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Meta-Analysis
. 2023 Feb;192(1):105-113.
doi: 10.1007/s11845-022-02944-9. Epub 2022 Feb 22.

Mediterranean Diet and its Effect on Endothelial Function: A Meta-analysis and Systematic Review

Kaneez Fatima  1 , Ahmed Mustafa Rashid  2 , Usama Abdul Ahad Memon  2 , Syeda Sidra Fatima  1 , Syed Sarmad Javaid  2 , Omema Shahid  3 , Fazila Zehri  1 , Muhammad Adil Obaid  2 , Mahlika Ahmad  3 , Talal Almas  4 , Abdul Mannan Khan Minhas  5
Affiliations
Meta-Analysis

Mediterranean Diet and its Effect on Endothelial Function: A Meta-analysis and Systematic Review

Kaneez Fatima et al. Ir J Med Sci. 2023 Feb.

Abstract

Background: Endothelial dysfunction serves as an early marker for the risk of cardiovascular disease (CVD); therefore, it is a site of therapeutic interventions to reduce the risk of CVD.

Aims: To examine the effect of the Mediterranean diet (MedDiet), as an intervention, on structural and functional parameters of endothelial function, and how it may reduce the risk of CVD and associated mortality.

Methods: Medline database was searched for randomized controlled trials. Random-effects meta-analysis was conducted on 21 independent datasets. Meta-regression and subgroup analysis were performed to assess whether the effect of MedDiet was modified by health status (healthy subjects or with increased CVD risk), type of MedDiet intervention (alone or combined), type of parameter (functional or structural), study design (cross-over or parallel), BMI, age, and study duration. Our study used sample size, mean, and standard deviation of endothelial function measurements for both MedDiet intervention and control in the analyses.

Results: Inverse relationship between endothelial function and intake of MedDiet was observed (SMD: 0.34; 95% CI: 0.16, 0.52; P = 0.0001). Overall, MedDiet increased FMD by 1.39% (95% CI: 0.47, 2.19; P < 0.001). There was a significant improvement in endothelial function in both healthy patients and in those with an increased risk of CVD. No significant variation was observed in the effects of MedDiet on endothelial function, due to study design or type of intervention.

Conclusions: These findings support that MedDiet can reduce the risk of CVD by improving endothelial function.

Keywords: Cardiovascular disease; Endothelial function; Flow-mediated dilation; Mediterranean diet.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the selection process of the randomized controlled trials included in the meta-analysis. EF, endothelial function; MD, Mediterranean diet
Fig. 2
Fig. 2
Forest plot showing overall effect of MedDiet on endothelial function. Data expressed as standardized mean difference (SMD)
Fig. 3
Fig. 3
Forest plot showing the composite effect of MedDiet on flow-mediated dilation (expressed as percentage change)
Fig. 4
Fig. 4
Meta-regression analysis of the association between study duration (weeks) and SMD of a) functional and b) structural parameters of endothelial function
See this image and copyright information in PMC

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