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reference
Sofi F, Abbate R, Gensini GF, Casini A. Gathering evidence for the health benefits of adhering to the Mediterranean diet: an updated systematic review and meta-analysis.Am J Clin Nutr. 2010;92(5):1189-1196.
Study design
This latest study by Francesco Sofi added data from seven prospective studies published in the past two years to an earlier meta-analysis from 2008. Statistical analysis of the compiled data correlated adherence to a Mediterranean diet with the relative risk of various diseases and the risk of all-cause mortality. These new additions included 1 all-cause mortality study, 3 cardiovascular incidence or mortality studies, 1 cancer incidence or mortality study, and 2 neurodegenerative disease studies.
Participant
The number of subjects whose data were compiled varied depending on the condition. Regarding the incidence and mortality of cardiovascular diseases, a total of 534,064 subjects with 8,739 events were recorded for analysis. For cancer incidence and mortality, there were 1,006,410 subjects and 11,378 events. For neurodegenerative diseases, there were 136,235 test subjects and 1,074 cases from which conclusions could be drawn. The earlier meta-analysis from 2008 used data from 12 qualifying studies published between 1966 and 2008 with a total of 1,574,299 subjects.1
Study intervention
Adherence to a Mediterranean diet was defined using scores that assessed the concordance of the subject's dietary pattern with the traditional Mediterranean dietary pattern. The 7 to 9 different dietary characteristics were assigned values of zero or 1, using the median consumption of the study participants as the divider. People whose consumption of typical Mediterranean diet (vegetables, fruits, beans, grains, fish, olive oil and moderate consumption of red wine with meals) was above the median consumption received 1 point for each characteristic in which they were above the average. Those whose consumption was below the median received a zero score. Individuals whose consumption patterns of components not considered part of a Mediterranean diet (red and processed meat, poultry, eggs or dairy products) were above the median also received a zero, while those above or below the median received 1 point for that category. Different studies differed in the total number of food categories assessed. While the lowest score was always zero, the highest possible score varied between studies between 7 and 9 points for greatest adherence.
Primary outcome measures
The study calculated changes in the relative risk of occurrence or mortality from cardiovascular disease, cancer or neurodegenerative diseases associated with greater adherence to a Mediterranean diet. The relative risk of all-cause mortality was also calculated.
Key findings
This paper is an update of Sofi et al. 2008 and adds data from newly published studies. The increased amount of data did not have a significant impact on Sofi's original findings. This new meta-analysis showed that two percentage points higher adherence to the Mediterranean diet was associated with a significant reduction in all-cause mortality [relative risk (RR)=0.92; 95% CI: 0.90, 0.94] cardiovascular incidence or mortality (RR = 0.90; 95% CI: 0.87, 0.93), cancer incidence or mortality (RR = 0.94; 95% CI: 0.92, 0.96) and neurodegenerative diseases (RR = 0.87, 95 % CI: 0.81). , 0.94).
Effects on practice
The exact definition of the Mediterranean diet is frustratingly vague. It is a concept rather than a defined intervention. It is clear that this diet contains elements that are beneficial to health. It is also clear that neither precision is required nor major dietary changes are required to achieve benefit. To achieve the minimal 2-point increase in adherence score required to achieve significant benefit, only improvement in 2 of 7 or 9 different categories was required. For example, to achieve a two-point increase in adherence, one might only need to increase fish consumption above the mean in the cohort of subjects in the study and decrease red meat consumption below the mean in the cohort.
Someone who starts a diet that is far from the Mediterranean pattern could easily score 0 and increase their score by 7 to 9 points with a change in their eating habits.
Someone who starts a diet that is far from the Mediterranean pattern could easily score 0 and increase their score by 7 to 9 points with a change in their eating habits.