Study: Honey May Encourage Mediterranean-Style Diet

A new food modeling substitution study published in Current Developments In Nutrition1 shows how 98% of adult Americans could eat a more Mediterranean-Style Diet by making just three recipe swaps in their diet that includes honey paired with olive oil on leafy greens with fruit, on whole grains and on fish2.

The Mediterranean-style Diet Pattern (MSDP), a dietary pattern recommended by the 2020-25 Dietary Guidelines for Americans, is abundant in whole grains, legumes, nuts, lean fish, fresh fruits and vegetables, and is relatively high in fat from olive oil, while low in refined or added sugars. The MSDP has been consistently associated with lower risk for several chronic diseases, including cardiovascular disease, diabetes and obesity. Although interest in the Mediterranean diet is high, study results showed that adherence to MSDP remains low among Americans.

An important factor in deciding what to eat and sticking to an eating pattern is palatability, and honey, a traditional sweetener of the Mediterranean region, can help elevate the taste of some key Mediterranean foods.

The purpose of this new study was to identify foods that, when substituted for commonly consumed American foods, would have the most impact in helping American adults who want to follow a healthy Mediterranean-style diet. This food substitution modeling study, led by Dr. Francine Overcash, Post-Doctoral Associate and Lecturer, and funded by the National Honey Board, determined the most impactful food swaps to promote a Mediterranean-style diet and how this can translate into three simple recipes that could improve MSDP adherence.

>>Recommended Recipe: Mediterranean Roasted Mushrooms 

Americans' diets were assessed using data from National Health and Nutrition Examination Survey (NHANES 2007-2018) to determine a Mediterranean diet scoring index appropriate for non-Mediterranean populations. The study included 19,987 adult participants, between 25 and 66 years of age with complete dietary data. Participants with relatively higher adherence (HA) were compared to the rest of adult Americans, the non-high adherence group (nHA), in order to identify food substitutions most likely to help eat a more Mediterranean-style diet pattern. These food substitutions were ranked to select the top ones with the highest potential to increase the Mediterranean diet score.

The most impactful isocaloric substitutions were:

1. Olive oil for other oils and saturated fats
2. Fruit for fruit juice
3. Fish for red meat
4. Whole grains for refined grains
5. Leafy greens for starchy/root vegetables

To help consumers make changes, these five food swaps were simplified down to three easy-to-follow recipes that included honey as a culinary ingredient to enhance palatability. Each recipe was nutritionally analyzed to determine a reasonable isocaloric swap. These recipes were whole grain tabbouleh with a honey olive oil dressing, kale and strawberry salad with an olive oil and honey dressing, and a fish marinaded with honey, herbs, and olive oil.

Study results showed that MSDP scores improved with these three recipes, even with the addition of a small amount of honey. The researchers determined that each honey-food pairing recipe improved the mean MSDP score not only for people in the low adherence group (nHA), but also for the group that started with a better MSDP better score (HA).

"These findings provide evidence that making simple dietary swaps can help adult Americans better adhere to a Mediterranean Diet. In fact, 98% of adult Americans could see a meaningful increase in MSDP adherence by making these three recipe substitutions that include honey as a culinary tool," says Francine Overcash, the study's principal investigator.

The limitations of the study include there is no universally accepted scoring system to measure Mediterranean diet adherence and that applies to the present study. The research design depends on self-reporting and 24-hour recall, which has inherent biases. Also, a 2-day diet recall may not accurately reflect dietary intakes over time. 

Finally, the substitutions suggested in this study do not take in to account economic barriers as the swaps may be expensive or access to food substitutions that are not available in food deserts.

In conclusion, the study confirms that although most people are not meeting the recommendations for a health-promoting Mediterranean-style dietary pattern, a few simple substitutions can improve adherence for those seeking to do so. Three simple Mediterranean-inspired recipes containing honey can help make food substitutions palatable while still helping Americans improve their diet.

Looking for healthy cooking inspo? Visit our Recipes section for tasty and nutritious Mediterranean-inspired dishes and more!