The Mediterranean diet health benefits and protective effects against chronic diseases have been well established by the scientific community. The pyramid includes all the food groups; a healthy or unhealthy diet relies in proportions and frequencies. This eating pattern is addressed to a healthy adult population and should be adapted to the specific needs of children, pregnant women and other health conditions.

Moreover, social and cultural elements characteristic of the Mediterranean way of life are also important. So, it is not just about prioritising some food groups over others, but also paying attention to the way they are selected, cooked and eaten. It also reflects the composition and number of servings per meals.

Foods that should sustain the diet are located at the base of the pyramid and foods to be eaten in moderate amounts are located in the upper levels. Plant-based foods, situated at the base of the pyramid, provide key nutrients and protective substances that contribute to general well-being and to maintain a balanced diet, and should be consumed in high proportions and frequency. Foods situated in the upper levels such as those from animal origin, rich in sugars and in fats should be eaten in moderation and left for special occasions. The pyramid establishes daily, weekly and occasional dietary guidelines in order to follow a healthy and balanced diet.

Every day:

The three main meals should contain three basic elements, which can also be found throughout the day:

• Fruit. One or two servings per meal. Should be chosen as the most frequent dessert.
• Cereals. One or two servings per meal in the form of bread, pasta, rice, couscous and others. Preferably whole grain, since some valuable nutrients (magnesium, phosphorus, etc.) and fibre can be lost during processing.
•  Vegetables. Present at lunch and dinner; or more than two servings per meal, at least one of the servings should be raw. A variety of colours and textures provide a diversity of antioxidants and protective compounds.

1. A daily intake of 1.5–2.0 litres of water should be guaranteed. Good hydration is essential to maintain the corporal water equilibrium, although needs may vary among people due of age, physical activity, personal circumstances and weather conditions. Aside from water, non-sugar rich herbal infusions and broths (with low fat and salt content) may complete the requirements.
2. Dairy products. Preference of low fat yoghurt, cheese and other fermented dairy products. They contribute to bone health, but can also be an important source of saturated fat.
3. Olive oil is located at the centre of the pyramid and should be the main source of dietary lipids because of its high nutritional quality (especially extra virgin olive oil, which should be preferred for dressings and adding it raw to foods). Its unique composition gives it a high resistance to cooking temperatures and should be used for cooking as well as dressings (one tablespoon per person).
4. Spices, herbs, garlic and onions are a good way to introduce a variety of flavours and palatability to dishes and contribute to the reduction of added salt. Olives, nuts and seeds are good sources of healthy lipids, proteins, vitamins, minerals and fibre. A reasonable consumption of olives, nuts and seeds (such as a handful) make for a healthy snack choice.
5. Respecting religious and social beliefs, a moderate consumption of wine and other fermented beverages (one glass per day for women and two glasses per day for men, as a generic reference) during meals is recommended.

Weekly:

A variety of plant and animal origin proteins should be consumed. Mediterranean traditional dishes usually have animal origin protein foods as a garnish instead of as a main ingredient.

• Fish (two or more servings), white meat (two servings) and eggs (two to four servings) are good sources of animal protein. Fish and shellfish are also a good source of healthy proteins and lipids.
• Red meat (less than two servings, preferably lean cuts) and processed meats (less than one serving) should be consumed in smaller quantities and les frequently.
• The combination of legumes (more than two servings) and cereals are a healthy source of proteins and lipids. Potatoes are also included in this group, as they are a part of many traditional recipes with meat and fish (three or less servings per week, preferably fresh potatoes).

Occasionally:

Sugary and unhealthy fats rich foods (sweets) are found in the vertex of the pyramid. Sugar, candies, pastries and beverages such as sweetened fruit juices and soft drinks, should be consumed in small amounts and left for special occasions.

Together with the proportion and frequency recommendations of consumption, the incorporation of lifestyle and cultural elements is one of the innovations of the pyramid. Adopting a healthy lifestyle and preserving cultural elements should also be considered in order to acquire all the benefits from the Mediterranean diet. These elements are:

Moderation: Portion sizes should be based on frugality, adapting energy needs to urban and modern sedentary lifestyles.

Socialisation: The aspect of conviviality is important for the social and cultural value of the meal, beyond nutritional aspects. Cooking, sitting around the table and sharing food in company of family and friends is a social support and gives a sense of community.

Cooking: Make cooking an important activity using the proper time and space. Cooking can be relaxing, fun and can be done with family, friends and loved ones.

Seasonality, biodiversity, eco-friendliness, traditional and local food products are presented at the bottom of the pyramid to highlight how the new revised modern Mediterranean diet is compatible with the development of a sustainable diet model for the present and future Mediterranean generations. The preference for seasonal, fresh and minimally processed foods maximises the content of protective nutrients and substances in the diet.

Activity: Regular practice of moderate physical activity (at least 30 min throughout the day) is a basic complement to the diet for balancing energy intake, for maintaining a healthy body and for many other health benefits. Walking, taking the stairs vs. the lift, housework, etc., are simple and easy ways of doing exercise. Practising leisure activities outdoors and preferably with others makes it more enjoyable and strengthens the sense of community.

Rest: Resting is also part of a healthy and balanced lifestyle.

This pyramid is the result of an international consensus and is based on the latest scientific evidence on nutrition and health published in hundreds of scientific articles in the last decades.

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