title: The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants.
abstract: OBJECTIVE
  The purpose of this work was to meta-analyze prospective studies that have evaluated the effect of a Mediterranean diet on the development of type 2 diabetes.
  
  
  METHODS
  PubMed, Embase and the Cochrane Central Register of Controlled Trials databases were searched up to 20 November 2013. English language publications were allocated; 17 original research studies (1 clinical trial, 9 prospective and 7 cross-sectional) were identified. Primary analyses were limited to prospective studies and clinical trials, yielding to a sample of 136,846 participants. A systematic review and a random effects meta-analysis were conducted.
  
  
  RESULTS
  Higher adherence to the Mediterranean diet was associated with 23% reduced risk of developing type 2 diabetes (combined relative risk for upper versus lowest available centile: 0.77; 95% CI: 0.66, 0.89). Subgroup analyses based on region, health status of participants and number of confounders controlling for, showed similar results. Limitations include variations in Mediterranean diet adherence assessment tools, confounders' adjustment, duration of follow up and number of events with diabetes.
  
  
  CONCLUSIONS
  The presented results are of major public health importance, since no consensus exists concerning the best anti-diabetic diet. Mediterranean diet could, if appropriately adjusted to reflect local food availability and individual's needs, constitute a beneficial nutritional choice for the primary prevention of diabetes.
authors.affiliation: School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
authors.forename: Efi
authors.initials: E
authors.lastname: Koloverou
authors.affiliation: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.affiliation: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Giugliano
authors.affiliation: School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. Electronic address: d.b.panagiotakos@usa.net.
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Panagiotakos
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005060:Europe / Q000453:epidemiology; D019317:Evidence-Based Medicine; D006293:Health Promotion; D006801:Humans; D015994:Incidence; D018673:Nutrition Policy; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Chronic disease; Diabetes; Dietary pattern; Incidence; Mediterranean; Meta-analysis; Review