The term “Mediterranean diet” is widely employed to indicate the typical diet of the Countries located on the Mediterranean sea coast. A growing body of scientific literature pointed out the healthy effects of this diet. In recent years we investigated about the protective effects of a regular and moderate wine consumption. As we know, alcoholic and non alcoholic wine constituents are responsible of different effects by means of molecular and cell mechanisms. Among the non alcoholic components, polyphenols (for example resveratrol and quercetin) were deeply investigated. The aim of this review is to underline the effects of a moderate and regular wine drinking in the context of the Mediterranean diet in light of the interactions between wine and important dietary factors such as olive oil, fruit and vegetables.
The term “Mediterranean diet” is greatly employed to indicate the typical diet of the Countries located on the Mediterranean sea coast [
Several data underline the healthy effects of this diet [
In recent years we examined the protective effects of a regular and moderate wine consumption on diabetes mellitus [
The main goal of this review is to show the effects of a moderate and regular wine consumption in the context of a healthy diet such the Mediterranean one. For this reason, the complex influences exerted by wine on cardiovascular, metabolic and renal systems, neurodegenerative diseases and cancer must be mentioned.
The J-shaped alcohol-mortality curve is well known. Light drinkers have about 30% lower cardiovascular morbidity and mortality risk than abstainers, with about a 10% lower total mortality risk [
The positive effects arising from alcohol consumption could be reached only with 5 years of regular physical exercise [
In 1992 Renaud and De Lorgeril with the worldwide known “French paradox” [
There are great amount of works in literature reporting the significant inverse relationship between wine drinking and cardiovascular mortality and morbidity [11,12].
Nowadays, we know that wine exerts its protective effects by means of different mechanisms directed towards different targets. So to elucidate this effects we have to mention the influence of wine on lipoprotein metabolism, haemostasis and thrombosis and endothelial function.
As it is known, wine contains alcohol and non alcoholic components: among the latters, polyphenols play a leading role in determining wine effects.
Alcohol consumption leads to higher HDL-cholesterol levels, but the same effect was observed in animal models with alcohol-free red wine [
Red wine phenolic extract decrease plasma cholesterol, triglyceride and Apo B levels in hamsters [
Polyphenols inhibits LDL oxidation in a more powerful manner than vitamin E as demonstrated by Frankel [
Recently, in a double-blind, placebo-controlled trial post-infarction patients treated with resveratrol for three months showed a significant reduction of LDL cholesterol. [
An inverse relationship between alcohol consumption and both fibrinogen and antithrombin has been demonstrated [
The same group showed is that differently from what observed with beer and spirits to which could be due ischaemic events 24 - 48 hours after consumption, wine does not exert rebound effects [
Three glasses a day of red wine can significantly inhibit platelet aggregation, more than what observed with grapejuice or resveratrol-enriched grape juice, thus underlining the role of alcoholic components [
Protection against cardiovascular diseases is exerted by wine polyphenols that play an important influence on endothelium. In animal models and cultured cells different authors showed a vasodilating effect elicited by wine [
If we consider that polyphenols are detectable in the plasma of non supplemented humans at concentrations comparable to those required to induce 50% of maximal endothelium-dependent vasorelaxation, it can be hypothesized that in vivo effective concentrations can be reached [
In more than 300 men and 200 women who underwent coronary angiography, Liu et al. [
Recently, Magyar showed that post infarction patients, treated with resveratrol show a significant improvement of endothelial function measured with FMD [
As we mentioned in our previous papers on this topic [3-6], all these data, rather controversial, lead us to think that beneficial effects could be due both to polyphenols and alcohol.
Many typical mediterranean foods, like onions, are a great source of polyphenols [
Hypertensives, according to WHO estimation [
In the Predimed Study [
In light of all these considerations, it’s easy to understand how the deep, complex interactions between dietary factors, wine and their pathophysiological targets could be responsible of a reduced cardiovascular risk.
