From the Department of Preventive Medicine and Public Health, IdiSNA, Navarra Institute for Health Research, University of Navarra, Pamplona, Spain (M.A.M.-G., A.G., M.R.-C.).
CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid, Spain (M.A.M.-G., A.G., M.R.-C.).
Circ Res. 2019 Mar;124(5):779-798. doi: 10.1161/CIRCRESAHA.118.313348.
The Mediterranean diet (MedDiet), abundant in minimally processed plant-based foods, rich in monounsaturated fat from olive oil, but lower in saturated fat, meats, and dairy products, seems an ideal nutritional model for cardiovascular health. Methodological aspects of Mediterranean intervention trials, limitations in the quality of some meta-analyses, and other issues may have raised recent controversies. It remains unclear whether such limitations are important enough as to attenuate the postulated cardiovascular benefits of the MedDiet. We aimed to critically review current evidence on the role of the MedDiet in cardiovascular health. We systematically searched observational prospective cohorts and randomized controlled trials which explicitly reported to assess the effect of the MedDiet on hard cardiovascular end points. We critically assessed all the original cohorts and randomized controlled trials included in the 5 most comprehensive meta-analyses published between 2014 and 2018 and additional prospective studies not included in these meta-analyses, totaling 45 reports of prospective studies (including 4 randomized controlled trials and 32 independent observational cohorts). We addressed the existing controversies on methodology and other issues. Some departures from individual randomization in a subsample of the landmark Spanish trial (PREDIMED [Prevención con Dieta Mediterránea]) did not represent any clinically meaningful attenuation in the strength of its findings and the results of PREDIMED were robust in a wide range of sensitivity analyses. The criteria for causality were met and potential sources of controversies did not represent any reason to compromise the main findings of the available observational studies and randomized controlled trials. The available evidence is large, strong, and consistent. Better conformity with the traditional MedDiet is associated with better cardiovascular health outcomes, including clinically meaningful reductions in rates of coronary heart disease, ischemic stroke, and total cardiovascular disease.
地中海饮食（MedDiet）富含加工最少的植物性食物，富含橄榄油中的单不饱和脂肪，但饱和脂肪、肉类和奶制品含量较低，它似乎是心血管健康的理想营养模式。地中海饮食干预试验的方法学方面、一些荟萃分析质量的局限性以及其他问题可能引发了最近的争议。目前尚不清楚这些局限性是否重要到足以减弱 MedDiet 假定的心血管益处。我们旨在批判性地审查当前关于 MedDiet 在心血管健康中的作用的证据。我们系统地搜索了前瞻性队列研究和随机对照试验，这些研究明确报告了评估 MedDiet 对硬性心血管终点的影响。我们批判性地评估了所有包含在 2014 年至 2018 年期间发表的五项最全面荟萃分析中的原始队列和随机对照试验，以及这些荟萃分析中未包含的其他前瞻性研究，共计 45 份前瞻性研究报告（包括 4 项随机对照试验和 32 个独立的观察性队列）。我们解决了在方法学和其他问题上存在的争议。标志性西班牙试验（PREDIMED [Prevención con Dieta Mediterránea]）的亚样本中个别随机分组的一些偏离并没有对其发现的强度产生任何有临床意义的减弱，并且 PREDIMED 的结果在广泛的敏感性分析中是稳健的。因果关系的标准得到满足，争议的潜在来源并没有构成对现有观察性研究和随机对照试验的主要发现提出质疑的任何理由。现有证据是大量的、强有力的、一致的。与传统的 MedDiet 更好地一致与更好的心血管健康结果相关，包括冠心病、缺血性中风和全因心血管疾病发生率的临床意义降低。
