Contents

Search

Mediterranean diet

Indications: - optimal brain health - cardiovascular risk reduction - non-alcoholic fatty liver disease (NAFLD) [40] - prevention of frailty [45] - prevention & treatment of depression [48] * also see Notes (below) Benefit/risk: - number needed to treat: - 61 for 5 years to prevent 1 stroke, myocardial infarction or death in subjects without known heart disease [15,24] - 30 to prevent 1 death or 1 cancer after myocardial infarction [25] - 556 to prevent one case of breast cancer/year in postmenopausal women [27] - no harmful effects noted Physiology: - associated with beneficial microbiome-related metabolomic profile - may be due to high-level consumption of plant foods [34] - increases in intestinal Prevotella & some fibre-degrading Firmicutes - increases levels of fecal short-chain fatty acids [34] - reduced inflammation (putative) - inflammatory dietary advanced glycation end-products are unchanged on the Mediterranean diet but decreased on a low-fat vegan diet [81] Laboratory: - lower levels of - serum C-reactive protein - serum interleukin-6 - serum homocysteine - plasma fibrinogen - lower WBC counts Management: Recommendations: 1) increase servings of fruits & vegetables - 2 servings of fruit & 3 servings of vegetables/day associated with lowest mortality [60] 2) increase servings of legumes & whole-grain vegetables 3) increase monounsaturated fats: olive oil - canola oil may not be advisable [data from mouse model] 4) eat fish 3-4 times/week; poultry 2 times/week 5) eat red meat only 2-3 times/month 6) drink red wine in moderate amounts: Total kcals = 1500 Protein = 17% Fat = 33% Carbohydrate = 50% * Green Mediterranean diet is enriched with plant polyphenols & lower in red or processed meat & simple carbohydrates [75] Notes: A Mediterranean diet 1) reduces all-cause mortality in healthy elderly [2,6,79] including mortality due to cardiovascular disease [18] a) (RR = 0.79) & cancer (RR = 0.83) [6] b) greatest contribution to mortality reduction from: 1] moderate consumption of alcohol 2] low intake of meat 3] high consumption of vegetables, fruits, nuts, monounsaturated fats, & legumes [9] c) no reduction in all-cause mortality [31] d) reduces all-cause & cardiovascular mortality in persons with cardiovascular risk factors [74] 2) reduces cardiovascular risk a) reduces risk of myocardial infarction [21 b) reduces risk of stroke [21] c) reduces risk of peripheral arterial disease; RR=0.34-0.5 [21] - olive oil seems more effective than nuts d) reduces risk of major cardiovascular events by 30% in people at high risk [15,16,17,47,71] - after reanalysis of data, conclusions remain unchanged [47] e) better than low-fat diet in reducing cardiovascular risk [3,15] & in reducing progression of atherosclerosis [62] - better in men, but not in women [66] f) associated with 29% fewer cardiovascular events [31] g) Mediterranean diet enriched with virgin olive oil improves HDL-mediated protection from atherosclerosis [36] h) Mediterranean diet supplemented with extra-virgin olive oil or nuts reduces major cardiovascular events in high-risk patients vs reduced fat diet [71] i) equally beneficial vs vegetarian diet in reducing weight & improving cardiovascular risk profiles i) cardiovascular benefit of pesco-Mediterranean diet in connection with time-restricted eating [58] k) healthiest diet available to prevent cardiovascular disease [70] l) green Mediterranean diet induces regression of proximal aortic stenosis [75] m) no effect no effect on mortality or cardiovascular disease [52] (suboptimal quality of the evidence) 3) reduces risk of metabolic syndrome [76] 4) beneficial effect on brain in the elderly - in combination with excercise, reduces risk of dementia [10] - reduces risk of brain infarcts (mostly silent infarcts) [13] - reduces white matter hyperintensities on MRI - protective effects for stroke (RR=0.71), depression (RR=0.68), cognitive impairment (RR=0.60) - in older subjects (mean age= 67), a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognition [26] - may preserve total brain volume, total gray matter volume, & total white matter volume in elderly [28] - higher fish intake & lower red meat intake associated most strongly with preservation of brain volume [28] - adherence to a Mediterranean diet associated with higher cerebral cortex thickness [33] - higher frontal cortex, parietal cortex, occipital cortex, & average lobar cortical thickness [33] - higher gray matter volume in right parahippocampal gyrus & right hippocampus [61] - legume & fish beneficial effects in particular noted - higher carbohydrate & sugar intakes were associated with lower entorhinal cortical thickness [33] - lower CSF p-tau & CSF Abeta42/Abeta40 [61] - associated with slower rates of cognitive decline [32] - diminished risk of Alzheimer's disease [56] - improvements in cognitive function - cognitive domains found to benefit include - memory (delayed recognition, long-term, & working memory) [61] - executive function - visual constructs [32] - adherence to a Mediterranean diet associated with lesser brain atrophy in the elderly [35] - fish & meat consumption does not account for this - may slow cognitive decline in community-dwelling elderly [43] - may delay onset of Parkinson's disease [59] - may have synergistic effects with DASH diet (see MIND diet) - adherence to a Mediterranean diet is associated with maintenance of cognition among middle-aged & older Hispanic adults [68] - among factors of fruit, vegetables, processed meat, unprocessed red meat & unprocessed poultry, fish, cheese, wholegrains, only fish comsumption & fruit consumption reduced risk of dementia (RR=0.84-0.85) - nutrients with favorable effects on cognitive function & brain health from the Mediterranean Diet include fatty acids, antioxidants, carotenoids & vitamins [80] 5) reduces mortality in Alzheimer's disease patients [5] 6) may have protective role in the prevention of depression [12] - may reduce risk of depression in the elderly [51] 7) a Mediterranean diet is associated with better cognition in people with multiple sclerosis [73] 8) associated with lower risk of type 2 diabetes [7,31] & improved glycemic control in diabetes type-2 [11] a) even without weight loss [20] b) olive oil better than nuts for reducing risk of type 2 diabetes [20] c) healthiest diet available to prevent type 2 diabetes [70] 9) may reduce risk of macular degeneration (39%) [38,46] 10) reduces oxidized LDL [4] 11) may reduce chronic inflammation a) serum CRP decreased b) serum IL6 decreased c) serum homocysteine decreased d) plasma fibrinogen decreased e) WBC count decreased [16] f) reduces risk of seropositive rheumatoid arthritis in men [50] g) upregulates specific receptors that have neuroprotective effects - reduces neuroinflammatory profiles in hippocampus [83] 12) reduces incidence of frailty in community-dwelling elderly [42] 13) Mediterranean diet supplemented with extra-virgin olive oil may have a beneficial effect in the primary prevention of breast cancer [27,29,31] - may have reduced risk for all-cause cancer & lung cancer [31] 14) Mediterranean diet may help slow or prevent progression of prostate cancer in men on active surveillance [57 15) positive association between a Mediterranean diet & response to treatment with immune checkpoint inhibitors in patients with advanced cutaneous melanoma [72] 16) in combination with alkaline water may be beneficial for treatment of laryngopharyngeal reflux [39 17) better than low fat diet for weight loss [8] - adherence to a Mediterranean diet even without energy restriction is associated with weight maintenance, not weight gain [70] 18) olive oil-rich Mediterranean diet helpful for weight reduction & reduction in waist circumference [30] 19) combination of a reduced calorie Mediterranean diet & exercise may mitigate age-dependent changes in body composition [77] 20) adherence to Mediterranean diet among women results in longer peripheral blood leukocyte telomeres [23] 21) may lower risk of gestational diabetes [53] 22) reduces risk of preeclampsia (RR=0.78) [65] 23) ties with DASH diet for best overall diet [41] 24) 'Green' Mediterranean diet is the addition of green tea & substitution of red meat for a plant-based (Mankai) protein shake at dinner [63] - may help improve insulin sensitivity & reduce visceral fat by increasing levels of ghrelin 25) adherence to a Mediterranean-style diet & higher total carotenoid intake may delay or prevent later life frailty, especially in adults < 60 years [67] 26) Mediterranean diet associated lower risk of all-cause mortality (RR=0.68) in cancer survivors [78] 27) high adherence to Mediterranean diet is a protective factor against COVID-19, - unclear benefits against COVID-19 symptoms & severity [82]

Related

olive oil

Specific

Green Mediterranean (Green-MED) diet Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet

General

healthy diet weight loss diet

References

  1. Jennifer Romo, MPH, RD, Clinical Dietician West Los Angeles VA Medical Center
  2. Journal Watch 25(13):105, 2005 Trichopoulou A et al, Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ. 2005 Apr 30;330(7498):991. Epub 2005 Apr 8. PMID: 15820966 http://bmj.bmjjournals.com/cgi/content/full/330/7498/991
  3. Estruch R et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006 Jul 4;145(1):1-11. Summary for patients in: Ann Intern Med. 2006 Jul 4;145(1):I11. PMID: 16818923
  4. Fito M, Guxens M, Corella D, Saez G, Estruch R, de la Torre R, Frances F, Cabezas C, Lopez-Sabater Mdel C, Marrugat J, Garcia-Arellano A, Aros F, Ruiz-Gutierrez V, Ros E, Salas-Salvado J, Fiol M, Sola R, Covas MI; for the PREDIMED Study Investigators. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med. 2007 Jun 11;167(11):1195-203. PMID: 17563030
  5. Scarmeas N et al, Mediterranean diet and Alzheimer's disease mortality. Neurology 2007, 69:1084 PMID: 17846408 - Galvin JE Pass the grain; spare the brain. Neurology 2007, 69:1072 PMID: 17846407
  6. Mitrou PN et al, Mediterranean dietary pattern and prediction of all-cause mortality in a US population. Results from the NIH-AARP Diet and Health Study PMID: 18071168
  7. Martinez-Gonzales MA et al, Adherence to a Mediterranean diet and risk of developing diabetes: Prospective cohort study. BMJ 2008, May 29 PMID: 18511765
  8. Shai I et al. for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008 Jul 17; 359:229. PMID: 18635428 http://content.nejm.org/cgi/content/full/359/3/229
  9. Trichopoulou A et al Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study BMJ 2009;338:b2337 PMID: 19549997 http://www.bmj.com/cgi/content/full/338/jun23_2/b2337
  10. Scarmeas N et al Physical Activity, Diet, and Risk of Alzheimer Disease JAMA. 2009;302(6):627-637. PMID: 19671904 http://jama.ama-assn.org/cgi/content/full/302/6/627 - Feart C et al Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia JAMA. 2009;302(6):638-648. PMID: 19671905 http://mail.google.com/mail/?hl=en&tab=wm#inbox/1230e5270aa617fe - Knopman DS et al Mediterranean Diet and Late-Life Cognitive Impairment A Taste of Benefit JAMA. 2009;302(6):686-687 PMID: 19671912 http://mail.google.com/mail/?hl=en&tab=wm#inbox/1230e5270aa617fe
  11. Esposito K 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 Sep 1; 151:306. PMID: 19721018
  12. Sanchez-Villegas A et al, Association of the Mediterranean Dietary Pattern With the Incidence of Depression Arch Gen Psychiatry. 2009;66(10):1090-1098 PMID: 19805699 http://archpsyc.ama-assn.org/cgi/content/short/66/10/1090
  13. Scarmeas N et al. Mediterranean diet and magnetic resonance imaging-assessed cerebrovascular disease. Ann Neurol 2011 Feb; 69:257. PMID: 21387371 - Gardener H et al Mediterranean diet and white matter hyperintensity volume in the northern Manhattan study. Arch Neurol. 2012 Feb;69(2):251-6. PMID: 22332193
