Health Benefits of Mediterranean Diet - PMC - NCBI
There is also evidence of a potential role of the Mediterranean diet in preventing certain cancers [9]. Finally, a new field of research has ...
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6. Becerra-Tomás N., Blanco Mejía S., Viguiliouk E., Khan T., Kendall C.W.C., Kahleova H., Rahelić D., Sievenpiper J.L., Salas-Salvadó J. Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials. Crit. Rev. Food Sci. Nutr. 2019:1–21. doi: 10.1080/10408398.2019.1565281. [ PubMed] [ <anchor>CrossRef</anchor>] [ Google Scholar]
Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials: Critical Reviews in Food Science and Nutrition: Vol 60 , No 7 - Get Access
Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials: Critical Reviews in Food Science and Nutrition: Vol 60 , No 7 - Get Access

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

[Nerea Becerra-Tomás](/author/Becerra-Tom%C3%A1s%2C+Nerea) Unitat de Nutrició, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Reus, Spain; ;Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain; ;Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; ;Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain; [View further author information](#Funding)
,
[Sonia Blanco Mejía](/author/Blanco+Mej%C3%ADa%2C+Sonia) Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ;Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; [View further author information](#Funding)
,
[Effie Viguiliouk](/author/Viguiliouk%2C+Effie) Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ;Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; [View further author information](#Funding)
,
[Tauseef Khan](/author/Khan%2C+Tauseef) Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ;Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; [View further author information](#Funding)
,
[Cyril W.C. Kendall](/author/Kendall%2C+Cyril+W+C) Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ;Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; ;College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; [View further author information](#Funding)
,
[Hana Kahleova](/author/Kahleova%2C+Hana) Institute for Clinical and Experimental Medicine, Prague, Czech Republic; ;Physicians Committee for Responsible Medicine, Washington, DC, USA; [View further author information](#Funding)
,
[Dario Rahelić](/author/Raheli%C4%87%2C+Dario) Department of Endocrinology, Diabetes and Clinical Pharmacology, Dubrava University Hospital, Zagreb, Croatia; ;School of Medicine, University of Zagreb, Zagreb, Croatia; [View further author information](#Funding)
,
[John L. Sievenpiper](/author/Sievenpiper%2C+John+L) Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ;Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; ;Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada [View further author information](#Funding)
&
[Jordi Salas-Salvadó](/author/Salas-Salvad%C3%B3%2C+Jordi) Unitat de Nutrició, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Reus, Spain; ;Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain; ;Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; ;Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain; Correspondence[jordi.salas@urv.cat](mailto:jordi.salas@urv.cat)

[![ORCID Icon](/templates/jsp/_style2/_tandf/images/orcid.svg)http://orcid.org/0000-0003-2700-7459](http://orcid.org/0000-0003-2700-7459) [View further author information](#Funding)
[![ORCID Icon](/templates/jsp/_style2/_tandf/images/orcid.svg)](http://orcid.org/0000-0003-2700-7459) show all

Pages 1207-1227
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Published online: 24 Jan 2019

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## 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](/keyword/Mediterranean+diet)
- [cardiovascular disease](/keyword/cardiovascular+disease)
- [cardiovascular mortality](/keyword/cardiovascular+mortality)
- [diabetes](/keyword/diabetes)
- [meta-analysis](/keyword/meta-analysis)

## Additional information

### Funding

The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) commissioned this systematic review and meta-analysis and provided funding and logistical support for meetings as part of their development of clinical practice guidelines for nutrition therapy. This work was supported by the Canadian Institutes of Health Research (funding reference number, 129920) through the Canada-wide Human Nutrition Trialists’ Network (NTN). The Diet, Digestive tract, and Disease (3-D) Centre, funded through the Canada Foundation for Innovation (CFI) and the Ministry of Research and Innovation’s Ontario Research Fund (ORF), provided the infrastructure for the conduct of this project. John L Sievenpiper was funded by a PSI Graham Farquharson Knowledge Translation Fellowship, Canadian Diabetes Association Clinician Scientist award, CIHR INMD/CNS New Investigator Partnership Prize, and Banting & Best Diabetes Centre Sun Life Financial New Investigator Award. With the exception of the Clinical Practice Guidelines Committee of the DNSG of the EASD, none of the sponsors had a role in any aspect of the present study, including design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, approval of the manuscript or decision to publish.

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