Cited by 762Nutritional Studies and DietDietary Effects on HealthNutrition, Genetics, and Disease

The DOI matches its Crossref record; 99 of the 103 references it cites were found in a registry or an index; 8 of the 129 sources its claims cite were checked for support.

Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms

Open access
Tosti, Valeria, Bertozzi, Beatrice, Fontana, Luigi·2018·The Journals of Gerontology: Series A

Abstract

Consuming a Mediterranean diet rich in minimally processed plant foods has been associated with a reduced risk of developing multiple chronic diseases and increased life expectancy. Data from several randomized clinic trials have demonstrated a beneficial effect in the primary and secondary prevention of cardiovascular disease, type 2 diabetes, atrial fibrillation, and breast cancer. The exact mechanism by which an increased adherence to the traditional Mediterranean diet exerts its favorable effects is not known. However, accumulating evidence indicates that the five most important adaptations induced by the Mediterranean dietary pattern are: (a) lipid-lowering effect, (b) protection against oxidative stress, inflammation and platelet aggregation, (c) modification of hormones and growth factors involved in the pathogenesis of cancer, (d) inhibition of nutrient sensing pathways by specific amino acid restriction, and (e) gut microbiota-mediated production of metabolites influencing metabolic health. More studies are needed to understand how single modifications of nutrients typical of the Mediterranean diet interact with energy intake, energy expenditure, and the microbiome in modulating the key mechanisms that promote cellular, tissue, and organ health during aging.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes evidence that greater adherence to a traditional Mediterranean diet is associated with reduced risk of chronic disease and mortality, and proposes five metabolic and molecular mechanisms for these benefits. It synthesizes epidemiological, randomized clinical trial, animal, and molecular findings, while noting that the exact mechanisms remain incompletely understood.

Key findings

  • In epidemiological studies cited, higher adherence to a traditional Mediterranean diet among 22,043 men and women was associated with lower total, cardiac, and cancer mortality; in 2,339 European men and women aged 70–90 years, adherence was associated with a 23% lower rate of all-cause mortality.
  • Randomized trials cited include the Lyon Diet Heart Study (605 men and women after myocardial infarction), which reported a 70% reduction in all-cause mortality and 73% reduction in coronary heart disease mortality; the Indo-Mediterranean diet trial (1,000 Indian patients at high risk or with existing coronary heart disease), which reported approximately 50% reduction in nonfatal myocardial infarction and approximately 60% reduction in sudden cardiac death; and PREDIMED (7,447 men and women at high cardiometabolic risk), which reported 288 primary-outcome events and approximately 30% relative risk reduction, with only stroke risk reaching statistical significance among combined primary endpoint components.
  • The paper proposes five main mechanisms: lipid-lowering; protection against oxidative stress, inflammation, and platelet aggregation; modification of hormones and growth factors involved in cancer; inhibition of nutrient sensing pathways by specific amino acid restriction; and gut microbiota-mediated production of metabolites influencing metabolic health.
  • It reports dietary differences such as saturated fat at approximately 8% of energy, at least 14 g vegetable fiber per 1,000 kcal, total protein intake about 20% lower and animal protein 50–60% lower than a Western diet, methionine intake about 40% lower, branched-chain amino acid intake 20–30% lower, and insoluble fiber 30 vs 14 g/day.

Methods

  • Narrative review; no new primary data are presented.
  • It synthesizes epidemiological studies, randomized clinical trials, animal studies, and molecular studies, including human samples such as 22,043; 2,339; 605; 1,000; and 7,447 participants in cited studies.
  • Main analysis is a qualitative synthesis of disease-risk evidence and proposed metabolic and molecular mechanisms.

Limitations

  • The paper states that the exact mechanism by which the traditional Mediterranean diet exerts its favorable effects is not known, and that more mechanistic studies are needed to understand interactions among calorie intake, single-nutrient modifications, the microbiome, and physical exercise.
  • The paper states that epidemiological studies are observational rather than experimental, and observed associations do not imply a cause–effect relationship.
  • Evident from the text: as a narrative review, it does not report a systematic search strategy, formal quality assessment, or meta-analysis, and its conclusions rely on cited literature and mechanistic hypotheses rather than new experimental testing.

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Integrity signals

Registry

Crossref · 10.1093/gerona/glx227

Cites

99 of 99 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

89 Not checked yet · 10 Own interpretation · 3 No basis given · 2 Partly supported · 1 Supported · 1 Not supported · 1 Own method · accuracy not yet measured

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  • It may state two separate claims as one. 58
  • Probably not a substantial claim. 10
62 of 62
  • The paper relies on this without support.

    Mechanisms observed in animal models and cell studies translate to humans.

