The American Journal of Medicine
Volume 124, Issue 9 , Pages 841-851.e2 , September 2011

Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors

  • Alain J. Nordmann, MD, MSc

      Affiliations

    • Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland
    • Corresponding Author InformationRequests for reprints should be addressed to Alain J. Nordmann, MD, MSc, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, Basel CH-4031, Switzerland
  • ,
  • Katja Suter-Zimmermann, PhD

      Affiliations

    • Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland
  • ,
  • Heiner C. Bucher, MD, MPH

      Affiliations

    • Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland
  • ,
  • Iris Shai, RD, PhD

      Affiliations

    • S. Daniel Abraham Center of Health and Nutrition and Department of Epidemiology, Ben-Gurion University of the Negev, Beer Sheva, Israel
  • ,
  • Katherine R. Tuttle, MD

      Affiliations

    • The Heart Institute of Spokane and Providence Medical Research Center, Spokane, Wash.
  • ,
  • Ramon Estruch, MD, PhD

      Affiliations

    • Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, and CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain
  • ,
  • Matthias Briel, MD, MSc

      Affiliations

    • Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland
    • Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

References 

  1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–1245
  2. Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004;8(21):iii–iv1-182
  3. Howard BV, Van HL, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655–666
  4. Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61(6 Suppl):1402S–1406S
  5. Serra-Majem L, Roman B, Estruch R. Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev. 2006;64(2 Pt 2):S27–S47
  6. Estruch R, Martinez-Gonzalez MA, Corella D, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145(1):1–11
  7. Malik VS, Hu FB. Popular weight-loss diets: from evidence to practice. Nat Clin Pract Cardiovasc Med. 2007;4(1):34–41
  8. Fung TT, Rexrode KM, Mantzoros CS, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093–1100
  9. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292(12):1433–1439
  10. Martinez-Gonzalez MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008;336(7657):1348–1351
  11. Scarmeas N, Luchsinger JA, Schupf N, et al. Physical activity, diet, and risk of Alzheimer disease. JAMA. 2009;302(6):627–637
  12. Willett WC, Skerrett PJ. Eat, Drink, and Be Healthy: the Harvard Medical School Guide to Healthy Eating. New York: Simon & Schuster; 2001;
  13. Krauss RM, Eckel RH, Howard B, et al. AHA Dietary Guidelines: revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102(18):2284–2299
  14. Juni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282(11):1054–1060
  15. Bassler D, Briel M, Montori VM, et al. Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. JAMA. 2010;303(12):1180–1187
  16. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–188
  17. Esposito K, Pontillo A, Di Palo C, et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA. 2003;289(14):1799–1804
  18. Sterne JA, Egger M, Smith GD. Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001;323(7304):101–105
  19. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–1558
  20. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560
  21. Singh RB, Dubnov G, Niaz MA, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet. 2002;360(9344):1455–1461
  22. Horton R. Expression of concern: Indo-Mediterranean Diet Heart Study. Lancet. 2005;366(9483):354–356
  23. De Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454–1459
  24. Esposito K, Marfella R, Ciotola M, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440–1446
  25. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–241
  26. Tuttle KR, Shuler LA, Packard DP, et al. Comparison of low-fat versus Mediterranean-style dietary intervention after first myocardial infarction (from The Heart Institute of Spokane Diet Intervention and Evaluation Trial). Am J Cardiol. 2008;101(11):1523–1530
  27. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151(5):306–314
  28. Robertson RM, Smaha L. Can a Mediterranean-style diet reduce heart disease?. Circulation. 2001;103(13):1821–1822
  29. National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation. 1994;89(3):1333–1445
  30. Sofi F, Cesari F, Abbate R, et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344
  31. Lawlor DA, Davey SG, Kundu D, et al. Those confounded vitamins: what can we learn from the differences between observational versus randomised trial evidence?. Lancet. 2004;363(9422):1724–1727
  32. De Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779–785

 Funding: A. Nordmann, M. Briel, K. Suter-Zimmermann, and H. Bucher, as collaborators of the Basel Institute for Clinical Epidemiology and Biostatistics, are supported by an unrestricted grant from santésuisse and the Gottfried and Julia Bangerter-Rhyner Foundation. The Heart Institute of Spokane Diet Intervention and Evaluation Trial was supported by a grant from the Washington State Attorney General Vitamins Settlement Fund. The Daily-Dose Consensus Interferon and Ribavirin: Efficacy of Combined Therapy (DIRECT) trial was supported by the Nuclear Research Center Negev, the Dr. Robert C. and Veronica Atkins Research Foundation, and the Daniel S. Abraham International Center for Health and Nutrition, Ben Gurion University, Israel. The Predimed study was supported by unrestricted grants from the Spanish Ministry of Health and the Generalitat Valenciana. This meta-analysis was supported by an unrestricted grant from the Forlen Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

 Conflict of Interest: None of the authors have a relationship with industry or financial associations that might pose a conflict of interest in connection with the submitted article.

 Authorship: A. Nordmann and M. Briel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors had access to the data and fulfill criteria for authorship.

PII: S0002-9343(11)00410-4

doi: 10.1016/j.amjmed.2011.04.024

The American Journal of Medicine
Volume 124, Issue 9 , Pages 841-851.e2 , September 2011