Cultural Adaptations Addressing Diversity and Health Access in the Mediterranean Diet: A Realist Synthesis

Abstract

Background: The Mediterranean diet (MD) has been studied for its benefits, including metabolic risk factors, since the 1950s. In recent years, debates around barriers to access within cultural and environmental fields have arisen within non-Eurocentric cultural backgrounds. Using data related to health benefits derived from dietary components, this review will produce a map of MD modifications to match various cultures. Methods: Foods and constituents of the MD were compared and analyzed to assess benefits for both healthy and metabolic disease states using both empirical and theoretical approaches. Databases (PubMed and Cochrane) were searched using terms for cultural diets and metabolic disease outcomes associated with the MD (e.g., HbA1C, cholesterol, waist circumference, weight, AST and ALT). One multicultural diet database was chosen to identify culturally specific foods that match components of the MD to each cultural affinity. Results: Cultural alternatives to foods and components of the MD exist. However, there is modest research on the specific health effects of most culturally adapted diets. Conclusion: While some evidence gaps exist, it is feasible to translate most components of the MD to diets suitable for various cultural affinities. Future research is needed to examine the overall effects of these diets based on MD macronutrient presentation and the barriers associated with cultural–religious dietary practices and access to foods. Healthcare practitioners may benefit from this as a resource and to facilitate inclusivity and cultural competency for a broader range of dietary behaviours.