    “In rodents, methionine restriction improves glucose metabolism, protects against obesity and hepatic steatosis, and reduces oxidative stress.”
  • The paper relies on this without support.

    Dietary adherence scores used in epidemiological studies validly capture adherence to the traditional Mediterranean diet.

    “In these studies, the adherence to the Mediterranean diet was calculated based on a dietary score, which integrated relatively high intakes of whole-grain cereals, beans, vegetables, fruits, nuts, fish, and monounsaturated fat oils; relatively low intakes of meat, including poultry, and dairy products; and moderate consumption of alcohol.”
  • The paper relies on this without support.

    The intake of methionine and other essential amino acids (leucine, isoleucine, valine, tryptophan) is 20–30% lower in the traditional Mediterranean diet than in the meat-, egg-, and dairy-rich Western diet.

    “Not only methionine but also the intake of other essential amino acids, such as leucine, isoleucine, valine, and tryptophan, is 20 to 30% lower in the traditional Mediterranean diet than in the meat, egg, and dairy rich Western diet.”
  • The paper relies on this without support.

    The availability of essential amino acids is sensed by multiple nutrient sensing pathways, the most important being mTOR and GCN2.

    “At the cellular level, the availability of essential amino acids is sensed by multiple nutrient sensing pathways, the most important being mTOR and GCN2.”
  • The paper relies on this without support.

    The traditional Mediterranean diet content of choline and l-carnitine is more than 50% lower than in a typical Western diet.

    “For example, the traditional Mediterranean diet content of choline and l-carnitine, which are abundant in red meat, eggs, and cheese, is more than 50% lower than in a typical Western diet.”
  • The paper relies on this without support.

    The Mediterranean diet has a very high content and bioavailability of fiber, particularly insoluble fiber, which is more than 2-fold higher than in a usual Western diet (30 vs 14 g/day).

    “Another major characteristic of the Mediterranean diet is its very high content and bioavailability of fiber, and in particular of insoluble fiber, which is more than 2-fold higher than in a usual Western diet (30 vs 14 g/day).”
  • The paper relies on this without support.

    High dietary fiber intake promotes modifications of the gut microbiota in both rodents and humans, with decreased Firmicutes and increased Bacteroidetes (in particular Bacteroides acidifaciens), which produces high levels of short-chain fatty acids, including acetate, propionate, or butyrate.

    “It has been shown that high dietary fiber intake promotes modifications of the gut microbiota in both rodents and humans, with decreased Firmicutes and increased Bacteroidetes (in particular Bacteroides acidifaciens), which produces high levels of short-chain fatty acids, including acetate, propionate, or butyrate.”
  • The paper relies on this without support.

    The traditional Mediterranean diet, unlike the typical North European and American diet, incorporates a wide range of minimally processed fiber-rich plant foods, packed with vitamins, minerals, and phytochemicals.

    “The traditional Mediterranean diet, unlike the typical North European and American diet, incorporates a wide range of minimally processed fiber-rich plant foods, packed with vitamins, minerals, and phytochemicals.”
  • The paper relies on this without support.

    The low consumption of fish, meat, eggs, and cheese in the traditional Mediterranean diet provides other essential nutrients, such as vitamin B12, which are lacking in an exclusive plant-based diet.

    “The low consumption of fish, meat, eggs, and cheese provides other essential nutrients, such as vitamin B12, which are lacking in an exclusive plant-based diet.”
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Metadata

Authors
Tosti, V., Bertozzi, B., & Fontana, L.
Affiliations
Washington University in St. Louis (US)
Corresponding author
Fontana, Luigi
Venue
The Journals of Gerontology: Series A
Published
2017-12-13
Volume
73
Issue
3
Pages
318-326
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
OpenAlex
W2774826291
Cited by
762
References
103
Citations by year
2026: 75 · 2025: 133 · 2024: 123 · 2023: 88 · 2022: 118 · 2021: 89 · 2020: 76 · 2019: 37 · 2018: 23
FWCI
6.04
Type
journal article
Language
en
Open access
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
Funders
  • Bakewell Foundation
  • Longer Life Foundation
  • National Center for Research Resources (UL1 RR024992)
  • NIH
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Physiology (medical) › Dietary Effects on Health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
Keywords
Mediterranean diet, health benefits, cardiovascular disease prevention, type 2 diabetes, atrial fibrillation, breast cancer, hypolipidemic effect, oxidative stress, inflammation, platelet aggregation, amino acid restriction, nutrient-sensing pathways, gut microbiota metabolites, aging, chronic disease prevention
MeSH terms
Amino Acids, Cardiovascular Diseases, Hormones, Humans, Hyperlipidemias, Inflammation, Life Expectancy, Neoplasms, Oxidative Stress, Intercellular Signaling Peptides and Proteins, Diet, Mediterranean, Microbiota

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