Simona Costanzo

Simona Costanzo earned her PhD in Epidemiology from the Faculty of Health, Medicine, and Life Sciences at Maastricht University, The Netherlands.

Currently, she serves as Associate Professor of Public Health at Insubria University in Varese, Italy, and a Senior Epidemiologist at the Research Unit of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.

Professor Costanzo’s research focuses on cardiovascular disease, cancer, and global health risks associated with environmental and lifestyle factors, particularly dietary habits. She has made internationally recognized contributions to the debated topic of alcohol/wine consumption and health.

She also leads data management for the Moli-sani Study, a 20-year prospective, population-based cohort study involving over 24,000 adults in Southern Italy. The study aims to assess the role of lifestyle factors—particularly dietary habits—and genetic contributions to chronic degenerative and metabolic diseases.

Mediterranean Diet – epidemiological evidence for being one of the best preventive diet

Simona Costanzo^1,2 and Marialaura Bonaccio¹

¹Research Unit of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy

² Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy

The Mediterranean Diet has long been considered as one of the most effective dietary patterns for preventing chronic diseases and promoting longevity. The Mediterranean Diet has been consistently linked to a reduced risk of cardiovascular disease, type 2 diabetes, certain cancers, and neurodegenerative disorders. Its health benefits are mainly attributed to its rich content of antioxidants, monounsaturated fats, and anti-inflammatory compounds.

This dietary pattern is characterized by a high intake of fruits, vegetables, whole grains, nuts, and olive oil, along with moderate consumption of fish and dairy and limited intake of red meat and processed foods. Additionally, only for adults, a traditional Mediterranean Diet includes moderate alcohol consumption, always during meals, preferably wine, spread out over the week. In light of this, the health effects of moderate alcohol/wine drinking should be analysed in the context of a Mediterranean way of living rather than as an individual risk/protective factor, as it is commonly done in most epidemiological studies. A way to investigate the relative importance of the individual components of the Mediterranean Diet has been proposed, that is by integrating associations with health outcomes of many individual components in a single unidimensional score that is obtained by alternate removal of each food item from the score. Results from the Greek segment of the EPIC cohort showed that moderate alcohol consumption (mostly in the form of wine and during meals) was a dominant component of the Mediterranean diet score as a predictor of lower mortality. Subsequent analyses conducted in the Moli-sani Study cohort in Italy substantiated these findings. Specifically, in a sample of participants with type 2 diabetes at study entry, the overall effect of the Mediterranean diet score was mainly contributed by moderate alcohol drinking, as we observed a reduction by 14.7% (HR=0.686; 95%CI 0.541–0.871) in the total effect of the MD (HR=0.632; 95%CI 0.494–0.803) after removing this component from the total score. Similar results were confirmed in the elderly from the same Moli-sani cohort.

Beyond its nutrient-rich composition, emerging research highlights the importance of considering not only the main food components, but also how foods are processed. Recent evidence, indeed, suggests that the diet-health relationship extends beyond nutrient composition. Overreliance on traditional nutrient-based metrics—such as those that prioritize calorie, sugar, or fat reduction—may obscure the impact of food processing on health.

The Nova classification highlights the risks associated with ultra-processed foods, which are heavily industrialized products containing additives, degraded food matrices, and potentially harmful compounds. Independently of their nutrient profiles, ultra-processed foods are associated with increased risks of cardiovascular disease, type 2 diabetes, and premature mortality.

The Mediterranean Diet, with its natural alignment to minimally processed foods, provides a dual advantage, in both nutrient quality and protection against the adverse effects of food processing.