title: Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Adherence to a Mediterranean diet is associated with significant improvements in health status. However, to date no systematic review and meta-analysis has summarized the effects of Mediterranean diet adherence on the risk of type 2 diabetes mellitus.
  
  
  METHODS
  Electronic searches for randomized controlled trials and cohort studies were performed in MEDLINE, SCOPUS, EMBASE and the Cochrane Trial Register until 2 April 2014. Pooled effects were calculated by an inverse-variance random-effect meta-analysis using the statistical software Review Manager 5.2 by the Cochrane Collaboration.
  
  
  METHODS
  Meta-analysis of randomized controlled trials and cohort studies.
  
  
  METHODS
  
  
  
  METHODS
  19+years of age.
  
  
  RESULTS
  One randomized controlled trial and eight prospective cohort studies (122 810 subjects) published between 2007 and 2014 were included for meta-analysis. For highest v. lowest adherence to the Mediterranean diet score, the pooled risk ratio was 0.81 (95 % CI 0.73, 0.90, P<0.0001, I 2=55 %). Sensitivity analysis including only long-term studies confirmed the results of the primary analysis (pooled risk ratio=0.75; 95 % CI 0.68, 0.83, P<0.00001, I 2=0 %). The Egger regression test provided no evidence of substantial publication bias (P=0.254).
  
  
  CONCLUSIONS
  Greater adherence to a Mediterranean diet is associated with a significant reduction in the risk of diabetes (19 %; moderate quality evidence). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of type 2 diabetes mellitus.
authors.affiliation: University of Vienna, Faculty of Life Sciences,Department of Nutritional Sciences,Althanstraße 14 UZA II,A-1090 Vienna,Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Schwingshackl
authors.affiliation: University of Vienna, Faculty of Life Sciences,Department of Nutritional Sciences,Althanstraße 14 UZA II,A-1090 Vienna,Austria.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Missbach
authors.affiliation: University of Vienna, Faculty of Life Sciences,Department of Nutritional Sciences,Althanstraße 14 UZA II,A-1090 Vienna,Austria.
authors.forename: Jürgen
authors.initials: J
authors.lastname: König
authors.affiliation: University of Vienna, Faculty of Life Sciences,Department of Nutritional Sciences,Althanstraße 14 UZA II,A-1090 Vienna,Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Hoffmann
mesh_terms: D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D019317:Evidence-Based Medicine; D006801:Humans; D008875:Middle Aged; D018673:Nutrition Policy; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D012306:Risk
keywords: Systematic review