The relationship between wine consumption and kidney disease is very interesting if we consider that chronic kidney disease is associated with accelerated atherosclerotic damage and more frequent cardiovascular events. Oxidative stress and endothelial dysfunction, which are interrelated [
Another wine constituent, the phytoalexin resveratrol, showed inhibitory effects on proteinuria, hypoalbuminemia and hyperlipidemia in nephritic rats [
The association between wine consumption and diabetes mellitus has been largely examined. From the epidemiological point of view, Conigrave and coworkers [
In animal models of metabolic syndrome (Zucker rats), Rivera [
In diabetic subjects, Ceriello and coworkers [
The antioxidant properties of wine polyphenols play a role in prevention of long term diabetic complications such as neuropathy, nephropathy and retinopathy. In fact polyphenols prevent the accumulation of oxidative/nitrative stress products in different body tissues as observed in animal models [
It has been demonstrated, in various cell culture and animal models, that wine polyphenols protect neuronal cells by attenuating oxidative stress and cell damage. Regular wine consumption has been associated with a reduced incidence of neurodegenerative diseases. Among the polyphenols, resveratrol has been related with a lower reduction of Beta-amyloid via sirtuin-1 actions [
However, as suggested by Albarracin [
The role of wine is controversial. A direct relationship between alcohol consumption and colo-rectal cancer has been reported and a similar association was observed for what regards liver, pharynx and larynx cancer [58-61]. A weaker association was observed between alcohol consumption and pancreas and neck cancer. No sure data are available for other many cancers whilst for what concerns the renal cancer a protective role of alcohol has been demonstrated [
Polyphenols, instead exert a protective role against cancer risk. Supposed mechanisms for this protections are: reduced expression of pro-oxidant enzymes which are involved in carcinogenesis; inhibition of transcription factor activation; apoptosis; impairment of cancer angiogenesis [
Recently resveratrol has been shown to involved in pain control, a crucial topic for cancer patients. In fact, it regulates nociceptive signaling via inhibition of cyclin-dependent kinase 5 (cdk5). Resveratrol blocks the TNF α- mediated increase in p35 promoter activity thus reducing cdk5, which is actually considered a key target molecule for analgesia [
Besides wine, many dietary constituents were associated with cancer prevention: olive oil, fish, fruit and vegetables. Considering that all these foods are present in the Mediterranean diet, we have to look at this dietary habit as the healthiest one for prevention.
A great number of observational studies and clinical trials investigated about the relationship between dietary habits and cardiovascular disease, which is more interesting if we consider that the 169 billions of euro is how much cardiovascular diseases yearly cost.
One of the most important study in this field is the Seven Countries Study [
Such an observation was strongly confirmed by Renaud’s so-called “Cretan Miracle” [
Mediterranean diet is inversely related with body mass index, obesity and hypertension [
- The high consumption of fruit and vegetables; fruit consumption is inversely associated with cardiovascular and cerebrovascular risk both in men and women [68,69].
- The significant intake of olive oil; it’s the leading constituent of this diet. For its high polyphenols content, it has been demonstrated a powerful antiarrythmic, antiinflammatory, antioxidant and vasodilating compound, [
- Regular consumption of garlic and onions. The former has shown to reduce blood pressure by means of angiotensin converting enzyme inhibiting activity. It also improves endothelial function by stimulating nitric oxide production and scavenging free radicals. Onions have fibrinolytic and hypotensive effects probably due to the high content of quercetin that is widely known to reduce blood pressure in hypertensives. The effects of onions’ consumption are strengthened by the presence in the same meal of olive oil and red wine.
- Fish consumption. It has been associated with a reduction of cardiovascular risk. Regular fish intake has been inversely related with ischemic stroke. A similar relationship is not applicable to hemorrhagic stroke because omega-3 have a potential antiaggregant activity [
A regular and moderate wine consumption, associated with a simple, healthy diet such the Mediterranean one, is an advisable life habit. Beyond theoretical hypotheses, polyphenols could find clinical applications and in fact resveratrol tablets are already available as antiviral.
More recently, resveratrol and quercetin have been employed in developing drug-eluting polymer coatings for endovascular devices. The gradual release of therapeutical concentration of these agents is useful to avoid the in-stent stenosis [
In light of all these considerations, a regular and moderate wine consumption, (The so called “Mediterranean way of drinking” of Giocosa and coworkers [