Mediterranean diet and health status: Active ingredients and pharmacological mechanisms

Schwingshackl, Lukas; Morze, Jakub; Hoffmann, Georg

doi:10.1111/bph.14778

Cited by 336

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Mediterranean diet and health status: Active ingredients and pharmacological mechanisms

Schwingshackl, Lukas, Morze, Jakub, Hoffmann, Georg·2020·British Journal of Pharmacology

DOI 10.1111/bph.14778

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Abstract

The Mediterranean diet (MedDiet) is one of the most widely described and evaluated dietary patterns in scientific literature. It is characterized by high intakes of vegetables, legumes, fruits, nuts, grains, fish, seafood, extra virgin olive oil, and a moderate intake of red wine. A large body of observational and experimental evidence suggests that higher adherence to the MedDiet is associated with lower risk of mortality, cardiovascular disease, metabolic disease, and cancer. Current mechanisms underlying the beneficial effects of the MedDiet include reduction of blood lipids, inflammatory and oxidative stress markers, improvement of insulin sensitivity, enhancement of endothelial function, and antithrombotic function. Most likely, these effects are attributable to bioactive ingredients such as polyphenols, monounsaturated and polyunsaturated fatty acids, or fibre. This review will focus on both established and less established mechanisms of action of biochemical compounds contained in a MedDiet. Linked Articles: This article is part of a themed section on The Pharmacology of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.6/issuetoc