  14. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  15. Estruch R Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med. 2013 Apr 4;368(14):1279-90 PMID: 23432189 http://www.nejm.org/doi/full/10.1056/NEJMoa1200303
  16. Prescriber's Letter 20(5): 2013 Effects of a Mediterranean Diet on Cardiovascular Disease Detail-Document#: 290520 (subscription needed) http://www.prescribersletter.com
  17. Corella D et al Mediterranean Diet Reduces the Adverse Effect of the TCF7L2- rs7903146 Polymorphism on Cardiovascular Risk Factors and Stroke Incidence. A randomized controlled trial in a high- cardiovascular-risk population. PMID: 23942586 http://care.diabetesjournals.org/content/early/2013/08/06/dc13-0955.abstract
  18. de Lorgeril M. Mediterranean diet and cardiovascular disease: historical perspective and latest evidence. Curr Atheroscler Rep. 2013 Dec;15(12):370. PMID: 24105622
  19. Psaltopoulou T et al. Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann Neurol 2013 Sep 16 PMID: 23720230
  20. Salas-Salvado J et al Prevention of Diabetes With Mediterranean Diets: A Subgroup Analysis of a Randomized Trial. Ann Intern Med. 2014;160(1):1-10-10 PMID: 24573661 http://annals.org/article.aspx?articleid=1811025
  21. Ruiz-Canela M, Estruch R, Corella D et al Association of Mediterranean diet with peripheral artery disease: the PREDIMED randomized trial. JAMA. 2014 Jan 22-29;311(4):415-7. PMID: 24449321
  22. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010 Nov;92(5):1189-96. Review. PMID: 20810976
  23. Crous-Bou M et al Mediterranean diet and telomere length in Nurses' Health Study: population based cohort study. BMJ 2014;349:g6674 PMID: 25467028 http://www.bmj.com/content/349/bmj.g6674 - Nilsson PM Mediterranean diet and telomere length. BMJ 2014;349:g6843 PMID: 25467755 http://www.bmj.com/content/349/bmj.g6843
  24. The NNT: Mediterranean Diet for 5 Years for Heart Disease Prevention (Without Known Heart Disease). http://www.thennt.com/nnt/mediterranean-diet-for-heart-disease-prevention-without-known-heart-disease/
  25. The NNT: Mediterranean Diet for Secondary Prevention After Heart Attack http://www.thennt.com/nnt/mediterranean-diet-for-post-heart-attack-care/ - de Lorgeril M, Salen P, Martin JL et al Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med. 1998 Jun 8;158(11):1181-7. PMID: 9625397 - de Lorgeril M, Renaud S, Mamelle N et al Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994 Jun 11;343(8911):1454-9. PMID: 7911176
  26. Valls-Pedret C, Sala-Vila A, Serra-Mir M et al Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(7):1094-1103 PMID: 25961184 http://archinte.jamanetwork.com/article.aspx?articleID=2293082
  27. Toledo E et al Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED TrialA Randomized Clinical Trial. JAMA Intern Med. Published online September 14, 2015. PMID: 26365989 http://archinte.jamanetwork.com/article.aspx?articleID=2434738 - Katz MH Can Diet Prevent Breast Cancer? JAMA Intern Med. Published online September 14, 2015. PMID: 26365829 http://archinte.jamanetwork.com/article.aspx?articleID=2434734
  28. Gu Y et al. Mediterranean diet and brain structure in a multiethnic elderly cohort. Neurology 2015 Oct 2 PMID: 26491085
  29. Slomski A Mediterranean Diet With Olive Oil May Reduce Breast Cancer Risk. JAMA. 2015;314(20):2122. PMID: 26599177 http://jama.jamanetwork.com/article.aspx?articleID=2471568
  30. Estruch R, Martinez-Gonzalez MA, Corella D et al Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes & Endocrinology. June 6, 2016 PMID: 27283479 http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2816%2930085-7/abstract - Mozaffarian D. Food and weight gain: time to end our fear of fat. Lancet Diabetes & Endocrinology. June 6, 2016 PMID: 27283481 http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2816%2930106-1/abstract
