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The Mediterranean Diet, its Components, and Cardiovascular Disease
Open accessAbstract
One of the best-studied diets for cardiovascular health is the Mediterranean diet. This consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes/nuts, and moderate alcohol consumption. The Mediterranean diet has been shown to reduce the burden, or even prevent the development, of cardiovascular disease, breast cancer, depression, colorectal cancer, diabetes, obesity, asthma, erectile dysfunction, and cognitive decline. This diet is also known to improve surrogates of cardiovascular disease, such as waist-to-hip ratio, lipids, and markers of inflammation, as well as primary cardiovascular disease outcomes such as death and events in both observational and randomized controlled trial data. These enhancements easily rival those seen with more established tools used to fight cardiovascular disease such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and exercise. However, it is unclear if the Mediterranean diet offers cardiovascular disease benefit from its individual constituents or in aggregate. Furthermore, the potential benefit of the Mediterranean diet or its components is not yet validated by concrete cardiovascular disease endpoints in randomized trials or observational studies. This review will focus on the effects of the whole and parts of the Mediterranean diet with regard to both population-based and experimental data highlighting cardiovascular disease morbidity or mortality and cardiovascular disease surrogates when hard outcomes are not available. Our synthesis will highlight the potential for the Mediterranean diet to act as a key player in cardiovascular disease prevention, and attempt to identify certain aspects of the diet that are particularly beneficial for cardioprotection.
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“Specific dietary patterns, such as low-glycemic index (GI), Mediterranean, and ketogenic diets, have shown promise in improving insulin sensitivity and hormonal balance in PCOS [10–12].”
From Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management (2025) · cites this paper as [12]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“This diet, characterized by olive oil [63], abundant fruits and vegetables, whole grains, legumes, nuts, fish, and moderate wine consumption, is associated with a 25% reduction in overall mortality and significantly lower rates of cardiovascular diseases [64].”
From The Power of Environment: A Comprehensive Review of the Exposome's Role in Healthy Aging, Longevity, and Preventive Medicine-Lessons from Blue Zones and Cilento (2025) · cites this paper as [64]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“The Mediterranean diet is characterized by high intake of polyphenols and unsaturated fats, with most of the beneficial effects from this diet being attributed to the high polyphenol intake [6,7].”
From Polyphenol Microbial Metabolites Exhibit Gut and Blood–Brain Barrier Permeability and Protect Murine Microglia against LPS-Induced Inflammation (2019) · cites this paper as [7]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Diets such as the Mediterranean diet or the DASH diet may further enhance these effects [257].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [257]
Experimental — accuracy not yet measuredIn the citing paper
“Moreover, the MD consists of many components rich in mono-unsaturated fatty acid such as oleic acid, in olive oil, omega-3-polyunsaturated fatty acid, such as alpha- linolenic acid in tree nuts, like walnuts, high amounts of flavonoids and antioxidants found in fruits and vegetables and high amounts of dietary fibers that have a great impact on the composition of gut microbiota—all considered to”
From Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing (2021) · cites this paper as [12]
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3 retracted
RETRACTED: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
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“However, recent RCT data mentioned early in the review offer evidence that the Mediterranean diet supplemented with nuts offers primary cardiovascular disease-prevention benefits.(21) Again, these benefits were seen in conjunction with the remainder of the Mediterranean diet, so ascribing the benefit solely to nuts wo…”
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3 of the 122 references couldn’t be matched to a known paper.
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“Some studies suggest that the Mediterranean diet, which is plant-based and rich in olive oil, nuts, fruits, vegetables, and fi sh containing monounsaturated fatty acids, can reduce liver fat, in fl ammation, diabetes, and even cardiovascular diseases [8].”
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“The MD is one of the most studied diets for preventing both CVD and in fl ammation (38).”
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“…(MedDiet), a dietary pattern described by Ancel Keys in 1975 [18] and which has subsequently had an explosion of research showing associations with reduced all-cause mortality [19], cardiovascular disease [20,21], depression [22,23], cognitive impairment [22,24], and overall healthier ageing [25].”
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“2015) by different mechanisms, including the reduction of blood pressure, BMI, waist circumference, oxidative stress, and improvement of lipid profile and vascular function (Widmer et al. 2015).”