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The Mediterranean diet is widely promoted with incomplete knowledge of the specific mechanisms underlying its protective effects.
“Furthermore, the Mediterranean diet is widely promoted with incomplete knowledge of the specific mechanisms underlying its protective effects, 214”
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Atherosclerosis--an inflammatory disease
Ross, R. (1999) · New England Journal of Medicine · doi:10.1056/nejm199901143400207 · Cited by 21,725
The Hallmarks of Aging
López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013) · Cell · doi:10.1016/j.cell.2013.05.039 · Cited by 14,982
Resveratrol improves health and survival of mice on a high-calorie diet
Baur, J. A., Pearson, K. J., Price, N. L., Jamieson, H. A., Lerin, C., Kalra, A., Prabhu, V. V., Allard, J. S., Lopez-Lluch, G., Lewis, K., et al. (2006) · Nature · doi:10.1038/nature05354 · Cited by 4,290
The impact of the gut microbiota on human health: an integrative view
Clemente, J. C., Ursell, L. K., Parfrey, L. W., & Knight, R. (2012) · Cell · doi:10.1016/j.cell.2012.01.035 · Cited by 3,710
Perceptions of epigenetics
Bird, A. (2007) · Nature · doi:10.1038/nature05913 · Cited by 3,011
Endothelial Function and Dysfunction: Testing and Clinical Relevance
Deanfield, J. E., Halcox, J. P., & Rabelink, T. J. (2007) · Circulation · doi:10.1161/circulationaha.106.652859 · Cited by 2,710
Human nutrition, the gut microbiome and the immune system
Kau, A. L., Ahern, P. P., Griffin, N. W., Goodman, A. L., & Gordon, J. I. (2011) · Nature · doi:10.1038/nature10213 · Cited by 2,588
High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome
De Filippis, F., Pellegrini, N., Vannini, L., Jeffery, I. B., La Storia, A., Laghi, L., Serrazanetti, D. I., Di Cagno, R., Ferrocino, I., Lazzi, C., et al. (2016) · Gut · doi:10.1136/gutjnl-2015-309957 · Cited by 1,638
Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies
Wood, A. M., Kaptoge, S., Butterworth, A. S., Willeit, P., Warnakula, S., Bolton, T., Paige, E., Paul, D. S., Sweeting, M., Burgess, S., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30134-x · Cited by 1,188
Autophagy and Neurodegeneration: Pathogenic Mechanisms and Therapeutic Opportunities
Menzies, F. M., Fleming, A., Caricasole, A., Bento, C. F., Andrews, S. P., Ashkenazi, A., Füllgrabe, J., Jackson, A., Jimenez Sanchez, M., Karabiyik, C., et al. (2017) · Neuron · doi:10.1016/j.neuron.2017.01.022 · Cited by 1,134 · cited 2×
“On the other hand, an updated Cochrane review found only a low to moderate certainty of evidence for interventions with the MedDiet in primary prevention of CVDs (Rees et al., 2019).”
Background
Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials
Dinu, M., Pagliai, G., Casini, A., & Sofi, F. (2018) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2017.58 · Cited by 1,016
Diet, metabolites, and “western-lifestyle” inflammatory diseases
Thorburn, A. N., Macia, L., & Mackay, C. R. (2014) · Immunity · doi:10.1016/j.immuni.2014.05.014 · Cited by 879
The Mediterranean Diet and Cardiovascular Health: A Critical Review
Martínez-González, M. A., Gea, A., & Ruiz-Canela, M. (2019) · Circulation Research · doi:10.1161/circresaha.118.313348 · Cited by 878
Leucocyte telomere length and risk of cardiovascular disease: systematic review and meta-analysis
Haycock, P. C., Heydon, E. E., Kaptoge, S., Butterworth, A. S., Thompson, A., & Willeit, P. (2014) · BMJ · doi:10.1136/bmj.g4227 · Cited by 856
Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies
Bechthold, A., Boeing, H., Schwedhelm, C., Hoffmann, G., Knüppel, S., Iqbal, K., De Henauw, S., Michels, N., Devleesschauwer, B., Schlesinger, S., et al. (2019) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2017.1392288 · Cited by 693 · cited 6×
“…a higher intake of fruit has been associated with lower risk of all‐cause mortality, CHD, stroke, Type 2 diabetes, CRC, hypertension, and adiposity (Bechthold et al., 2019; Schlesinger et al., 2019; Schwingshackl, Hoffmann, Lampousi, et al., 2017; Schwingshackl, Schwedhelm, Hoffmann, Knuppel,…”
BackgroundInfluentialSelf-citation
Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis
Schwingshackl, L., Schwedhelm, C., Galbete, C., & Hoffmann, G. (2017) · Nutrients · doi:10.3390/nu9101063 · Cited by 632
Self-citation
Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies ,