  31. Bloomfield HE, Koeller E, Greer N et al Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake: A Systematic Review and Meta- analysis. Ann Intern Med. Published online 19 July 2016 PMID: 27428849 http://annals.org/article.aspx?articleid=2534409
  32. Hardman RJ, Kennedy G, Macpherson H, Scholey AB, Pipingas A Adherence to a Mediterranean-Style Diet and Effects on Cognition in Adults: A Qualitative Evaluation and Systematic Review of Longitudinal and Prospective Trials. Front. Nutr., 22 July 2016 PMID: 27500135 Free PMC Article http://journal.frontiersin.org/article/10.3389/fnut.2016.00022/full
  33. Staubo SC, Aakre JA, Vemuri P et al Mediterranean diet, micronutrients and macronutrients, and MRI measures of cortical thickness. Alzheimers Dement. 2016 Jul 23. pii: S1552-5260(16)32661-9 PMID: 27461490 http://www.alzheimersanddementia.com/article/S1552-5260(16)32661-9/abstract
  34. De Filippis F, Pellegrini N, Vannini L et al High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. 2015 Sep 28. (online) Gut. 2016;65(11):1812-1821 PMID: 26416813
  35. Luciano M et al. Mediterranean-type diet and brain structural change from 73 to 76 years in a Scottish cohort. Neurology 2017 Jan 4 PMID: 28053008 http://www.neurology.org/content/88/5/449
  36. Wendling P Mediterranean Diet With Olive Oil Boosted HDL Function: PREDIMED. Medscape. Feb 13, 2017. http://www.medscape.com/viewarticle/875713 - Hernaez A, Castaner O, Elosua R, et al. Mediterranean diet improves high-density lipoprotein function in high-cardiovascular-risk individuals: A randomized controlled trial. Circulation 2017; 135:633-643. PMID: 28193797 http://circ.ahajournals.org/content/135/7/633 - Rader DJ. Mediterranean approach to improving high-density lipoprotein function. Circulation 2017; 135:644-647. PMID: 28193798 http://circ.ahajournals.org/content/135/7/644
  37. Alternate Mediterranean Diet Score Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr July 1, 2005. vol. 82 no. 1 163-173 http://ajcn.nutrition.org/content/82/1/163/T9.expansion.html
  38. Garcia J Mediterranean Diet May Protect Against Macular Degeneration. Medscape - Nov 10, 2016. http://www.medscape.com/viewarticle/871752 - Frellick M Mediterranean Diet May Cut AMD Risk by More Than a Third Medscape - Oct 19, 2016. http://www.medscape.com/viewarticle/870519
  39. Zalvan CH, Hu S, Greenberg B et al A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg. Published online Sept 7, 2017 PMID: 28880991 http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2652893 - Kavitt RT Dietary Modifications in the Treatment of Laryngopharyngeal Reflux - WIll "an Apple a Day" Keep the Laryngopharyngeal Reflux Away? JAMA Otolaryngol Head Neck Surg. Published online Sept 7, 2017 PMID: 28880985 http://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2652892
  40. Zelber-Sagi S, Salomone F;, Mlynarsky L. The Mediterranean Dietary Pattern as the Diet of Choice for Non-alcoholic Fatty Liver Disease: Evidence and Plausible Mechanisms. Liver Int. 2017 Jul;37(7):936-949 PMID: 28371239
  41. Orciari Herman A, Sadoughi S, Saitz R DASH and Mediterranean Diets Tie for Best Overall Diet. Physician's First Watch, Jan 4, 2018 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Doheny K. Mediterranean, DASH Top US News Best Diets List Medscape - Jan 04, 2018. https://www.medscape.com/viewarticle/890919 - US News. Best Diets. Jan 3, 2018 https://health.usnews.com/best-diet - Mediterranean diet ranked best diet overall DASH diet ties with Flexitarian diet for second best US News. Best Diets. Jan 2, 2020 https://health.usnews.com/best-diet
  42. Kojima G, Avgerinou C, Iliffe S, Walters K. Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2018 Jan 11. PMID: 29322507
  43. Brooks M Mediterranean Diet May Slow Cognitive Decline With Age. Medscape - Jan 06, 2011. https://www.medscape.com/viewarticle/735367 - Tangney CC, Kwasny MJ, Li H, Wilson RS, Evans DA, Morris MC. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr. 2011 Mar;93(3):601-7. Epub 2010 Dec 22. PMID: 21177796 Free PMC Article
