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Abbreviations: DQI-I, Diet Quality Index-International; MDP, Mediterranean dietary pattern
The traditional diet in southern Spain corresponds to the typical Mediterranean dietary pattern (MDP)1,2 . The MDP is characterized by: a high intake of vegetables, legumes, fruits and nuts, cereals (largely unrefined in the past); a high intake of olive oil but a low intake of saturated lipids; a moderately high intake of fish (depending on the proximity to the sea); a low-to-moderate intake of dairy products (mostly cheese or yoghurt); a low intake of meat and poultry; and a regular but moderate intake of wine, generally during meals3-7 . The MDP has been associated with better health and a longer life3-5,8-11 and has been promoted as a model for healthy eating5,8,9,12,13 . However, there is wide epidemiological evidence of a rapid change in dietary patterns in Mediterranean countries, with a higher consumption of animal products and SFA to the detriment of vegetable foodstuffs4,14-16 . This trend can be attributed to substantial socio-economic changes throughout Europe over the past 40 years. Departure from the MDP might be accompanied by loss of its protective effects on health, leading to a rise in diet-related diseases such as CVD and cancer7,11,17,18 .
A nutritional study in the Balearic Islands19-22 examined secular changes in dietary patterns in relation to the traditional Mediterranean diet and evaluated compliance of the current diet with nutritional recommendations. In comparison with the prevalent dietary pattern at the beginning of the twentieth century, there was a higher fat and saturated fat content and a lower consumption of fruit and vegetables, reflecting loss of the MDP in the Balearic Islands19 . By 2004, the mean percentage of adherence to the MDP in this population was 43·14 %, which was similar in all socio-demographic and lifestyle groups but with some differences in relation to age, sex and physical status. Thus, young people and the sedentary showed a lower adherence to the MDP20 . Similar results were reported by other studies of dietary changes in Mediterranean countries and among...