Introduction
Methodology
Selection criteria for studies
Literature search
Data extraction and quality assessment
Data analysis
Name of Scoring system | Range of MD adherence score for classification in categories | ||
---|---|---|---|
Low | Moderate | High | |
Mediterranean diet scale (MDS) by Trichoupoulo et al. (2003) [12] | 0–2.9 | 3–5.9 | 6–9 |
Italian Mediterranean Index (IMI) by Agnoli et al. (2013) [29] | 0–2.9 | 3–5.9 | 6–9 |
rMed by Buckland et al. (2010) [30] | 0–6.9 | 7–10.9 | ≥ 11 |
MedDietScore by Panagiotakos et al. (2006) [13] | 0–32.9 | 33–36.9 | 37–55 |
MEDAS by Schroder et al. et al. (2011) [31] | 0–6.9 | 7–10.9 | 11–14 |
Lebanese Mediterranean Index (LMD) by Naja et al. (2015) [32] | 9–14.9 | 15–20.9 | 21–27 |
Mediterranean Diet Scoring System (MDSS) by Monteagudo et al. (2015) [33] | 0–9.9 | 10–13.9 | ≥ 14 |
Medi-Lite score by Sofi et al. (2017) [34] | 0–10.9 | 11–14.9 | ≥ 15 |
Results
Study selection
Characteristics of included studies
References | Study design (name of cohort) | Sample size | Sample characteristics (sociodemographic)* | |
---|---|---|---|---|
France | ||||
1 | Féart et al. (2011) [39] | PC (Three-City 3C) | 1410 | Age ≥ 65; mean age 75.9 (67.7 – 94.9) 37.3% males |
2 | Féart et al. (2012) [16] | PC (Three-City 3C) | 1595 | Age ≥ 65; mean age: 76.1 (67.7–94.9) 38.1% males |
3 | Kesse-Guyot et al. (2013) [40] | PC (SU.VI.MAX.2) | 3083 | Mean age: 52.0 ± 4.6 53.7% males |
4 | Barré et al. (2017) [36] | PC (French E3N Cohort) | 64,052 | Mean age: 52.7 100% females 36% high education level Mean BMI: 22.8 |
5 | Trebuchet et al. (2019) [50] | PC (NutriNet-Santé) | 94,113 | Age > 18; mean age: 43.9 ± 14.6 21% males post-secondary education 64.3% Mean BMI: 23.84 ± 4.57 |
6 | Adjibade et al. (2018) [51] | PC (SU.VI.MAX) | 3523 | Mean age: 49.5 ± 6.2 42.3% males |
7 | Lavalette et al. (2018) [52] | PC (NutriNet-Santé) | 41,543 | Age ≥ 18; mean age: 54.6 ± 8.7 26.5% males 73.7% post-secondary education Mean BMI: 24.5 ± 4.5 |
8 | Lelong et al. (2016) [41] | PC (NutriNet-Santé) | 11,302 | Age ≥ 18; mean age: 51.7 ± 13.5 24.6% males 68.2% had university or equivalent Mean BMI: 23.8 ± 4.0 |
9 | Lassale et al. (2012) [42] | PC (SU.VI.MAX) | 3151 | Age range: 45–60; mean age: 52.3 ± 4.6 53.3% males 40.8% university graduates Mean BMI: 24.4 (3.4) |
10 | Buckland et al. (2010) [30] | PC (EPIC) | 180,718 | Age range: 35–70 |
Greece | ||||
11 | Koustonida et al. (2021) [63] | PC (EHS) | 1273 | Age range: 21–77; mean age: 47.82 ± 11 40.55% males 67% High education Mean BMI: 26.41 (4.68) |
12 | Mantzorou et al. (2021) [8] | CS | 2092 | Age > 65; mean age: 74.97 ± 8.41 48% males |
13 | Mamalaki et al. (2020) [57] | CS (HELIAD) | 1993 | Age ≥ 65; mean age: 73 ± 6 41% males Mean BMI: 28.9 ± 4.7 |
14 | Mamalaki et al. (2018) [58] | CS (HELIAD) | 1639 | Age ≥ 65; mean age: 72.7 ± 5.7 41% males Mean BMI: 28.9 ± 4.7 |
15 | Maraki et al. (2019) [59] | CS (HELIAD) | 1731 | Age ≥ 65; mean age: 73 ± 6 41% males Mean BMI: 28.9 ± 4.7 |
16 | Panagiotakos et al. (2015) [26] | PC (ATTICA) | 3042 | Age range: 18–89; mean age: 46 ± 14 49.8% males 78% urban dwellers Mean BMI: 26 ± 5 |
Spain | ||||
17 | Zazpe I et al. (2021) [49] | PC (The SUN) | 5515 | Age > 20; Mean age: 36.3 years (10.7) 41% males |
18 | Gutiérrez-Carrasquilla et al. (2019) [64] | CS (ILERVAS) | 3020 | Age range: 45–70 |
19 | Navarrete-Muñoz et al. (2018) [53] | PC (DiSA-UMH) | 1026 | Age range: 17–35 28% males Health sciences university students |
20 | Galilea-Zabalza et al. (2018) [54] | PC (REDIMED-PLUS) | 6430 | Age range: 55–75 |
21 | Cornejo del Rio et al. (2017) [65] | CS (SPREDIA-2) | 1586 | Mean age: 61.5 (6) 43% males 32% university education |
22 | Ferreira-Pêgo et al. (2017) [66] | CS | 1262 | Age ≥ 18 50% males |
23 | Domınguez et al. (2013) [43] | PC (The SUN) | 20,155 | Mean age: 38.4 39.5% males |
24 | Mateo-Gallego et al. (2017) [44] | CS (The Aragon Workers' Health) | 2588 | Mean age: 51.3 ± 3.89 94.9% men |