  44. Busko M Vegetarian or Mediterranean? Both Diets Improve Weight, Lipids. Medscape. Feb 27, 2018 https://www.medscape.com/viewarticle/893184 - Sofi F, Dinu M, Pagliai G. Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet). Circulation. February 26, 2018 PMID: 29483085 http://circ.ahajournals.org/content/early/2018/02/14/CIRCULATIONAHA.117.030088
  45. Voelker R. The Mediterranean Diet's Fight Against Frailty. JAMA. Published online April 25, 2018 PMID: 29710236 https://jamanetwork.com/journals/jama/fullarticle/2679958
  46. Janeczko LL Mediterranean Diet Linked With Lower Incidence of Advanced AMD. Medscape - Jun 01, 2018. https://www.medscape.com/viewarticle/897504
  47. Estruch R, Ros E, Salas-Salvado J et al Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. June 13, 2018 PMID: 29897866 https://www.nejm.org/doi/full/10.1056/NEJMoa1800389 - Estruch R, Ros E, Salas-Salvado J et al Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90. PMID: 29897867
  48. Lassale C, Batty GD, Baghdadli A Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Molecular Psychiatry (2018). Sept 26. PMID: 30254236 https://www.nature.com/articles/s41380-018-0237-8
  49. Balistreri WF Mediterranean Diet's Benefits May Extend to Multiple Diseases. Medscape. Nov 7, 2018 https://www.medscape.com/viewarticle/904271
  50. Johansson K, Askling J, Alfredsson L, Di Giuseppe D for the EIRA study group. Mediterranean Diet and Risk of Rheumatoid Arthritis. A Population-Based Case-Control Study. Arthritis Res Ther. 2018 Aug 9;20(1):175 PMID: 30092814 Free PMC Article https://www.medscape.com/viewarticle/903581
  51. Monaco K Mediterranean Diet Might Stave Off Depression in Late Life - Study looked at cohort of elderly adults in Greece. MedPage Today. May 20, 2019 https://www.medpagetoday.com/meetingcoverage/apa/79930 - Argyropoulos K, et al Adherence to Mediterranean Diet and Risk of Late-Life Depression. American Psychiatric Association (APA) 2019; Abstract P6-156.
  52. Khan SU, Khan MU, Riaz H et al Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map. Ann Intern Med. 2019. July 9. PMID: 31284304 https://annals.org/aim/article-abstract/2737825/effects-nutritional-supplements-dietary-interventions-cardiovascular-outcomes-umbrella-review-evidence - Pandey AC, Topol EJ Dispense With Supplements for Improving Heart Outcomes. Ann Intern Med. 2019. July 9. PMID: 31284306 https://annals.org/aim/article-abstract/2737826/dispense-supplements-improving-heart-outcomes
  53. H Al Wattar B, Dodds J, Placzek A et al Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial. PLOS Medicine. July 23, 2019 PMID: 31335871 Free Article https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002857
  54. University of Minnesota Medical School Mediterranean diet ingredient may extend life. Olive oil in the diet may also help mitigate aging-related diseases. Science News. February 21, 2020 https://www.sciencedaily.com/releases/2020/02/200221125120.htm - Najt CP, Khan SA, Heden TD et al Lipid Droplet-Derived Monounsaturated Fatty Acids Traffic via PLIN5 to Allosterically Activate SIRT1. Mol Cell. 2020 Feb 20;77(4):810-824.e8. doi: 10.1016/j.molcel.2019.12.003. Epub 2019 Dec 31. PMID: 31901447
  55. MedlinePlus. Mediterranean diet. https://medlineplus.gov/ency/patientinstructions/000110.htm
  56. George J Fish, Veggie-Rich Diet Tied to Less Cognitive Impairment Risk. Post-hoc analyses show benefit of alternative Mediterranean diet. MedPage Today April 15, 2020 https://www.medpagetoday.com/neurology/dementia/85986 - Keenan TD, Agron E, Mares JA et al Adherence to a Mediterranean diet and cognitive function in the Age- Related Eye Disease Studies 1 & 2. Alzheimer's & Dementia. April 13, 2020 PMID: 32285590 https://alz-journals.onlinelibrary.wiley.com/doi/abs/10.1002/alz.12077
