Relationship between the Mediterranean dietary pattern and musculoskeletal health in children, adolescents, and adults: systematic review and evidence map

Abstract

An understanding of the modifiable effects of diet on bone and skeletal muscle mass and strength over the life course will help inform strategies to reduce age-related fracture risk. The Mediterranean diet is rich in nutrients that may be important for optimal musculoskeletal health. The aim of this systematic review was to investigate the relationship between a Mediterranean diet and musculoskeletal outcomes (fracture, bone density, osteoporosis, sarcopenia) in any age group. Ten electronic databases were searched. Randomized controlled trials and prospective cohort studies that investigated a traditional Mediterranean diet, published in any language, were eligible. Studies using other designs or other definitions of the Mediterranean diet were collated separately in an evidence map. Details on study design, methods, population, dietary intervention or exposure, length of follow-up, and effect on or association with musculoskeletal outcomes were extracted. The search yielded 1738 references. Data from eligible randomized controlled trials (n = 0) and prospective cohort studies (n = 3) were synthesized narratively by outcome for the systematic review. Two of these studies reported on hip fracture incidence, but results were contradictory. A third study found no association between the Mediterranean diet and sarcopenia incidence. Overall, the systematic review and evidence map demonstrate a lack of research to understand the relationship between the Mediterranean diet and musculoskeletal health in all ages. PROSPERO registration number IDCRD42016037038.

Keywords: Mediterranean diet; fracture; musculoskeletal; osteoporosis; sarcopenia; systematic review.

Figure 1

Flow diagram of the literature search process. Abbreviation: MD, Mediterranean diet.

Figure 2

Volume (no. of studies) and nature (study designs) of evidence identified in the systematic review and evidence map, grouped by outcome: 18 studies in total, some of which reported more than 1 outcome. Abbreviation: RCT, randomized controlled trial.

Figure 3

Forest plot of most-adjusted hazard ratios for first fracture incidence associated with a 1-unit increment in MD adherence score (on a scale of 0–9, 9 indicating greatest adherence to MD), by fracture site. Abbreviations: IV, inverse variance; MD, Mediterranean diet; SE, standard error; w, with.