title: A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: Are individual components equal?
abstract: Many studies have reported that higher adherence to Mediterranean diet may decrease cardiovascular disease (CVD) incidence and mortality. We performed a meta-analysis to explore the association in prospective studies and randomized control trials (RCTs) between Mediterranean diet adherence and CVD incidence and mortality. The PubMed database was searched up to June 2014. A total of 17 studies were extracted and 11 qualified for the quantitative analysis. Individuals in the highest quantile of adherence to the diet had lower incidence [relative risk (RR): 0.76, 95% confidence intervals (CI): 0.68, 0.83] and mortality (RR: 0.76, 95% CI: 0.68, 0.83) from CVD compared to those least adherent. A significant reduction of risk was found also for coronary heart disease (CHD) (RR: 0.72, 95% CI: 0.60, 0.86), myocardial infarction (MI) (RR: 0.67; 95% CI: 0.54, 0.83), and stroke (RR: 0.76; 95% CI: 0.60, 0.96) incidence. Pooled analyses of individual components of the diet revealed that the protective effects of the diet appear to be most attributable to olive oil, fruits, vegetables, and legumes. An average reduced risk of 40% for the aforementioned outcomes has been retrieved when pooling results of RCTs. A Mediterranean dietary pattern is associated with lower risks of CVD incidence and mortality, including CHD and MI. The relative effects of specific food groups should be further investigated.
authors.affiliation: a Integrated Cancer Registry of Catania-Messina-Siracusa-Enna , Catania , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grosso
authors.affiliation: b Department of Medical, Surgical Sciences, and Advanced Technologies "G.F. Ingrassia," Section of Hygiene and Preventive Medicine, University of Catania , Catania , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Marventano
authors.affiliation: c Department of Environmental Health , Environmental & Occupational Medicine & Epidemiology, Harvard TH Chan School of Public Health , Boston , Massachusetts , USA.|d St. Elizabeth's Medical Center , Tufts University School of Medicine , Boston , Massachusetts , USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Yang
authors.affiliation: e Department of Epidemiology and Population Studies , Jagiellonian University Medical College , Krakow , Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Micek
authors.affiliation: e Department of Epidemiology and Population Studies , Jagiellonian University Medical College , Krakow , Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pajak
authors.affiliation: f Department of Food Science , "Federico II" University Medical School , Naples , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Scalfi
authors.affiliation: g Department of Biomedical and Biotechnological Sciences, Section of Pharmacology and Biochemistry , University of Catania , Catania , Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Galvano
authors.affiliation: c Department of Environmental Health , Environmental & Occupational Medicine & Epidemiology, Harvard TH Chan School of Public Health , Boston , Massachusetts , USA.|h The Cambridge Health Alliance, Harvard Medical School , Cambridge , Massachusetts , USA.
authors.forename: Stefanos N
authors.initials: SN
authors.lastname: Kales
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003327:Coronary Disease; D038441:Diet, Mediterranean; D006801:Humans; D011446:Prospective Studies; D020521:Stroke
keywords: Prevention; fruit; legumes; olive oil; prospective cohort studies; randomized controlled trials; vegetables