There has been growing interest over recent years in the potential preventive role of the Mediterranean diet in the development of cardiovascular disease and cancer. The present study was designed to evaluate the relationship between the components of the Mediterranean diet and lung cancer. A hospital-based, case-control study of lung cancer was conducted on subjects aged 35+ yr living in the Lazio region and admitted to one of the main hospitals in Rome in the period from 1993 to 1996. Cases (n = 342) were patients with newly diagnosed primary lung cancer. Controls (n = 292) were recruited from departments of general surgery, orthopedics, ENT, and general medicine and were frequency matched by sex and age (+/-5 yr) to the cases. Exposure characteristics were obtained by interviewing study subjects. A self-administered food-frequency questionnaire was used. After careful control for several smoking variables, we found a protective effect for high consumption of carrots (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.42-1.05), tomatoes (OR = 0.59, 95% CI = 0.34-1.03), white meat (OR = 0.66, 95% CI = 0.42-1.02), exclusive use of olive oil (OR = 0.67, 95% CI = 0.45-0.99), and regular consumption of sage (OR = 0.43, 95% CI = 0.29-0.65). In a multivariate model, considering all food items simultaneously, the protective effect of exclusive olive oil use and sage remained statistically significant. Our results indicate that some food items typical of the Mediterranean diet are associated with decreased lung cancer risk.