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The aim of this study is to investigate whether adherence to the Mediterranean diet changed during the period 1991–2006 in an Italian population.We derived data from the comparison groups of a network of case-control studies on cancer and acute myocardial infarction conducted in the greater Milan area between 1991 and 2006. Subjects were 3247 adults (1969 women, 1278 men; median age 59 years) admitted to major teaching and general hospitals for a wide spectrum of acute conditions unrelated to long-term modifications of diet. Trained interviewers collected data on selected socioeconomic and demographic characteristics, lifestyle habits and other personal and familial factors. Information on diet was collected through an interviewer-administered, reproducible and validated food-frequency questionnaire. We computed a Mediterranean diet score (MDS) on the basis of nine a priori defined peculiar characteristics of the Mediterranean dietary pattern.In multiple linear regression models, adjusted for age, education, place of birth and residence, and total energy intake, there was no significant association between the period of interview and MDS in both sexes. Subjects aged 55–64 years, those with high education, and those born in central and southern Italy showed the highest adherence to the Mediterranean diet in both sexes.In this population, adherence to the Mediterranean diet showed no significant change over the last 15 years.