TY - JOUR
T1 - The Mediterranean Diet and Cardiovascular Disease
T2 - Gaps in the Evidence and Research Challenges
AU - Temple, Norman J.
AU - Guercio, Valentina
AU - Tavani, Alessandra
N1 - Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - In this article, we critically evaluate the evidence relating to the effects of the Mediterranean diet (MD) on the risk of cardiovascular disease (CVD). Strong evidence indicating that the MD prevents CVD has come from prospective cohort studies. However, there is only weak supporting evidence from randomized controlled trials (RCTs) as none have compared subjects who follow an MD and those who do not. Instead, RCTs have tested the effect of 1 or 2 features of the MD. This was the case in the Prevencion con Dieta Mediterránea (PREDIMED) study: the major dietary change in the intervention groups was the addition of either extravirgin olive oil or nuts. Meta-analyses generally suggest that the MD causes small favorable changes in risk factors for CVD, including blood pressure, blood glucose, and waist circumference. However, the effect on blood lipids is generally weak. The MD may also decrease several biomarkers of inflammation, including C-reactive protein. The 7 key features of the MD can be divided into 2 groups. Some are clearly protective against CVD (olive oil as the main fat; high in legumes; high in fruits/vegetables/nuts; and low in meat/meat products and increased in fish). However, other features of the MD have a less clear relationship with CVD (low/moderate alcohol use, especially red wine; high in grains/cereals; and low/moderate in milk/dairy). In conclusion, the evidence indicates that the MD prevents CVD. There is a need for RCTs that test the effectiveness of the MD for preventing CVD. Key design features for such a study are proposed.
AB - In this article, we critically evaluate the evidence relating to the effects of the Mediterranean diet (MD) on the risk of cardiovascular disease (CVD). Strong evidence indicating that the MD prevents CVD has come from prospective cohort studies. However, there is only weak supporting evidence from randomized controlled trials (RCTs) as none have compared subjects who follow an MD and those who do not. Instead, RCTs have tested the effect of 1 or 2 features of the MD. This was the case in the Prevencion con Dieta Mediterránea (PREDIMED) study: the major dietary change in the intervention groups was the addition of either extravirgin olive oil or nuts. Meta-analyses generally suggest that the MD causes small favorable changes in risk factors for CVD, including blood pressure, blood glucose, and waist circumference. However, the effect on blood lipids is generally weak. The MD may also decrease several biomarkers of inflammation, including C-reactive protein. The 7 key features of the MD can be divided into 2 groups. Some are clearly protective against CVD (olive oil as the main fat; high in legumes; high in fruits/vegetables/nuts; and low in meat/meat products and increased in fish). However, other features of the MD have a less clear relationship with CVD (low/moderate alcohol use, especially red wine; high in grains/cereals; and low/moderate in milk/dairy). In conclusion, the evidence indicates that the MD prevents CVD. There is a need for RCTs that test the effectiveness of the MD for preventing CVD. Key design features for such a study are proposed.
KW - Mediterranean diet
KW - cardiovascular disease
KW - nuts
KW - olive oil
UR - http://www.scopus.com/inward/record.url?scp=85064316752&partnerID=8YFLogxK
U2 - 10.1097/CRD.0000000000000222
DO - 10.1097/CRD.0000000000000222
M3 - Review article
C2 - 30946700
AN - SCOPUS:85064316752
SN - 1061-5377
VL - 27
SP - 127
EP - 130
JO - Cardiology in Review
JF - Cardiology in Review
IS - 3
ER -