Public Health Nutrition Editorial Highlight: ‘Changing the Irish dietary guidelines to incorporate the principles of the Mediterranean Diet – Proposing the MedÉire Diet’. Authors: Audrey Tierney and Ioannis Zabetakis discuss their research below.

Dietary guidelines in the Republic of Ireland encourage a healthy dietary pattern in order to achieve optimal nutrition and maintain a healthy weight to prevent nutrition-related chronic diseases. The guidelines are depicted using a food pyramid and whilst it has been found that the overall messages are well understood, the findings of a recent Healthy Ireland survey demonstrate that they do not translate into daily food choices or dietary pattern population changes.

The best international evidence should be at the core and foundation of the development and redevelopment of any dietary guidelines. We suggest that the Irish dietary guidelines needs revisiting in light of the more recent evidence base for the Mediterranean Diet (Med Diet), the most globally researched and healthiest dietary pattern promoted for the management of chronic diseases and longevity.

The traditional Med Diet is predominantly a plant based diet, characterised by a high consumption of vegetables, fruits and nuts, legumes and unprocessed cereals with a low consumption of red meat, meat products and sweets, moderate consumption of fermented dairy, poultry and fish, with red wine consumed in moderation with meals. As a percentage of energy, total fat content can be as high as 40% with over half being monounsaturated fat (>20%). This is predominantly due to the liberal use of extra virgin olive oil (EVOO), the main source of added fat, which occupies a central position in the diet.

In the current Irish Food Pyramid increased consumption of fruits, vegetables and wholegrains with small amounts of fats and oils are encouraged. Olive oil is grouped with other fats (‘Choose rapeseed, olive, canola, sunflower or corn oils’) and the message is to ‘always cook with as little fat or oil as possible’, a message that is entirely opposite to the recommendations of the Med Diet. The advice to consume 1 teaspoon of oil when cooking is in stark contrast and falls well below the recommended 50ml EVOO per person per day that has been associated with reduction in the risk of cardiovascular diseases as found in the landmark PREDIMED study.

In the 2016 Irish dietary guidelines and recommendations, there are some inadequacies in the messages conveyed. Grouping together red meat with poultry and fish in the current Irish Food Pyramid, in the frequency promoted, is not reflective of the current evidence base and conveys to the public that these foods are of similar nutritional value; a message that is not entirely scientifically valid.

The Med Diet with its basic themes are easily adaptable to the cuisine/culture of individual countries. Although not produced in Ireland, the staple component, EVOO, is readily accessible in all supermarkets, food stores and markets at a reasonable price, as are other key components such as canned or dry legumes and nuts. Other fundamental foods that constitute the Med Diet pattern such as whole grains, leafy greens and all other vegetables, Irish grown beans, fish, fresh fruit and dairy are produced, abundant and affordable, highlighting that the Med Diet can be adapted for the Irish context.

In this commentary paper we suggest that adapting our food and dietary pattern guidelines towards a ‘MedÉire’ type diet, whereby the principles of the Med Diet (i.e. using olive oil liberally, consuming vegetables at every meal, encouraging low meat intake (with some meat free days), instead opting for oily fish and legumes) are of high importance and urgency. Following ‘MedÉire’, there is potential to change the overall macronutrient content of the diet by the addition of key staple and functional foods to prevent chronic diseases. In such an approach, we need to overcome barriers, commence promotion and education early, engage with government and industry stakeholders to make healthier food cheaper, more accessible and market appropriately to inform the public of the benefits of such a diet.

The full article ‘Changing the Irish dietary guidelines to incorporate the principles of the Mediterranean Diet – Proposing the MedÉire Diet’ published in Public Health Nutrition is available to download for free until 30th April 2019.

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