Hareer Laima W, Lau Yan Ying, Mole Frances, Reidlinger Dianne P, O'Neill Hayley M, Mayr Hannah L, Greenwood Hannah, Albarqouni Loai
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Nutr Diet. 2025 Feb;82(1):8-41. doi: 10.1111/1747-0080.12891. Epub 2024 Aug 14.
This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.
Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.
Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.
This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.
本研究旨在回顾评估地中海饮食对心血管疾病一级和二级预防效果的随机对照试验的荟萃分析。
检索了五个数据库（Medline、Embase、Cochrane、CINAHL和ProQuest），检索时间从建库至2022年11月。纳入标准为：（i）对随机对照研究进行系统评价并进行荟萃分析；（ii）来自普通人群的18岁及以上成年人，患有（二级预防）和未患有（一级预防）已确诊的心血管疾病；（iii）将地中海饮食与另一种饮食干预或常规护理进行比较。使用AMSTAR-2进行的文献筛选和质量评估由两人独立完成。从每项综述中提取GRADE，并对结果进行叙述性综合分析。
纳入了18项对238项随机对照试验的荟萃分析，其中纳入的原始研究有8%的重叠。与常规护理相比，地中海饮食与心血管疾病死亡率降低相关（n = 4项综述，GRADE低确定性；风险比范围：0.35 [95%置信区间：0.15 - 0.82]至0.90 [95%置信区间：0.72 - 1.11]）。与另一种积极干预相比，非致命性心肌梗死有所减少（n = 4项综述，风险比范围：0.47 [95%置信区间：0.28 - 0.79]至0.60 [95%置信区间：0.44 - 0.82]）。大多数综述（n = 16/18；84%）的方法学质量较低或极低，证据强度普遍较弱。
本综述表明，地中海饮食可使致命性心血管疾病结局风险降低10% - 67%，非致命性心血管疾病结局风险降低21% - 70%。在纳入已确诊心血管疾病人群的研究中，这种预防效果更为显著。需要质量更高的综述。
