Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis

• Published in: The American journal of clinical nutrition Vol. 92; no. 5; pp. 1189 - 1196
• Main Authors: Sofi, Francesco, Abbate, Rosanna, Gensini, Gian Franco, Casini, Alessandro
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Nutrition 01.11.2010; American Society for Clinical Nutrition, Inc
• Subjects: Biological and medical sciences; cardiovascular diseases; Cardiovascular Diseases - mortality; Cardiovascular Diseases - prevention & control; Chronic Disease - prevention & control; chronic diseases; Cognition Disorders - mortality; Cognition Disorders - prevention & control; cohort studies; compliance; Diet; Diet, Mediterranean; disease incidence; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Health; health status; human diseases; human nutrition; Humans; Meta-analysis; Mortality; neoplasms; Neoplasms - mortality; Neoplasms - prevention & control; nervous system diseases; Neurodegeneration; Neurodegenerative Diseases - mortality; Neurodegenerative Diseases - prevention & control; Prospective Studies; regression analysis; Stroke - mortality; Stroke - prevention & control; Systematic review; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Human; Review; Mediterranean diet; Health; Adhesion
• ISSN: 0002-9165; 1938-3207; 1938-3207
• DOI: 10.3945/ajcn.2010.29673

The Mediterranean diet has long been reported to be protective against the occurrence of several different health outcomes. We aimed to update our previous meta-analysis of published cohort prospective studies that investigated the effects of adherence to the Mediterranean diet on health status. We conducted a comprehensive literature search through electronic databases up to June 2010. The updated review process showed 7 prospective studies published in the past 2 y that were not included in the previous meta-analysis (1 study for overall mortality, 3 studies for cardiovascular incidence or mortality, 1 study for cancer incidence or mortality, and 2 studies for neurodegenerative diseases). These recent studies included 2 health outcomes not previously investigated (ie, mild cognitive impairment and stroke). The meta-analysis for all studies with a random-effects model that was conducted after the inclusion of these recent studies showed that a 2-point increase in adherence to the Mediterranean diet was associated with a significant reduction of overall mortality [relative risk (RR) = 0.92; 95% CI: 0.90, 0.94], cardiovascular incidence or mortality (RR = 0.90; 95% CI: 0.87, 0.93), cancer incidence or mortality (RR = 0.94; 95% CI: 0.92, 0.96), and neurodegenerative diseases (RR = 0.87; 95% CI: 0.81, 0.94). The meta-regression analysis showed that sample size was the most significant contributor to the model because it significantly influenced the estimate of the association for overall mortality. This updated meta-analysis confirms, in a larger number of subjects and studies, the significant and consistent protection provided by adherence to the Mediterranean diet in relation to the occurrence of major chronic degenerative diseases.