Economics messes everything up.  Just about the time we figure out a new way to make all boats rise, the boats don't play along.

So it goes with the Mediterranean diet, which went from food fad to inclusion in the UNESCO Olympus of the World heritage list and saw lots and lots of research grant money dumped into extolling its virtues, as kind of a cure-all for obesity.  And people listened.

Now the actual food in the Mediterranean diet, which was once eaten by healthy poor people, has been priced far out of their reach. The diet has become yet another fad for rich people and even the Italians who invented the diet can no longer afford it.  Researchers  from the Research Laboratories at the Fondazione di ricerca e cura Giovanni Paolo II – Catholic University of Campobasso, published their results of 13,000 subjects. 

The 13,000 people were a sub-sample of the widest epidemiological Moli-sani Project. Since 2005 this project has been recruiting about 25,000 adult subjects from the Molise region aiming to investigate the relationship between genetic and environmental factors in the onset of chronic disease such as cardiovascular disease and tumors. The authors explored the association between income and dietary habits of participants, evaluated according to specific scores of adherence to Mediterranean diet. 

"We found that low-income people showed the poorest adherence to Mediterranean diet as compared to those in the uppermost group of income," says Licia Iacoviello, chairperson of the Moli-sani Project. "In particular, high-income people have 72% odds of being in the top category of adherence to Mediterranean diet. This means a less healthy diet for the poorest, who are more likely to get prepackaged or junk food, often cheaper than the fresh foods of the Mediterranean tradition. In the lowest-income category we have recorded a higher prevalence of obesity as well. Low-income people report 36 % of obesity compared to 20% in the uppermost income class."

"Obviously we have considered all the possible confounding factors which may bias the observed effects," the authors wrote. "The educational level, for instance, has a huge role in determining health status, as showed by previous studies. That is why we have further divided our population according to educational level but in this case too income appears to influence people's food choices."

"An interesting aspect of our study," said Giovanni de Gaetano, director of the Research Laboratories at the centre of Campobasso," is that the income categories considered were not so different from each another. We are talking about relatively small economic differences, from 10,000 Euros to over 40,000 Euros net per year. Yet, also in a quite homogenous region as Molise we could observe substantial differences in dietary habits and consequent health outcomes.

"This is a very serious issue which shall foster a discussion on healthy food accessibility in terms of economic costs within those appointed to guarantee the rights to health to everybody, independently from socioeconomic status. Keep on gaining proofs on the beneficial effect of Mediterranean diet is no longer the only task. We have to be sure that everyone has the chance to take advantage from it."

Citation: Marialaura Bonaccio, Americo Ettore Bonanni, Augusto Di Castelnuovo, Francesca De Lucia, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello, 'Low income is associated with poor adherence to a Mediterranean diet and a higher prevalence of obesity: cross-sectional results from the Moli-sani study', BMJ Open 2012;2:6 e001685 doi:10.1136/bmjopen-2012-001685