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Wright, R. S., Gerassimakis, C., Bygrave, D. C., & Waldstein, S. R. (2017) · Current Nutrition Reports · doi:10.1007/s13668-017-0186-x · Cited by 18
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“In addition, other constituents of the Mediterranean diet, such as fish rich in omega-3 polyunsaturated fatty acids (PUFA), have been shown to reduce cardiovascular morbidity and mortality and contribute to cardio protective effects with improved lipid profiles, reduced inflammation and oxidation (Widmer et al. 2015).”
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“The mechanisms involved in CVD protection associated with MeDi have not been fully elucidated.(5) Proposed mechanisms include the retardation of atherosclerosis development and progression through the improvement of CVD risk factors such as decrease in LDL cholesterol and blood pressure, or increase in HDL cholesterol.”
BackgroundLipids as Nutraceuticals: A Shift in Paradigm
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“Adherence to the MD has been inversely related to coronary heart disease mortality [14], cancer mortality, and all-cause mortality [15].”
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“The MD has many foods high in antioxidant compounds, contributing to its advantages [9], such as a decrease in cardiovascular disease, breast cancer, colorectal cancer, diabetes, obesity, and inflammatory indicators [10].”
BackgroundCan the Mediterranean diet decrease the risk of depression in older persons – a systematic review
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“It also includes a significant intake of olive oil as the foremost contributor of fat, desired consumption of dairy products like cheese and yogurt, prudent consumption of fish and poultry and moderate alcohol consumption [200–202] (Figure 3).”
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“The Mediterranean diet is characterised by high consumption of fruits, vegetables, whole grains, legumes, nuts, and olive oil, with moderate intake of fish, poultry, and moderate alcohol [73].”
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“interventions and aggressive risk factor modification will dual impact on reducing 317 cardiovascular[43,44] and hepatic events.”
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Stamatelopoulos, K. S., Papavagelis, C., Augoulea, A., Armeni, E., Karagkouni, I., Avgeraki, E., Georgiopoulos, G. A., Yannakoulia, M., & Lambrinoudaki, I. V. (2018) · Maturitas · doi:10.1016/j.maturitas.2018.07.006 · Cited by 14
Razavi, A. C., Monlezun, D. J., Sapin, A., Sarris, L., Schlag, E., Dyer, A., & Harlan, T. S. (2019) · American Journal of Lifestyle Medicine · doi:10.1177/1559827619861933 · Cited by 15
López-Salas, L., Cea, I., Borrás‐Linares, I., Emanuelli, T., Robert, P. S., Segura‐Carretero, A., & Lozano‐Sánchez, J. (2021) · Foods · doi:10.3390/foods10061407 · Cited by 13
“In this industrial processing, large quantities of wastes are generated in different steps over the production [1,21].”
BackgroundShimizu, A., Okada, K., Tomata, Y., Uno, C., Kawase, F., & Momosaki, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912636 · Cited by 13
“Epidemiological evidence shows that adherence to dietary patterns, such as Japanese and Mediterranean diets, decreases the incidence of coronary heart disease [1,2], disability [3,4], and all-cause mortality rate [5,6].”
BackgroundZhu, Q., Shu, L., Zhou, F., Chen, L.-P., & Feng, Y. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1259453 · Cited by 16
“Up to date, accumulating epidemiological evidence has suggested the beneficial role for high adherence to the Mediterranean diet on certain chronic non-communicable diseases, such as cardiovascular diseases, non-alcohol fatty liver disease and some types of cancers (12–14).”
BackgroundDietary antioxidants and vascular calcification: From pharmacological mechanisms to challenges
Lian, Y., Li, Y., Liu, A., Ghosh, S., Shi, Y., & Huang, H. (2023) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2023.115693 · Cited by 13
Huang, H., Liao, D., He, B., Zhou, G., & Cui, Y. (2023) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2023.102909 · Cited by 13
The Recommendation of the Mediterranean-styled Japanese Diet for Healthy Longevity
Santa, K., Kumazawa, Y., Watanabe, K., & Nagaoka, I. (2024) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/0118715303280097240130072031 · Cited by 15
Kasti, A., Katsas, K., Petsis, K., Lambrinou, S., Synodinou, K. D., Kapetani, A., Smart, K., Nikolaki, M. D., Halvatsiotis, P., Triantafyllou, K., et al. (2024) · Nutrients · doi:10.3390/nu16111592 · Cited by 12
“Furthermore, they will be guided to eat vegetables in small quantities, low in FODMADs, and to drink wine optionally, in the context of the Mediterranean way of life [17].”
