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Crit Rev Food Sci Nutr. 2019 Jan 24:1-21. doi: 10.1080/10408398.2019.1565281. [Epub ahead of print]

Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials.

Author information

1
a Unitat de Nutrició, Departament de Bioquímica i Biotecnologia , Universitat Rovira i Virgili , Reus , Spain.
2
b Institut d'Investigació Sanitària Pere Virgili (IISPV) , Reus , Spain.
3
c Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) , Institute of Health Carlos III , Madrid , Spain.
4
d Nutrition Unit , University Hospital of Sant Joan de Reus , Reus , Spain.
5
e Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada.
6
f Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre , St. Michael's Hospital , Toronto , Ontario , Canada.
7
g College of Pharmacy and Nutrition , University of Saskatchewan , Saskatoon , Saskatchewan , Canada.
8
h Institute for Clinical and Experimental Medicine , Prague , Czech Republic.
9
i Physicians Committee for Responsible Medicine , Washington , DC , USA.
10
j Department of Endocrinology, Diabetes and Clinical Pharmacology , Dubrava University Hospital , Zagreb , Croatia.
11
k School of Medicine , University of Zagreb , Zagreb , Croatia.
12
l Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , Ontario , Canada.

Abstract

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.

KEYWORDS:

Mediterranean diet; cardiovascular disease; cardiovascular mortality; diabetes; meta-analysis

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