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This pyramid, representing a healthy, traditional Mediterranean diet, is based on the dietary traditions of Crete, much of the rest of Greece and southern Italy circa 1960, structured in light of current nutrition research. The selection of these regions and this time period as a basis for the design follows from three considerations:

Variations of this diet have traditionally existed in other parts of Italy, parts of Spain and Portugal, southern France, parts of North Africa (especially Morocco and Tunisia), parts of Turkey, other parts of the Balkan region, as well as parts of the Middle East (especially Lebanon and Syria). The diet is closely tied to traditionally areas of olive oil cultivation in the Mediterranean region.

Given these carefully-defined parameters of geography and time, the phrase traditional Mediterranean diet is used here as shorthand for the healthy traditional diets of these regions at that time.

The design of the pyramid is not based solely on either the weight or the percentage of energy (calories) that foods account for in the diet, but on a blend of these that is meant to give relative proportions and a general sense of frequency of servings-as well as an indication of which foods to favor in a healthy Mediterranean-style diet. The pyramid describes a diet for most healthy adults. Whether changes would need to be made for children, women in the reproductive years, and other special population groups is an issue that needs further consideration.

A principal objective of this graphic illustration is to foster a dialogue within the international scientific, public health, food and agricultural, governmental and other communities as to what specific elements and configuration of the traditional diets of the Mediterranean should be regarded as healthful.

For Americans, northern and eastern Europeans and others who want to improve their diets, this model provides a highly palatable, healthful framework for change. Equally positive results can be obtained either by entirely adopting a Mediterranean-style diet, or by alternating meals based on this Mediterranean model with meals inspired by healthful dietary traditions of other cultures in other parts of the world. For those living in the Mediterranean region, his pyramid provides a basis for preserving and revitalizing within a modern lifestyle centuries-old traditions that contribute to excellent health and a sense of pleasure and well-being and are a vital part of our collective cultural heritage.

This pyramid was the first in a series in development to illustrate geographically the healthy traditional food and dietary patterns of carious cultures and regions of the world. This initiative is an outgrowth of a multiyear conference series, "Public Health Implications of Traditional Diets," jointly organized by Harvard School of Public Health, a United Nations World Health Organization/Food and Agriculture Organization (WHO/FAO) Collaborating Center, and Oldways Preservation & Exchange Trust. These pyramids, taken as a collection, offer substantive refinements of the United States Department of Agriculture's Food Guide Pyramid, refinements that reflect the current state of clinical and epidemiological research worldwide and our understanding of what constitutes optimal human nutrition status.

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