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Crit Rev Food Sci Nutr. 2017 Oct 13;57(15):3218-3232. doi: 10.1080/10408398.2015.1107021.

A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: Are individual components equal?

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a Integrated Cancer Registry of Catania-Messina-Siracusa-Enna , Catania , Italy.
b Department of Medical, Surgical Sciences, and Advanced Technologies "G.F. Ingrassia," Section of Hygiene and Preventive Medicine, University of Catania , Catania , Italy.
c Department of Environmental Health , Environmental & Occupational Medicine & Epidemiology, Harvard TH Chan School of Public Health , Boston , Massachusetts , USA.
d St. Elizabeth's Medical Center , Tufts University School of Medicine , Boston , Massachusetts , USA.
e Department of Epidemiology and Population Studies , Jagiellonian University Medical College , Krakow , Poland.
f Department of Food Science , "Federico II" University Medical School , Naples , Italy.
g Department of Biomedical and Biotechnological Sciences, Section of Pharmacology and Biochemistry , University of Catania , Catania , Italy.
h The Cambridge Health Alliance, Harvard Medical School , Cambridge , Massachusetts , USA.


Many studies have reported that higher adherence to Mediterranean diet may decrease cardiovascular disease (CVD) incidence and mortality. We performed a meta-analysis to explore the association in prospective studies and randomized control trials (RCTs) between Mediterranean diet adherence and CVD incidence and mortality. The PubMed database was searched up to June 2014. A total of 17 studies were extracted and 11 qualified for the quantitative analysis. Individuals in the highest quantile of adherence to the diet had lower incidence [relative risk (RR): 0.76, 95% confidence intervals (CI): 0.68, 0.83] and mortality (RR: 0.76, 95% CI: 0.68, 0.83) from CVD compared to those least adherent. A significant reduction of risk was found also for coronary heart disease (CHD) (RR: 0.72, 95% CI: 0.60, 0.86), myocardial infarction (MI) (RR: 0.67; 95% CI: 0.54, 0.83), and stroke (RR: 0.76; 95% CI: 0.60, 0.96) incidence. Pooled analyses of individual components of the diet revealed that the protective effects of the diet appear to be most attributable to olive oil, fruits, vegetables, and legumes. An average reduced risk of 40% for the aforementioned outcomes has been retrieved when pooling results of RCTs. A Mediterranean dietary pattern is associated with lower risks of CVD incidence and mortality, including CHD and MI. The relative effects of specific food groups should be further investigated.


Prevention; fruit; legumes; olive oil; prospective cohort studies; randomized controlled trials; vegetables

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