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Meta-Analysis
. 2016 Aug 10;11(8):e0159252.
doi: 10.1371/journal.pone.0159252. eCollection 2016.

Effects of the Mediterranean Diet on Cardiovascular Outcomes-A Systematic Review and Meta-Analysis

Thaminda Liyanage  1   2 , Toshiharu Ninomiya  1 , Amanda Wang  1 , Bruce Neal  1 , Min Jun  1   3 , Muh Geot Wong  1   2 , Meg Jardine  1   4 , Graham S Hillis  1 , Vlado Perkovic  1
Affiliations
Meta-Analysis

Effects of the Mediterranean Diet on Cardiovascular Outcomes-A Systematic Review and Meta-Analysis

Thaminda Liyanage et al. PLoS One. .

Abstract

Background: A Mediterranean dietary pattern is widely recommended for the prevention of chronic disease. We sought to define the most likely effects of the Mediterranean diet on vascular disease and mortality.

Methods: We searched MEDLINE, EMBASE and the Cochrane Central Register without language restriction for randomized controlled trials comparing Mediterranean to control diets. Data on study design, patient characteristics, interventions, follow-up duration, outcomes and adverse events were sought. Individual study relative risks (RR) were pooled to create summary estimates.

Results: Six studies with a total of 10950 participants were included. Effects on major vascular events (n = 477), death (n = 693) and vascular deaths (n = 315) were reported for 3, 5 and 4 studies respectively. For one large study (n = 1000) there were serious concerns about the integrity of the data. When data for all studies were combined there was evidence of protection against major vascular events (RR 0.63, 95% confidence interval 0.53-0.75), coronary events (0.65, 0.50-0.85), stroke (0.65, 0.48-0.88) and heart failure (0.30, 0.17-0.56) but not for all-cause mortality (1.00, 0.86-1.15) or cardiovascular mortality (0.90, 0.72-1.11). After the study of concern was excluded the benefit for vascular events (0.69, 0.55-0.86) and stroke (0.66, 0.48-0.92) persisted but apparently positive findings for coronary events (0.73, 0.51-1.05) and heart failure (0.25, 0.05-1.17) disappeared.

Conclusion: The Mediterranean diet may protect against vascular disease. However, both the quantity and quality of the available evidence is limited and highly variable. Results must be interpreted with caution.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests. Thaminda Liyanage, Toshiharu Ninomiya, Amanda Wong, Min Jun and Muh Geot Wong have no conflicts of interests to declare. Vlado Perkovic has no conflicts of interest related to this work, but has served on advisory boards and/or received funding for trials from Abbvie, Astellas, Astra Zeneca, Baxter, Boehringer Ingelheim, GSK, Janssen, Pfizer, Roche, Servier, and Vitae. Meg Jardine has no conflicts of interest related to this work but has received funding for trials from Baxter, Gambro, Shire and Janssen. Bruce Neal has no conflicts of interest related to this work but has served on advisory boards and/or received funding for trials from Abbott, Abbvie, Australian Food and Grocery Council, Bupa Australia, Compumedics, Dr Reddy’s Laboratories, Janssen, Novartis, Pharmacy Guild of Australia, ResMed, Roche, Servier and United Healthcare Group. Graham Hillis has no conflicts of interest related to this work but has received research funding support or served on advisory boards, trial steering or end-point adjudication committees for Astra Zeneca, Biotronik, Boehringer Ingelheim, Bristol-Myers Squibb, BUPA Australia, Janssen, and Pfizer. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Identification process for eligible studies.
Fig 2
Fig 2. Forrest plot of the included studies showing relative risk of Mediterranean diet compared to control diet by various outcome measures (Fixed effects model analysis).
See this image and copyright information in PMC

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