Consensus of the Spanish Society of Arteriosclerosis and the Spanish Society of Internal Medicine on the Mediterranean Diet and Health: A comprehensive approach beyond nutrients.

Mediterranean Diet has proven to be one of the most effective dietary patterns for preventing cardiovascular disease and other cardiometabolic outcomes, however, scientific research has historically tended to focus on the composition of foods and their nutrients, neglecting other essential components of this dietary pattern. These non-nutritional factors, including commensality and conviviality, food seasonality and sustainability, culinary practices, and the temporal synchronization of food intake, are integral to the conceptual framework of Mediterranean Diet and were a key criterion for its recognition as an Intangible Cultural Heritage of Humanity. Despite their relevance, their systematic treatment in the scientific literature has been limited. This consensus statement reviews and synthesizes recent evidence on these non-nutritional factors, identifying the mechanisms by which they influence adherence to the pattern and biological determinants relevant to vascular health, such as metabolic regulation, low-grade inflammation, and circadian function. Furthermore, highlighting these elements contributes to the implementation and adaptation of MediterraneanDiet in other sociocultural contexts, promoting the adoption of a comprehensive pattern that preserves its conceptual foundations beyond the mere replication of foods, and allows these individuals to access the additional benefits conferred by these non-nutritional factors. This holistic approach proposes that the Mediterranean Diet, conceived as a lifestyle pattern, can be coherently adapted to different cultural and geographical realities, thus optimizing its transfer to clinical practice and to strategies for the prevention of arteriosclerosis and its risk factors.