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Meta-Analysis
. 2019 Nov 1;10(6):1029-1039.
doi: 10.1093/advances/nmz041.

Adherence to the Mediterranean Diet in Relation to All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Sepideh Soltani  1 , Ahmad Jayedi  2 , Sakineh Shab-Bidar  3 , Nerea Becerra-Tomás  4   5 , Jordi Salas-Salvadó  4   5
Affiliations
Meta-Analysis

Adherence to the Mediterranean Diet in Relation to All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Sepideh Soltani et al. Adv Nutr. .

Abstract

A previous meta-analysis provided convincing evidence for an inverse association between adherence to a Mediterranean diet (MedDiet) and the risk of all-cause mortality. Since then, 19 prospective studies have been published. We updated the evidence from these prospective studies and conducted a dose-response meta-analysis to test the linear and potential nonlinear dose-response associations between adherence to a MedDiet and the risk of all-cause mortality. The PubMed, Scopus, ISI Web of Knowledge, and Embase bibliographic databases were systematically searched up to August 24, 2018. Summary HRs were estimated with the use of a random-effects meta-analysis to assess the association between a 2-point increment in MedDiet adherence and the risk of all-cause mortality. Sensitivity and subgroup analyses were performed and potential publication bias was tested. Twenty-nine prospective studies with 1,676,901 participants and 221,603 cases of all-cause mortality were included in the final analysis. The pooled HR of all-cause mortality was 0.90 (95% CI: 0.89, 0.91; I2 = 81.1%) for a 2-point increment in adherence to a MedDiet. Subgroup analyses showed that a significant inverse association was stronger in participants who lived in the Mediterranean region compared with non-Mediterranean areas (HRs: 0.82 compared with 0.92, respectively), and in studies that used the Panagiotakos MedDiet score. A nonlinear dose-response meta-analysis indicated that the risk of all-cause mortality linearly decreased with the increase in adherence to a MedDiet. The robustness of findings was confirmed in the sensitivity analyses. In conclusion, low-quality evidence from prospective cohort studies suggests an inverse association between adherence to a MedDiet and the risk of all-cause mortality, especially in Mediterranean regions. An inverse linear dose-response relation was also observed between adherence to a MedDiet and the risk of all-cause mortality.

Keywords: Mediterranean diet; dose-response; meta-analysis; mortality; prospective cohort studies.

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Figures

FIGURE 1
FIGURE 1
Flow diagram for study selection process. CAD, coronary artery disease; EPIC, European Prospective Investigation into Cancer and Nutrition; ES, effect size; MEC, Multiethnic Cohort; REGARDS, REasons for Geographic and Racial Differences in Stroke study; SUN, Seguimiento University of Navarra cohort study.
FIGURE 2
FIGURE 2
Risk of all-cause mortality associated with each 2-point increment in adherence to MedDiet. The black square and horizontal line represents the study-specific HR and 95% CI, respectively; the area of the black square is proportional to the specific-study weight to the overall meta-analysis. The center of the open diamond presents the pooled HR and its width represents the pooled 95% CI. Weights are from random-effects analysis.
FIGURE 3
FIGURE 3
Dose-response analysis of risk of all-cause mortality and adherence to a Mediterranean diet. The solid line and the long-dashed line represent the estimated HR and its 95% CI; the solid line represents the linear relation.
See this image and copyright information in PMC

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