1Department of Hygiene,Epidemiology and Medical Statistics, Medical School,National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens 115 27, Greece.
4Department of Clinical Sciences and Community Health,University of Milan,Via Vanzetti 5, 20133 Milan,Italy.
Br J Nutr. 2018 Nov;120(10):1081-1097. doi: 10.1017/S0007114518002593.
The beneficial association of the Mediterranean diet (MedDiet) with longevity has been consistently demonstrated, but the associations of MedDiet components have not been accordingly evaluated. We performed an updated meta-analysis of prospective cohort studies published up to 31 December 2017, to quantify the association of adherence to MedDiet, expressed as an index/score (MDS) and of its components with all-cause mortality. We estimated summary relative risks (SRR) and 95 % CI using random effects models. On the basis of thirty studies (225 600 deaths), SRR for the study-specific highest/lowest and per 1sd MDS increment were 0·79 (95 % CI 0·77, 0·81, Ι 2=42 %, P-heterogeneity 0·02) and 0·92 (95 % CI 0·90, 0·94, Ι 2 56 %, P-heterogeneity <0·01), respectively. Inversely, statistically significant associations were evident in stratified analyses by country, MDS range and publication year, with some evidence for heterogeneity across countries overall (P-heterogeneity 0·011), as well as across European countries (P=0·018). Regarding MDS components, relatively stronger and statistically significant inverse associations were highlighted for moderate/none-excessive alcohol consumption (0·86, 95 % CI 0·77, 0·97) and for above/below-the-median consumptions of fruit (0·88, 95 % CI 0·83, 0·94) and vegetables (0·94, 95 % CI 0·89, 0·98), whereas a positive association was apparent for above/below-the-median intake of meat (1·07, 95 % CI 1·01, 1·13). Our meta-analyses confirm the inverse association of MedDiet with mortality and highlight the dietary components that influence mostly this association. Our results are important for better understanding the role of MedDiet in health and proposing dietary changes to effectively increase adherence to this healthy dietary pattern.
地中海饮食（MedDiet）与长寿之间有益的关联已得到一致证明，但 MedDiet 成分的关联尚未得到相应评估。我们对截至 2017 年 12 月 31 日发表的前瞻性队列研究进行了更新的荟萃分析，以量化 MedDiet 依从性（表示为指数/评分[MDS]）及其成分与全因死亡率之间的关联。我们使用随机效应模型估计汇总相对风险（SRR）和 95 %置信区间。基于三十项研究（225600 例死亡），研究特异性最高/最低和每 1sd MDS 增量的 SRR 分别为 0·79（95 %置信区间 0·77，0·81，I 2=42 %，P 异质性=0·02）和 0·92（95 %置信区间 0·90，0·94，I 2=56 %，P 异质性<0·01）。在按国家、MDS 范围和发表年份进行的分层分析中，观察到统计学上显著的关联，并且总体上存在国家间的异质性证据（P 异质性=0·011），以及欧洲国家之间的证据（P=0·018）。关于 MDS 成分，对于适度/无过量饮酒（0·86，95 %置信区间 0·77，0·97）和高于/低于中位数的水果（0·88，95 %置信区间 0·83，0·94）和蔬菜（0·94，95 %置信区间 0·89，0·98）的消耗，观察到相对更强且统计学上显著的反比关联，而高于/低于中位数的肉类摄入（1·07，95 %置信区间 1·01，1·13）则呈正相关。我们的荟萃分析证实了 MedDiet 与死亡率之间的反比关联，并强调了影响这种关联的饮食成分。我们的结果对于更好地理解 MedDiet 在健康中的作用以及提出有效的饮食改变以有效增加对这种健康饮食模式的依从性非常重要。