  57. MD Anderson News Release January 07, 2021 Mediterranean diet may decrease risk of prostate cancer progression for men on active surveillance. https://www.mdanderson.org/newsroom/mediterranean-diet-may-decrease-risk-of-prostate-cancer-progression-for-men-on-active-surveillance.h00-159457689.html
  58. O'Keefe JH, Torres-Acosta N, O'Keefe EL et al Pesco-Mediterranean Diet With Intermittent Fasting. J Am Coll Cardiol. 2020;76(12):1484-1493 PMID: 32943166 Free article
  59. Metcalfe-Roach A, Yu AC, Golz E et al MIND and Mediterranean Diets Associated with Later Onset of Parkinson's Disease. Movement Disorders. 2021. Jan 6 PMID: 33404118 https://onlinelibrary.wiley.com/doi/10.1002/mds.28464
  60. Wang DD, Li Y, Bhupathiraju SN et al Fruit and Vegetable Intake and Mortality. Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. 2021;143:00-00 PMID: 33641343 https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.048996
  61. George J Alzheimer's Pathology Linked to Diet. Can a certain variety of foods slow Alzheimer's progression? MedPage Today May 6, 2021 https://www.medpagetoday.com/neurology/alzheimersdisease/92460 - Ballarini T, van Lent DM, Brunner J et al Mediterranean Diet, Alzheimer Disease Biomarkers and Brain Atrophy in Old Age. Neurology 2021. May 5 PMID: 33952652 https://n.neurology.org/content/early/2021/05/04/WNL.0000000000012067
  62. Brooks M Mediterranean Diet Slows Progression of Atherosclerosis in CHD. Medscape - Aug 18, 2021 https://www.medscape.com/viewarticle/956837 - Jimenez-Torres J, Alcala-Diaz JF, Torres-Pena JD et al Mediterranean Diet Reduces Atherosclerosis Progression in Coronary Heart Disease: An Analysis of the CORDIOPREV Randomized Controlled Trial. Stroke. 2021. August 10. https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.033214
  63. Tucker ME 'Green' Mediterranean Diet Benefits Arise From Hunger Hormone. Medscape. October 26, 2021 https://www.medscape.com/viewarticle/961581 - Tsaban G, Yaskolka Meir A, Zelicha H et al Diet-induced Fasting Ghrelin Elevation Reflects the Recovery of Insulin Sensitivity and Visceral Adiposity Regression. J Clin Endocrinol Metab. October 6, 2021 PMID: 34643713 https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgab681/6382201
  64. Davis C, Bryan J, Hodgson J et al. Definition of the Mediterranean diet; a literature review. Nutrients. 2015;7(11):9139-9153 https://www.mdpi.com/2072-6643/7/11/5459
  65. Hughes S Mediterranean Diet Linked to Lower Risk for Preeclampsia. Medscape. April 21, 2022 - Minhas AS, Hong X, Wang G et al Mediterranean-Style Diet and Risk of Preeclampsia by Race in the Boston Birth Cohort. J Am Heart Assoc. 2022. Apr 20;e022589. PMID: 35441523 https://www.ahajournals.org/doi/full/10.1161/JAHA.121.022589
  66. Delgado-Lista J et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): A randomised controlled trial. Lancet 2022 May 14; 399:1876. PMID: 35525255 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00122-2/fulltext
  67. Millar CL, Costa E, Jacques PF, Dufour AB, Kiel DP, Hannan MT, Sahni S. Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: Results from the Framingham Offspring Study. Am J Clin Nutr. 2022 May 12 PMID: 35551593
  68. Moustafa B, Trifan G, Isasi CR et al Association of Mediterranean Diet With Cognitive Decline Among Diverse Hispanic or Latino Adults From the Hispanic Community Health Study/Study of Latinos. JAMA Netw Open. 2022;5(7):e2221982 PMID: 35834250 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794208
  69. Dobreva I, Marston L, Mukadam N. Which components of the Mediterranean diet are associated with dementia? A UK Biobank cohort study. GeroScience. 2022 July 6. PMID: 35794436 https://link.springer.com/article/10.1007/s11357-022-00615-2
  70. Apovian C Does the Mediterranean Diet Prevent Obesity? Medscape. Oct 12, 2022 https://www.medscape.com/viewarticle/982111
