July 20, 2016
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Mediterranean diet can reduce health risks without fat intake restrictions

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Without restricting fat intake, a Mediterranean diet may lower the occurrence of cardiovascular events, breast cancer, and type 2 diabetes, according to a study published in the Annals of Internal Medicine.

“Typical Western diets, which are high in saturated fats, sugar, and rened grains, are causally associated with development of cardiovascular disease, diabetes, and some types of cancer, including breast and colorectal cancer,” Hanna E. Bloomfield, MD, MPH, and colleagues wrote. “The purpose of this systematic review is to summarize the literature on the effect of the Mediterranean diet on health outcomes and to assess whether North American populations are likely to adhere to such a diet.”

Bloomfield and colleagues assessed whether the Mediterranean diet is more effective than other diets in preventing mortality and new onset of disease in healthy persons (primary prevention), or mortality and disease progression in those who have diabetes, cardiovascular disease, cancer, hypertension, cognitive impairment, rheumatoid arthritis, or kidney disease (secondary prevention). They also evaluated the level of adherence to a Mediterranean diet in trials conducted in the United States and Canada.

The researchers searched Ovid MEDLINE, CINAHL, and the Cochrane Library from 1990 through April 2016 to identify controlled trials of 100 or more persons surveyed for at least one year for mortality, cardiovascular, hypertension, diabetes, and adherence outcomes. They also searched for cohort studies for cancer outcomes.

In two primary prevention trials, Bloomfield and colleagues found no difference in all-cause mortality between diet groups. The researchers observed in one primary prevention trial that a Mediterranean diet resulted in a lower occurrence of cardiovascular events (HR = 0.71;95% CI, 0.56-0.9), breast cancer (HR = 0.43; 95% CI, 0.21-0.88), and diabetes (HR = 0.7; 95% CI, 0.54-0.92). Compared with the lowest quantile, the more one adhered to a Mediterranean diet, the greater a reduction in total cancer mortality (RR = 0.86; 95% CI, 0.82-0.91; 13 studies) and in the occurrence of total (RR = 0.96; 95% CI, 0.95-0.97; 3 studies) and colorectal (RR = 0.91; 95% CI, 0.84-0.98; 9 studies) cancer, according to pooled analyses of primary prevention cohort studies.

One secondary prevention study of cardiovascular outcomes found a lower risk for recurrent myocardial infarction and cardiovascular death with the Mediterranean diet. There was no significant evidence relating to adherence, hypertension, cognitive function, kidney disease, rheumatoid arthritis, and quality of life.

“There is limited evidence from randomized trials that a Mediterranean diet with no restriction on fat intake may be associated with a reduced incidence of cardiovascular events, breast cancer, and type 2 diabetes mellitus but does not affect all-cause mortality,” Bloomfield and colleagues wrote. by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.