BackgroundThe Early Appearance of Asthma and Its Relationship with Gut Microbiota: A Narrative Review
Suárez-Martínez, C., Santaella, M., Yagüe‐Guirao, G., García‐Marcos, L., Ros, G., & Martínez‐Graciá, C. (2024) · Microorganisms · doi:10.3390/microorganisms12071471 · Cited by 17
Oteri, V., Galeano, F., Panebianco, S., Piticchio, T., Moli, R. L., Frittitta, L., Vella, V., Baratta, R., Gullo, D., Frasca, F., et al. (2024) · Nutrients · doi:10.3390/nu16193397 · Cited by 13
“Conversely, gluten and nickel might exacerbate symptoms, indicating the importance of dietary adjustments in managing EM [12,14].”
BackgroundMolani‐Gol, R., & Rafraf, M. (2025) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2025.2466111 · Cited by 13
“…sugars or honey; olive oil as the main source of fat and cooking ingredient; low to moderate amounts of yogurt and cheese; higher quantities of fish and low quantities of red meat; and low to moderate amounts of red wine (Willett et al. 1995; Trichopoulou and Lagiou 1997; Widmer et al. 2015).”
Nutraceutical Bioactive Compounds Promote Healthspan Counteracting Cardiovascular Diseases
Malaguti, M., Angeloni, C., & Hrelia, S. (2015) · Journal of the American College of Nutrition · doi:10.1080/07315724.2015.1080107 · Cited by 13
The Mediterranean diet between traditional foods and human health through culinary examples
Renna, M., Montesano, F. F., Serio, F., & Gonnella, M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-820057-5.00005-4 · Cited by 13
Filipek, A., & Gierlikowska, B. (2021) · Journal of Functional Foods · doi:10.1016/j.jff.2021.104373 · Cited by 13
Specialized Pro-Resolving Lipid Mediators in Neonatal Cardiovascular Physiology and Diseases
Gila-Díaz, A., Carrillo, G. H., Singh, P., & Ramiro‐Cortijo, D. (2021) · Antioxidants · doi:10.3390/antiox10060933 · Cited by 13
Ruiz-Narváez, E., Baylín, A., Azofeifa, J., Leal, A., & Rosero‐Bixby, L. (2021) · Nutrients · doi:10.3390/nu13082585 · Cited by 16
de Luis, D. A., Izaola, O., & Primo, D. (2021) · Disease Markers · doi:10.1155/2021/1257145 · Cited by 13
Gila-Díaz, A., Carrillo, G. H., Arribas, S. M., & Ramiro‐Cortijo, D. (2021) · Children · doi:10.3390/children8100937 · Cited by 13
“Furthermore, it has been demonstrated that a Mediterranean diet protects against depression and mood disorders, also reducing their intensity [36,37].”
Backgrounddos Santos, J. L., Portal, V. L., Markoski, M. M., de Quadros, A. S., Bersch-Ferreira, Â. C., & Marcadenti, A. (2021) · European Journal of Clinical Nutrition · doi:10.1038/s41430-021-01045-7 · Cited by 11
“In other study, in which 805 individuals with CAD were followed-up for one year, a MedDiet dietary pattern (including ≥3 handfuls/week of nuts and ≥40 ml/day of virgin olive oil) did not change the FG, insulin, and HbA1C levels when compared to a low-fat diet [20].”
BackgroundInfluentialMultiple sclerosis and the microbiota
Engelenburg, H. J., Lucassen, P. J., Sarafian, J. T., Parker, W., & Laman, J. D. (2022) · Evolution Medicine and Public Health · doi:10.1093/emph/eoac009 · Cited by 13
“Several different types of dietary interventions have been investigated (Box 5), including: (i) the Mediterranean diet, consisting of fish, monounsaturated fats from olive oil, vegetables, whole grains and legumes/nuts [50], (ii) high fiber diets, (iii) the paleolithic diet, based on the estimated food-intake of ancie…”
BackgroundAlves-Silva, J. M., Zuzarte, M., Girão, H., & Salgueiro, L. (2022) · Plants · doi:10.3390/plants11151920 · Cited by 13
Rodrigues, D., Muc, M., Rodrigues, P. R. M., Mota‐Pinto, A., & Padez, C. M. P. (2016) · Ecology of Food and Nutrition · doi:10.1080/03670244.2016.1200038 · Cited by 13
“The primary components of this diet include an abundance of vegetables, fruits, and olive oil and a moderate intake of fish and meat, little consumption of sugars, and a low amount of animal and trans fats (Widmer et al. 2015).”
