Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials
Open accessAbstract
To update the clinical practice guidelines for nutrition therapy of the European Association for the Study of Diabetes, we conducted a systematic review and meta-analysis of prospective cohort studies and randomized clinical trials (RCTs) to evaluate the effect of the Mediterranean diet (MedDiet) on the prevention of cardiovascular disease (CVD) incidence and mortality. We searched Medline, EMBASE (through April 20, 2018) and Cochrane (through May 7, 2018) databases. Pooled relative risks (RRs) and 95% confidence interval (CI) were calculated by the generic inverse variance method. A total of 41 reports (3 RCTs and 38 cohorts) were included. Meta-analyses of RCTs revealed a beneficial effect of the MedDiet on total CVD incidence (RR: 0.62; 95% CI: 0.50, 0.78) and total myocardial infarction (MI) incidence (RR: 0.65; 95% CI: 0.49, 0.88). Meta-analyses of prospective cohort studies, which compared the highest versus lowest categories of MedDiet adherence, revealed an inverse association with total CVD mortality (RR: 0.79; 95% CI: 0.77, 0.82), coronary heart disease (CHD) incidence (RR: 0.73; 95% CI: 0.62, 0.86), CHD mortality (RR: 0.83; 95% CI: 0.75, 0.92), stroke incidence (RR: 0.80; 95% CI: 0.71, 0.90), stroke mortality (RR: 0.87; 95% CI: 0.80, 0.96) and MI incidence (RR: 0.73; 95% CI: 0.61, 0.88). The present study suggests that MedDiet has a beneficial role on CVD prevention in populations inclusive of individuals with diabetes.
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Mediterranean diets showed beneficial effects on liver lipid content and non-invasive markers of MASLD, but also on type 2 diabetes and cardiovascular outcomes.
“Besides macronutrient composition, overall healthy eating behavior may be relevant, as Mediterranean diets showed beneficial effects on liver lipid content and non-invasive markers of MASLD [62,63], but also on type 2 diabetes [64] and cardiovascular outcomes [65].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [64]
A recent meta-analysis found that adherence to the Mediterranean diet was associated with significantly lower incidences of coronary heart disease, myocardial infarction, stroke, and mortality from these causes.
“A recent meta-analysis of 38 cohort studies and 3 RCTs (including patients with type 2 diabetes) found that adherence to MD was associated with significantly lower incidences of CHD (RR 0.73; 95% CI 0.62 to 0.86), MI (RR 0.73; 95% CI 0.61 to 0.88), and stroke (RR 0.80; 95% CI 0.71 to 0.90), as well as of CHD mortality (RR 0.83; 95% CI 0.75 to 0.92), stroke mortality (RR 0.87; 95% CI 0.80 to 0.96),”
From Mediterranean Diet and Obesity-related Disorders: What is the Evidence? (2022) · cites this paper as [84]
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- Authors
- Becerra-Tomás, N., Blanco Mejía, S., Viguiliouk, E., Khan, T., Kendall, C. W. C., Kahleova, H., Rahelić, D., Sievenpiper, J. L., & Salas-Salvadó, J.
- Affiliations
- Unitat de Nutrició, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Reus, Spain;
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;
- St. Michael's Hospital (CA)
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic;
- University of Zagreb (HR)
- Venue
- Critical Reviews in Food Science and Nutrition
- Publisher
- Informa UK Limited
- Published
- 2019-01-24
- Volume
- 60
- Issue
- 7
- Pages
- 1207-1227
- ISSN
- 1040-8398 (ISSN-L)
- 1549-7852
- OpenAlex
- W2914823832
- Cited by
- 300
- References
- 13
- Citations by year
- 2026: 26 · 2025: 35 · 2024: 48 · 2023: 59 · 2022: 59 · 2021: 32 · 2020: 24 · 2019: 16 · 2018: 1
- FWCI
- 5.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Critical Reviews in Food Science and Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Figshare (cc-by)
- Funders
- Canadian Institutes of Health Research (129920)
- 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, diabetes mellitus, cardiovascular disease, cardiovascular mortality, myocardial infarction, coronary artery disease, stroke, dietary adherence, nutritional therapy, cardiovascular disease prevention
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Humans, Cohort Studies, Randomized Controlled Trials as Topic, Diet, Mediterranean
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