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Francesco Sofi, researcher in clinical nutrition1,2,5, Francesca Cesari, researcher1, Rosanna Abbate, full professor of internal medicine1,5, Gian Franco Gensini, full professor of internal medicine3, Alessandro Casini, associate professor of clinical nutrition2,4,5

Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Viale Morgagni 85, 50134 Florence, Italy, 2 Regional Agency for Nutrition, Azienda

Ospedaliero-Universitaria Careggi, Florence, 3 Don Carlo Gnocchi Foundation, Onlus IRCCS, Impruneta, Florence, 4 Department of Clinical Pathophysiology, Unit of Clinical Nutrition, University of Florence, 5 Centro Interdipartimentale per la Ricerca e la Valorizzazione degli Alimenti (CeRA), University of FlorenceCorrespondence to: F Sofi This email address is being protected from spambots. You need JavaScript enabled to view it.


Objective To systematically review all the prospective cohort studies that have analysed the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases in a primary prevention setting.

Design Meta-analysis of prospective cohort studies.

Data sources English and non-English publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1966 to 30 June 2008.

Studies reviewed Studies that analysed prospectively the association between adherence to a Mediterranean diet, mortality, and incidence of diseases; 12 studies, with a total of 1 574 299 subjects followed for a time ranging from three to 18 years were included.

Results The cumulative analysis among eight cohorts (514 816 subjects and 33 576 deaths) evaluating overall mortality in relation to adherence to a Mediterranean diet showed that a two point increase in the adherence score was significantly associated with a reduced risk of mortality (pooled relative risk 0.91, 95% confidence interval 0.89 to 0.94). Likewise, the analyses showed a beneficial role for greater adherence to a Mediterranean diet on cardiovascular mortality (pooled relative risk 0.91, 0.87 to 0.95), incidence of or mortality from cancer (0.94, 0.92 to 0.96), and incidence of Parkinson's disease and Alzheimer's disease (0.87, 0.80 to 0.96).

Conclusions Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson's disease and Alzheimer's disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.


The Mediterranean diet, representing the dietary pattern usually consumed among the populations bordering the Mediterranean sea, has been widely reported to be a model of healthy eating for its contribution to a favourable health status and a better quality of life.1 2 Since the first data from the seven countries study,3 several studies in different populations have established a beneficial role for the main components of the Mediterranean diet on the occurrence of cardiovascular diseases and chronic degenerative diseases.2 4 However, research interest in this field over the past years has been focused on estimating adherence to the whole Mediterranean diet rather than analysing the individual components of the dietary pattern in relation to the health status of the population.5 This because the analyses of single nutrients ignore important interactions between components of a diet and, more importantly, because people do not eat isolated nutrients. Hence, dietary scores estimating adherence to a Mediterranean diet, devised a priori on the basis of the characteristic components of the traditional diet of the Mediterranean area, have been found to be associated with a reduction of overall mortality and mortality from cardiovascular diseases and cancer.6 The aim of this study was to do a systematic review with meta-analysis of all the available prospective cohort studies that have assessed the association between adherence to a Mediterranean diet and adverse outcomes, in order to establish the role of adherence to a Mediterranean diet in primary prevention.
BMJ 5/08

Copyright © 2009 American Association for Geriatric Psychiatry

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