BackgroundGrimaldi, M., Ciano, O., Manzo, M., Rispoli, M., Guglielmi, M., Limardi, A., Calatola, P., Lucibello, M., Pardo, S., Capaldo, B., et al. (2017) · Acta Diabetologica · doi:10.1007/s00592-017-1078-7 · Cited by 14
Baxter, D. A., & Lovell, G. P. (2021) · Australian Psychologist · doi:10.1080/00050067.2021.1893597 · Cited by 12
“Explanation of these positive effects have been attributed to the protective role a quality diet has on the cardiovascular system (Martínez-González et al., 2015; Widmer et al., 2015), in turn shielding against vascular dementia type conditions.”
BackgroundHuang, H., Liao, D., He, B., Zhou, G., & Cui, Y. (2023) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2023.102055 · Cited by 12
“Cardiovascular disease (CVD) is a serious public health problem and is signi fi cantly connected to most disabilities, morbidities, and mortalities worldwide [1,2].”
BackgroundDiamantis, D. V., Shalit, A., Katsas, K., Zioga, E., Zota, D., Kastorini, C. M., Veloudaki, A., Kouvari, M., & Linos, A. (2023) · Nutrients · doi:10.3390/nu15245124 · Cited by 13
“Additionally, red meat consumption is limited, while alcohol and particularly wine can be consumed in moderation [7,8].”
BackgroundKaya, D. G., Arslan, N., Ayyıldız, F., Bayramoğlu, E., Turan, H., & Ercan, O. (2024) · BMC Endocrine Disorders · doi:10.1186/s12902-024-01593-6 · Cited by 12
“The Mediterranean diet provides balanced and diverse macronutrients, as well as low saturated fat content, high monosaturated fatty acid content, fiber, complex carbohydrates, and significant anti-oxidant content[16], preventing many chronic diseases, especially obesity and type 2 diabetes [17].”
BackgroundUnraveling the intricate dance of the Mediterranean diet and gut microbiota in autoimmune resilience
Tsigalou, C., Tsolou, A., Stavropoulou, E., Konstantinidis, T. G., Zafiriou, E., Dardiotis, E., Tsirogianni, A., & Bogdanos, D. P. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1383040 · Cited by 14
Damigou, E., Anastasiou, C. A., Chrysohoou, C. A., Barkas, F., Tsioufis, C., Pitsavos, C. S., Liberopoulos, E. N., Sfikakis, P. P., & Panagiotakos, D. B. (2024) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2024.10.015 · Cited by 13
The Effect of a Mediterranean Diet on Arterial Stiffness: A Systematic Review
Zupo, R., Castellana, F., Lisco, G., Corbo, F., Crupi, P., Sardone, R., Catino, F., Perna, S., Gesualdo, L., Lozupone, M., et al. (2025) · Nutrients · doi:10.3390/nu17071192 · Cited by 13
“The Mediterranean diet, characterized by a substantial consumption of fruits, vegetables, whole grains, seafood, and healthy fats such as olive oil, has been proposed as an effective dietary approach to improve these parameters [2,3].”
The Gut Mycobiome for Precision Medicine
Jaddaoui, I. E., Sehli, S., Idrissi, N. A., Bakri, Y., Belyamani, L., & Ghazal, H. (2025) · Journal of Fungi · doi:10.3390/jof11040279 · Cited by 14
“The Mediterranean diet (MD), characterized by the consumption of whole grains, legumes, nuts, omega-3-rich foods, olive oil, and fruits while limiting eggs and adding sugars, has been linked to a lower risk of cardiovascular disease and cancer, as well as increased longevity [166,167].”