Schwingshackl, L., Schwedhelm, C., Hoffmann, G., Lampousi, A.-M., Knüppel, S., Iqbal, K., Bechthold, A., Schlesinger, S., & Boeing, H. (2017) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.117.153148 · Cited by 600
Self-citation
Olive oil and health: Summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008
López-Miranda, J., Pérez-Jiménez, F., Ros, E., De Caterina, R., Badimón, L., Covas, M. I., Escrich, E., Ordovás, J. M., Soriguer, F., Abiá, R., et al. (2010) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2009.12.007 · Cited by 520
Why do omega-3 fatty acids lower serum triglycerides?
Harris, W. S., & Bulchandani, D. (2006) · Current Opinion in Lipidology · doi:10.1097/01.mol.0000236363.63840.16 · Cited by 398 · cited 2×
“Although the exact mechanisms are not yet clear, there is evidence that some of the lipid‐modulating effects of resveratrol may be mediated through inhibition of the pleiotropic transcription factor NF‐κB and via activation of AMP‐activated protein kinase (AMPK) and sirtuin 1 (SIRT1; Voloshyna, Hussaini, & Reiss, 2012…”
Background
Plant sterols/stanols as cholesterol lowering agents: a meta-analysis of randomized controlled trials
Abumweis, S., Barake, R., & Jones, P. (2008) · Food & Nutrition Research · doi:10.3402/fnr.v52i0.1811 · Cited by 369
The TMAO-Producing Enzyme Flavin-Containing Monooxygenase 3 Regulates Obesity and the Beiging of White Adipose Tissue
Schugar, R. C., Shih, D. M., Warrier, M., Helsley, R. N., Burrows, A., Ferguson, D., Brown, A. L., Gromovsky, A. D., Heine, M., Chatterjee, A., et al. (2017) · Cell Reports · doi:10.1016/j.celrep.2017.05.077 · Cited by 291
Effects of Eicosapentaenoic Acid Versus Docosahexaenoic Acid on Serum Lipids: A Systematic Review and Meta-Analysis
Wei, M. Y., & Jacobson, T. A. (2011) · Current Atherosclerosis Reports · doi:10.1007/s11883-011-0210-3 · Cited by 284
Antioxidant effect of virgin olive oil in patients with stable coronary heart disease: A randomized, crossover, controlled, clinical trial
Fitó, M., Cladellas, M., de la Torre, R., Martí, J., Alcántara, M., Pujadas-Bastardes, M., Marrugat, J., Bruguera, J., López-Sabater, M. C., Vila, J., et al. (2005) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2004.12.036 · Cited by 258
Effects of Olive Oil on Markers of Inflammation and Endothelial Function—A Systematic Review and Meta-Analysis
Schwingshackl, L., Christoph, M., & Hoffmann, G. (2015) · Nutrients · doi:10.3390/nu7095356 · Cited by 252
Self-citation
The impact of the mediterranean diet on the cognitive functioning of healthy older adults: a systematic review and meta-analysis
Loughrey, D. G., Lavecchia, S., Brennan, S., Lawlor, B. A., & Kelly, M. E. (2017) · Advances in Nutrition · doi:10.3945/an.117.015495 · Cited by 250
Dietary metabolites and the gut microbiota: an alternative approach to control inflammatory and autoimmune diseases
Richards, J. L., Yap, Y. A., McLeod, K. H., Mackay, C. R., & Mariño, E. (2016) · Clinical & Translational Immunology · doi:10.1038/cti.2016.29 · Cited by 250
Evaluating Mediterranean diet and risk of chronic disease in cohort studies: an umbrella review of meta-analyses
Galbete, C., Schwingshackl, L., Schwedhelm, C., Boeing, H., & Schulze, M. B. (2018) · European Journal of Epidemiology · doi:10.1007/s10654-018-0427-3 · Cited by 212
Self-citation
Effects of the Mediterranean Diet on Cardiovascular Outcomes—A Systematic Review and Meta-Analysis
Liyanage, T., Ninomiya, T., Wang, A., Neal, B., Jun, M., Wong, M. G., Jardine, M., Hillis, G. S., & Perkovic, V. (2016) · PLOS ONE · doi:10.1371/journal.pone.0159252 · Cited by 210
Gut‐Derived Serum Lipopolysaccharide is Associated With Enhanced Risk of Major Adverse Cardiovascular Events in Atrial Fibrillation: Effect of Adherence to Mediterranean Diet
Pastori, D., Carnevale, R., Nocella, C., Novo, M., Santulli, M., Cammisotto, V., Menichelli, D., Pignatelli, P., & Violi, F. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.005784 · Cited by 182
Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake: A Systematic Review and Meta-analysis
Bloomfield, H. E., Koeller, E., Greer, N., MacDonald, R., Kane, R., & Wilt, T. J. (2016) · Annals of Internal Medicine · doi:10.7326/m16-0361 · Cited by 159
Adherence to the Mediterranean diet and risk of depression: a systematic review and updated meta-analysis of observational studies
Shafiei, F., Salari-Moghaddam, A., Larijani, B., & Esmaillzadeh, A. (2019) · Nutrition Reviews · doi:10.1093/nutrit/nuy070 · Cited by 147

