A narrative review published in The American Journal of Clinical Nutrition examined three decades of global research on the Mediterranean diet, synthesizing findings from large population-based cohort studies, randomized clinical trials, and biological analyses. The authors found consistent associations between the Mediterranean-style diet and reduced risks of cardiovascular disease, type 2 diabetes, cancer, cognitive decline, and all-cause mortality.
What Is the Mediterranean-Style Diet?
Cardiometabolic and Cognitive Benefits
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In the PREDIMED trial, individuals at high cardiovascular risk randomized to a Mediterranean-style diet supplemented with extra-virgin olive oil had a 31% lower risk of major cardiovascular events over five years, compared to a control group advised to follow a low-fat diet. However, the authors note that the control group’s fat intake averaged 37% of total energy, suggesting it functioned more as a usual care group than a true low-fat comparator.
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A secondary prevention trial, CORDIOPREV, found a 26% risk reduction in recurrent cardiovascular events among patients with coronary artery disease who followed the Mediterranean-style diet. A similar intervention with mixed nuts yielded a 28% risk reduction.
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Among 22,000+ Greek adults, higher adherence to the diet was associated with reduced cardiovascular and cancer mortality.
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The Nurses’ Health Study and Health Professionals Follow-Up Study, involving over 200,000 participants, found a 29% lower risk of coronary artery disease and a 17% lower risk of all-cause mortality with high adherence to the Mediterranean diet.
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A meta-analysis of 14 prospective studies (410,000+ participants) found a 21% reduced risk of type 2 diabetes among those with the highest adherence. Each 2-point increase in diet adherence score reduced risk by 14%.
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In cancer-related outcomes, a meta-analysis of more than 3.2 million individuals linked the diet to a 13% reduction in cancer mortality and lower risks for colorectal, breast, gastric, liver, head and neck, bladder, and respiratory cancers.
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Cognitive benefits were also noted. High adherence was associated with a 25% lower risk of mild cognitive impairment and a 29% lower risk of Alzheimer disease. Randomized trials reported improvements in memory performance.