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

• Published in: Critical reviews in food science and nutrition 2020-04, Vol.60 (7), p.1207-1227
• Main Authors: Becerra-Tomás, Nerea, Blanco Mejía, Sonia, Viguiliouk, Effie, Khan, Tauseef, Kendall, Cyril W.C., Kahleova, Hana, Rahelić, Dario, Sievenpiper, John L., Salas-Salvadó, Jordi
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cardiovascular Diseases - prevention & control; cardiovascular mortality; Cerebral infarction; Clinical trials; Cohort analysis; Cohort Studies; Confidence intervals; Coronary artery disease; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diet; Diet, Mediterranean - statistics & numerical data; Health risk assessment; Heart diseases; Humans; Mediterranean diet; Meta-analysis; Mortality; Myocardial infarction; Nutrition; Nutrition therapy; Prevention; Randomization; Randomized Controlled Trials as Topic; Risk assessment; Stroke; Systematic review
• ISSN: 1040-8398; 1549-7852
• DOI: 10.1080/10408398.2019.1565281

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.