Flagged first, then by citations

Research works printed but not linked: 123

10.1111/bph.13880 · DOI
10.1111/bph.13877 · DOI
10.1111/bph.13883 · DOI
10.1002/9780813804149.ch7 · DOI
10.3945/ajcn.113.073445 · DOI
10.1002/mnfr.201601080 · DOI
10.1017/S1368980011002515 · DOI
10.1111/j.1474-9728.2004.00097.x · DOI · Paper page
10.1089/rej.2011.1245 · DOI
10.1016/j.atherosclerosis.2006.01.011 · DOI
10.1055/s-0035-1546173 · DOI
10.1155/2018/9086947 · DOI
10.1056/NEJMra0903373 · DOI
10.1016/j.biochi.2009.01.008 · DOI · Paper page
10.1186/1471-2164-11-253 · DOI
10.1007/s12035-015-9516-4 · DOI
10.1016/j.vph.2014.10.001 · DOI
10.1007/s10654-019-00504-7 · DOI
10.1016/j.abb.2010.05.003 · DOI
10.1080/07315724.2008.10719705 · DOI
10.1093/carcin/bgy023 · DOI
10.1016/j.joca.2016.11.014 · DOI
10.3390/nu7115459 · DOI
10.2174/0929867324666170428103848 · DOI
10.1371/journal.pone.0057622 · DOI
10.1016/j.phrs.2019.03.005 · DOI
10.1007/978-3-319-29370-7 · DOI
10.2174/138161211795428876 · DOI
10.1016/j.jnutbio.2014.10.013 · DOI
10.1155/2017/4080364 · DOI
10.1038/nm.4222 · DOI · Paper page
10.1017/S0007114518002593 · DOI
10.1016/j.fct.2012.07.048 · DOI
10.1093/jn/138.8.1411 · DOI
10.1093/jn/136.2.466 · DOI · Paper page
10.1016/j.molcel.2017.05.032 · DOI
10.1111/pai.12071 · DOI
10.1080/09637486.2016.1221900 · DOI
10.3390/ijms11041365 · DOI
10.1016/j.jnutbio.2009.03.012 · DOI
10.1093/nar/gkx1121 · DOI
10.1097/00041433-200302000-00003 · DOI
10.1111/nure.12040 · DOI
10.1371/journal.pone.0109896 · DOI
10.1186/s12943-015-0450-x · DOI
10.1007/978-1-4939-7046-9_4 · DOI · Paper page
10.1038/embor.2012.142 · DOI
10.1016/j.atherosclerosis.2008.09.011 · DOI
10.1159/000364974 · DOI
10.1161/CIRCRESAHA.116.306819 · DOI · Paper page
10.1111/j.1753-4887.2008.00109.x · DOI
10.1002/ijc.11697 · DOI
10.1111/jgs.15251 · DOI
10.1093/abbs/gms108 · DOI · Paper page
10.1016/j.beem.2012.03.009 · DOI
10.3390/molecules21101374 · DOI
10.1007/s00394-016-1188-y · DOI
10.3945/ajcn.110.003251 · DOI
10.1016/j.neurobiolaging.2014.08.029 · DOI
10.1096/fj.06-6328com · DOI
10.1007/s00394-017-1490-3 · DOI
10.1016/j.pcad.2015.04.003 · DOI
10.1089/met.2014.0082 · DOI · Paper page
10.3390/ijms18112275 · DOI
Mensink R.(2016).Effects of saturated fatty acids on serum lipids and lipoproteins: A systematic review and regression analysis. World Health Organization.
10.1007/s11130-016-0534-9 · DOI
10.3109/07420528.2012.719967 · DOI
10.1111/j.1753-4887.2008.00075.x · DOI
10.1016/j.clnu.2012.08.002 · DOI
10.1016/j.cell.2011.10.026 · DOI
10.1016/j.arr.2017.11.001 · DOI
10.1083/jcb.201008167 · DOI
10.1016/j.jneb.2015.08.023 · DOI
Oliveras‐Ferraros C., 2011, Crude phenolic extracts from extra virgin olive oil circumvent de novo breast cancer resistance to HER1/HER2‐targeting drugs by inducing GADD45‐sensed cellular stress, G2/M arrest and hyperacetylation of Histone H3, International Journal of Oncology, 38, 1533
10.1111/j.1538-7836.2006.01963.x · DOI
10.1016/j.phymed.2013.05.002 · DOI
10.1159/000486586 · DOI
10.1016/j.clnu.2014.09.011 · DOI
10.1017/S0007114511007070 · DOI
10.1016/j.jnutbio.2014.01.009 · DOI · Paper page
10.3945/ajcn.111.027847 · DOI · Paper page
10.1093/gerona/61.2.107 · DOI
10.1093/ajcn/nqx070 · DOI · Paper page
10.2337/diacare.24.2.371 · DOI
Rees K., 2019, Mediterranean‐style diet for the primary and secondary prevention of cardiovascular disease, The Cochrane Database of Systematic Reviews, 3, Cd009825
10.1073/pnas.85.17.6465 · DOI
10.1007/978-3-319-18365-7_1 · DOI
10.1007/s00394-017-1582-0 · DOI · Paper page
10.1093/ajcn/86.2.341 · DOI
10.1016/j.jacc.2005.06.078 · DOI
10.1016/j.yexcr.2014.01.024 · DOI
10.1007/s11357-011-9223-7 · DOI
10.3945/an.114.007492 · DOI
10.1080/10408390701764732 · DOI
10.1093/advances/nmy092 · DOI
10.1016/j.numecd.2014.03.003 · DOI
10.1186/1476-511X-13-154 · DOI · Paper page
10.1007/s10654-017-0246-y · DOI · Paper page
10.2174/1381612822666161010121356 · DOI
10.1017/S1368980014001542 · DOI · Paper page
10.1017/S0029665118000125 · DOI
10.3945/an.117.017178 · DOI
10.1002/ijc.31198 · DOI
10.1002/jbt.21906 · DOI
10.1016/j.cmet.2007.08.014 · DOI · Paper page
10.1016/j.physbeh.2008.01.001 · DOI · Paper page
10.1016/j.jnutbio.2016.05.009 · DOI
10.1016/j.atherosclerosis.2017.12.012 · DOI
10.1056/NEJMoa025039 · DOI · Paper page
10.1136/bmj.311.7018.1457 · DOI
10.1002/biof.1399 · DOI
10.1152/ajpheart.00260.2010 · DOI
10.1093/gerona/glx082 · DOI
10.1007/s00394-004-0504-0 · DOI
10.1017/S0007114507876203 · DOI
10.1089/jmf.2012.0025 · DOI
10.1089/jmf.2011.0243 · DOI
10.1111/1750-3841.12555 · DOI
10.1139/cjpp-2016-0676 · DOI
10.2174/0929867321666140706130807 · DOI
10.1093/gerona/glv115 · DOI
10.3892/ijmm.2012.1156 · DOI
10.1016/j.ejphar.2011.03.045 · DOI

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Authors: Schwingshackl, L., Morze, J., & Hoffmann, G.
Affiliations: Institute for Evidence in Medicine, Faculty of Medicine and Medical Centre University of Freiburg Freiburg Germany
Department of Human Nutrition, Faculty of Food Sciences University of Warmia and Mazury Olsztyn Poland
Department of Nutritional Sciences University of Vienna Vienna Austria
ORCID: Schwingshackl, Lukas
Venue: British Journal of Pharmacology
Publisher: Wiley
Published: 2019-07-25
Volume: 177
Issue: 6
Pages: 1241-1257
ISSN: 0007-1188
1476-5381
DOI: 10.1111/bph.14778
Cited by: 336
References: 31
Language: en
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)

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Mediterranean diet and health status: Active ingredients and pharmacological mechanisms

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