Updates on Mediterranean diet and health status: active ingredients and pharmacological mechanisms

The Mediterranean diet (MedDiet) is among the most extensively studied dietary patterns and has been consistently associated with reduced risk of all-cause mortality, cardiovascular disease, metabolic disorders, cognitive decline and several types of cancers. It is defined by a high intake of vegetables, fruits, legumes, nuts, (whole) grains, fish, seafood and extra virgin olive oil, along with moderate consumption of red wine. Several physiological pathways may contribute to its beneficial effects, including favourable modulation of lipid profiles, enhanced insulin sensitivity, reduction of inflammatory and oxidative stress markers, improved endothelial function and antithrombotic activity. These effects are largely attributed to bioactive compounds such as polyphenols, monounsaturated and polyunsaturated fatty acids and dietary fibre. This updated review summarizes the most recent evidence and discusses both established and emerging mechanisms of action related to individual dietary components within the MedDiet. It aims to provide a refined understanding of how this dietary pattern contributes to chronic disease prevention and overall health.