COMMENTARY

Mediterranean Diet's Benefits May Extend to Multiple Diseases

William F. Balistreri, MD

Disclosures

November 07, 2018

In This Article

Evidence in Obesity and Diabetes

Long-term intervention in the PREDIMED trial with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with decreases in body weight and less gain in central adiposity compared with a control diet.[12,13,14,15,16] Interventions promoting weight loss can also reduce the incidence of type 2 diabetes mellitus (T2DM).

In another PREDIMED trial, Salas-Salvadó and colleagues[31] assessed the efficacy of Mediterranean diets for the primary prevention of diabetes. During follow-up, 80, 92, and 101 new-onset cases of diabetes occurred in the Mediterranean diet supplemented with EVOO, Mediterranean diet supplemented with mixed nuts, and control diet groups, respectively, corresponding to rates of 16, 19, and 24 cases per 1000 person-years.

Vitale and colleagues[32] assessed 2568 people with T2DM, and reported that high adherence to the Mediterranean diet was associated with lower glycated hemoglobin level, plasma lipid levels, blood pressure, and body mass index. The relationship of the single food items of the Mediterranean diet with the achievement of treatment targets were also explored; the beneficial health effects of the diet were primarily due to synergy among various nutrients and were not based on any individual dietary component.

A related, significant issue is that elderly persons and patients with T2DM are at high risk of becoming frail, which clearly affects long-term health.[33] Lopez-Garcia and colleagues[34] assessed whether a Mediterranean-style diet was associated with lower risk for frailty among older women with diabetes. In a prospective cohort study (8970 women aged ≥ 60 years with T2DM), adherence to the Mediterranean diet pattern over a 20-year period was associated with a reduced risk for frailty syndrome. After adjustment for lifestyle factors and medication use, the hazard ratio of frailty was 1.0 for the lowest quartile of adherence, 0.88 for the second quartile, 0.69 for the third quartile, and 0.54 for the highest quartile. The largest reduction in risk was observed in persons with the highest consumption of vegetables and fruit.

Additional Disorders Also Show Extensive Benefits

Long-term intervention in the PREDIMED trial with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with decreases in body weight and less gain in central adiposity compared with a control diet.[12,13,14,15,16] Interventions promoting weight loss can also reduce the incidence of type 2 diabetes mellitus (T2DM).

In another PREDIMED trial, Salas-Salvadó and colleagues[31] assessed the efficacy of Mediterranean diets for the primary prevention of diabetes. During follow-up, 80, 92, and 101 new-onset cases of diabetes occurred in the Mediterranean diet supplemented with EVOO, Mediterranean diet supplemented with mixed nuts, and control diet groups, respectively, corresponding to rates of 16, 19, and 24 cases per 1000 person-years.

Vitale and colleagues[32] assessed 2568 people with T2DM, and reported that high adherence to the Mediterranean diet was associated with lower glycated hemoglobin level, plasma lipid levels, blood pressure, and body mass index. The relationship of the single food items of the Mediterranean diet with the achievement of treatment targets were also explored; the beneficial health effects of the diet were primarily due to synergy among various nutrients and were not based on any individual dietary component.

Martinez-Lacoba and colleagues[35] summarized the effects of the Mediterranean diet pattern on different health outcomes. They concluded that promoting the diet may improve health status and reduce total lifetime costs. The effect is larger if the dietary pattern is combined with physical activity, and also if tobacco and excessive alcohol consumption are avoided.

Galilea-Zabalza and colleagues[36] reported that adherence to a traditional Mediterranean diet was associated with better health-related quality of life among older Spanish men and women with overweight or obesity harboring the metabolic syndrome.

De Amicis and colleagues[37] reported that adherence to the Mediterranean diet was associated with a lower risk for cognitive impairment, as was consumption of wine and nuts. No association was found with other food groups.

The Mediterranean diet has been associated with improved overall life expectancy in the general population.[38] In a longitudinal analysis of 5200 individuals aged ≥ 65 years, Bonaccio and colleagues[39] showed that close adherence to the Mediterranean diet was associated with prolonged survival, supporting its adoption or preservation among older persons.

Sleep duration and sleep quality are important predictors of risk for CVD. Castro-Diehl and colleagues[40] reported that a Mediterranean-style diet was associated with adequate sleep duration and less insomnia symptoms. They suggest that further research should quantify the impact on CVD.

Morales-Ivorra and colleagues[41] systematically analyzed the epidemiologic evidence in humans that indicated the positive association between a higher adherence to a Mediterranean diet and the prevalence and the quality of life of participants suffering osteoarthritis. However, they also suggest prospective and longer interventions to evaluate the long-term effect of the Mediterranean diet on symptoms and prevention of osteoarthritis.

Toledo and colleagues[42] evaluated the effect of the Mediterranean diet on breast cancer incidence in women participating in the PREDIMED study. They determined a beneficial effect of a Mediterranean diet supplemented with EVOO in the primary prevention of breast cancer. It should be noted that these results were extracted from a secondary analysis of the trial and are based on few incident cases; therefore, they need to be confirmed in larger, longer-term studies.

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