Associations Between MASLD, Ultra-Processed Food and a Mediterranean Dietary Pattern in Older Adults
Commins, I., Clayton‐Chubb, D., Fitzpatrick, J. A., George, E. S., Schneider, H. G., Phyo, A. Z. Z., Majeed, A., Janko, N., Vaughan, N. V., Woods, R. L., et al. (2025) · Nutrients · doi:10.3390/nu17091415 · Cited by 14
“In addition, the Mediterranean Diet has been associated with reductions in all-cause mortality [22], CVD [23,24], cognitive impairment and dementia [25], and improved healthy ageing [26].”
Núñez, S. R., García, M. R., Martín, V., Álvarez‐Álvarez, L., & Molina, A. J. (2025) · Nutrients · doi:10.3390/nu17122005 · Cited by 21
“This observation is consistent with previous literature reviews, which have suggested that the MedD may act as a protective factor against obesity [57], cardiovascular disease [58], metabolic syndrome [59], and chronic inflammation [60], in addition to its beneficial impact on the environment [61].”
Bui, T. A., O’Croinin, B. R., Dennett, L., Winship, I. R., & Greenshaw, A. J. (2025) · Microbiology · doi:10.1099/mic.0.001568 · Cited by 14
The Mediterranean diet: History, concepts and elements
Salas‐Salvadó, J., & Papandreou, C. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818649-7.00001-1 · Cited by 14
Fernandes, S., Ribeiro, C., Paiva‐Martins, F., Catarino, C., & Santos‐Silva, A. (2020) · Food & Function · doi:10.1039/d0fo01690j · Cited by 12
Could Dietary Factors Reduce COVID-19 Mortality Rates? Moderating the Inflammatory State
Eiser, A. R. (2020) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2020.0441 · Cited by 12
Hayashi, H., Sato, I., & Suganuma, H. (2020) · Diseases · doi:10.3390/diseases9010004 · Cited by 12
“Typical well-known healthy diets include the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets [2,3].”
BackgroundWang, F., Mubarik, S., Zhang, Y., Shi, W., & Yu, C. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1151445 · Cited by 12
“In recent years, the Mediterranean diet, which focuses on olive oil, vegetables, fruits, nuts, and seeds, has been praised as the most comprehensive dietary pattern and has swept the world (9).”
BackgroundDietary Manipulations for Nonalcoholic Fatty Liver Disease (NAFLD)
Cheah, M. C. C., McCullough, A. J., & Goh, G. B. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813822-9.00005-9 · Cited by 13
Adherence to Mediterranean diet and subsequent cognitive decline in men with cardiovascular disease
Lutski, M., Weinstein, G., Ben-Zvi, S., Goldbourt, U., & Tanné, D. (2020) · Nutritional Neuroscience · doi:10.1080/1028415x.2020.1715049 · Cited by 11
“Thus, in our sample of individuals with a history of CVD, adherence to the Mediterranean diet may decrease existing vascular burden or prevent additional vascular injury, which in turn lead to improved cognitive performance and reduced decline [17].”
BackgroundInfluentialNutraceuticals in the Management of Cardiovascular Risk Factors: Where is the Evidence?
Russell, C., Keshavamurthy, S., & Saha, S. P. (2021) · Cardiovascular & Haematological Disorders - Drug Targets · doi:10.2174/1871529x21666211201104124 · Cited by 12
Metadata
- Authors
- Widmer, R. J., Flammer, A. J., Lerman, L. O., & Lerman, A.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Lerman, Amir
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 128
- Issue
- 3
- Pages
- 229-238
- ISSN
- 0002-9343 (ISSN-L)
- PMC
- PMC4339461
- OpenAlex
- W2066595212
- Cited by
- 963
- References
- 122
- Citations by year
- 2026: 48 · 2025: 86 · 2024: 109 · 2023: 140 · 2022: 109 · 2021: 114 · 2020: 151 · 2019: 60 · 2018: 44 · 2017: 41 · 2016: 35 · 2015: 25
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PASMP3_132551)
- National Institutes of Health (92954, 085307)
- Swiss Re Foundation
- Universität Zürich
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Keywords
- Mediterranean diet, cardiovascular disease prevention, cardioprotection, olive oil, monounsaturated fatty acids, fish consumption, whole grains, Fabaceae, nuts, moderate drinking, cardiovascular risk factors, inflammatory markers, cardiovascular mortality, food components
- MeSH terms
- Cardiovascular Diseases, Humans, Metabolism, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Diet, Mediterranean, Observational Studies as Topic
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