  71. Estruch R et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34 PMID: 29897866 Free article
  72. Bolte LA, Lee KA, Bjork JR et al Association of a Mediterranean Diet With Outcomes for Patients Treated With Immune Checkpoint Blockade for Advanced Melanoma. JAMA Oncol. 2023;9(5):705-709 PMID: 36795408 PMCID: PMC9936383 Free PMC article https://jamanetwork.com/journals/jamaoncology/fullarticle/2801594
  73. George J Cognitive Impairment in Multiple Sclerosis Tied to Diet. Mediterranean diet was strongest predictor of better cognitive scores. MedPage Today March 3, 2023 https://www.medpagetoday.com/meetingcoverage/aan/103374
  74. Karam G et al. Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: Systematic review and network meta-analysis. BMJ 2023 Mar 29; 380:e072003. PMID: 36990505 PMCID: PMC10053756 Free PMC article https://www.bmj.com/content/380/bmj-2022-072003
  75. Phend C 'Green' Mediterranean Diet Linked to Aortic Stiffness Reversal. All healthy diets helped, but one had the biggest impact in post hoc trial analysis. MedPage Today April 17, 2023 https://www.medpagetoday.com/cardiology/prevention/104049 - Tsaban G, Shalev A, Katz A et al Effect of Lifestyle Modification and Green Mediterranean Diet on Proximal Aortic Stiffness. J Am Coll Cardio, 2023 Apr, 81(16):1659-1661 PMID: 37076220 https://www.jacc.org/doi/abs/10.1016/j.jacc.2023.02.032
  76. Romero-Cabrera JL et al. Adherence to a Mediterranean lifestyle improves metabolic status in coronary heart disease patients: A prospective analysis from the CORDIOPREV study. J Intern Med 2023 May; 293:574. PMID: 36585892 https://onlinelibrary.wiley.com/doi/10.1111/joim.13602
  77. Konieczna J, Ruiz-Canela M, Galmes-Panades AM et al An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition: An Interim Subgroup Analysis of the PREDIMED-Plus Randomized Clinical Trial. JAMA Netw Open. 2023 Oct 2;6(10):e2337994. PMID: 37851444 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810826
  78. Bassett M Mediterranean Diet Tied to Lower Mortality Risk in Cancer Survivors. High levels of adherence associated with lower risk of all-cause and cardiovascular mortality. MedPage Today July 6, 2024 https://www.medpagetoday.com/hematologyoncology/othercancers/110982 - Bonaccio M et al Mediterranean Diet Is Associated With Lower All-Cause and Cardiovascular Mortality Among Long-Term Cancer Survivors. J Am Coll Cardiol CardioOnc. 2024, Jul 2 PMID: 39239350 PMCID: PMC11372299 Free PMC article https://www.jacc.org/doi/10.1016/j.jaccao.2024.05.012
  79. Maroto-Rodriguez J, Delgado-Velandia M, Ortola R et al Association of a Mediterranean Lifestyle With All-Cause and Cause-Specific Mortality: A Prospective Study from the UK Biobank. Mayo Clin Proc. 2024 Apr;99(4):551-563. PMID: 37589638
  80. Zwilling CE, Wu J, Barbey AK. Investigating nutrient biomarkers of healthy brain aging: a multimodal brain imaging study. NPJ Aging. 2024 May 21;10(1):27. PMID: 38773079 PMCID: PMC11109270 Free PMC article. https://www.nature.com/articles/s41514-024-00150-8
  81. Kahleova H, Znayenko-Miller T, Motoa G et al Dietary advanced glycation end-products and their associations with body weight on a Mediterranean diet and low-fat vegan diet: a randomized, cross-over trial. Front Nutr. 2024 Aug 8;11:1426642. PMID: 39176029 PMCID: PMC11340516 Free PMC article. https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1426642/full
  82. Halim C, Howen M, Fitrisubroto AANB et al Relevance of Mediterranean diet as a nutritional strategy in diminishing COVID-19 risk: A systematic review PLoS One. 2024 Aug 21;19(8):e0301564. PMID: 39167591 PMCID: PMC11338465 Free PMC article. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0301564
  83. Park G, Kadyan S, Hochuli N et al A modified Mediterranean-style diet enhances brain function via specific gut-microbiome-brain mechanisms. Gut Microbes. 2024 Jan-Dec;16(1):2323752. PMID: 38444392 PMCID: PMC10936641 Free PMC article.