the recommended amount of iron (and red meat is considered a great source of dietary iron); and
- low or high consumption of red meat might be associated with negative mental health outcomes. However, overall, the macro- and micronutrient content of the ModiMed diet closely matched the traditional Mediterranean-style diets.
The ModiMed diet pyramid
The ModiMed diet was based on 12 food groups. The diagram below demonstrates the proportion in which each of the food group was recommended for consumption. We will have a close look at the number of serves and serve sizes for each group in the next step.
The ModiMed diet features a wide variety of foods. Adapted from Opie, et al. (2017).
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The ModiMed diet was constructed to provide approximately 11,000kJ (around 2,600kCal) of energy per day. Similar to the traditional Mediterranean diet, the ModiMed delivered moderate amount of protein (approximately 18% of energy) and carbohydrate (approximately 36% of energy).
The diet was relatively high in fat (approximately 40% of energy); however, the majority of this (>50%) was monounsaturated fats from olive oil. The energy from alcohol (if consumed) was estimated at 2% and from red wine.
The diet was high in dietary fibre (around 50g of fibre per day) and other micronutrients due to its high intake of vegetables and fruit (over 700g and 400g per day, respectively).
The diet was also calculated to meet almost all of the recommended and adequate intakes of vitamins and nutrients recommended for adults and to provide enough food for satiety, with the only recommended restrictions around ‘extras’ – highly processed, salty or sugary foods.
Consider the main advantages of a modified approach to traditional diets.
How does modification of a dietary style or recommendations fit within the concept of personalised nutrition that we discussed in Week 2? Share your thoughts in the comments.
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