25 | Olza et al. (2019) [44] | CS (ANIBES) | 2286 | Age range: 19–75 51% males |
26 | Sayon-Orea et al. (2015) [37] | CS | 8954 | Mean age: 54.3 ± 6.6 100% females population-based peri-/post-menopausal women 60.0% had high school/university education Mean BMI: 25.4 (± 4.5) |
27 | León-Muñoz et al. (2012) [18] | CS (ENRICA) | 11,742 | Age ≥ 18 49.5% males Representative of the population aged ≥ 18 28.2% had university education 39.2% had normal BMI |
28 | Campanini et al. (2017) [67] | PC (Seniors-ENRICA) | 1596 | Age ≥ 60 years Population-based sample |
29 | Alemán et al. (2016) [24] | CS (DIMERICA) | 1732 | Age > 20; median age: 51 47% males Healthy volunteers 44.2% had university degree Mean BMI: 25.6 (22.7–29.2) |
30 | León-Muñoz et al. (2014) [46] | PC (Seniors-ENRICA) | 1815 | Age ≥ 60 years Population-based adult sample |
31 | Rodríguez-Mireles et al. (2018) [27] | CS | 4160 (2009); 4143 (2015) | Age > 16; mean age: 47.6 ± 17.2; 50.8 ± 16.8 (2009; 2015, respectively) 41%—43% males (2009; 2015, respectively); 50%- 54% secondary education (2009; 2015, respectively) Mean BMI: 2009: 26.2 (± 4.83), 2015: 26.21 (± 4.71) |
32 | Moreno-Agostino et al. (2019) [68] | CS (COURAGE in Europe) | 2397 | Age range: 21–101; mean age: 61.9 ± 15.2 46% males 86% urban dwellers 43% retirees 31% employed 41.23% were overweight |
33 | Garcıa-Arenzana et al. (2012) [38] | CS (DDM-Spain) | 3564 | Age range: 45–68; mean age: 56.2 ± 5.5 100% females 28.9% > secondary education 41.7% had normal BMI |
Italy | ||||
34 | Dinu M et al. (2020) [69] | CS (Medi-Lite) | 1820 | Age > 18; 46.3% aged 18–30 y 39.6% males 52.1% unmarried/single 48.4% university degree |
35 | Ruggiero et al. (2019) [17] | PC (INHES) | 7430 | Age > 20; 65% aged 35–64 y 46% males 42% upper secondary education; 17% post-secondary 86% urban dwellers 32% retirees 49.8% had normal BMI |
36 | Barrea et al. (2017) [70] | CS | 1013 | Age range: 8–58; mean age: 37 (18–58) 46% males Mean BMI: 33.5 (19.5–57.9) |
37 | Limongi et al. (2017) [71] | PC (ILSA) | 4232 | Age range: 65–84 |
38 | Zappala et al. (2019) [55] | CS (MEAL) | 1936 | Age ≥ 18 Urban dwellers |
39 | Marventano et al. (2018) [56] | CS (MEAL) | 1937 | Age ≥ 18 Urban dwellers |
40 | Bertoli et al. (2015) [72] | CS (ICANS) | 4388 | Age range: 18–80; median age: 46 26.8% males Mean BMI: 27.9 (25.0–31.0) |
41 | Bonaccio et al. (2012) [47] | PC (Moli-sani) | 13,262 | Age ≥ 35 years; mean age: 53.3 ± 10.6 49.7% males |
42 | Veronese et al. (2020) [20] | CS (MICOL) | 2451 (1985–1989) 2375 (2005–2006) | Age range: 30–69 55%-60% males |
Other Mediterranean countries (Malta, Cyprus, Croatia, Lebanon, Israel, and MD islands) | ||||
43 | Cuschieri S et al. (2021) [73] | CS | 3947 | Age range: 18–70; mean age 44.8 ± 15.1 50.6% males |
44 | Kyprianidou et al. (2020) [62] | CS | 1140 | Age > 18; mean age: 41 ± 17 43.6% males 54% married, 64% higher education 40% private employees Mean BMI: 25 ± 5 kg/m2 |
45 | Quarta S et al. (2021) [74] | CS (MeDiWeb) | 2163 | Age > 18; 32.8% males Mean BMI: 24.6 (± 4.5) |
46 | Foscolou et al. (2018) [60] | PC (MEDIS) | 3131 | Age > 65 |
47 | Cherfan et al. (2018) [61] | CS | 2014 | Age > 20; mean age: 41.3 ± 17.0 48.5% males 46% university education 52.55 urban dwellers 62% employed Mean BMI: 26.8 (± 4.9) |
48 | Kolčić et al. (2016) [75] | CS (10,001 Dalmatians) | 2768 | Age ≥ 18; median age: 55.0–58.0 36.6–39.7% males |
49 | Naja et al. (2015) [32] | CS | 2048 | Age range: 20–55; mean age: 34.7 ± 9.9 45.1% males Nationally representative adult sample 34.1% had university and higher education |
50 | Zbeida et al. (2014) [48] | PC (MABAT ZAHAV) | 1786 | Age ≥ 65 50% males Community-dwelling representative sample |
Author(s) | Sample size | Mean score (± SD) | Classification of mean | Distribution of population (%) by categories of MD adherence(k) | |||||
---|---|---|---|---|---|---|---|---|---|
Low | Moderate | High | |||||||
France | |||||||||
1 | Feart C et al. (2011)a [39] | 1410 | 4.4 (1.7) | Moderate | 30.0 | 43.6 | 26.4 | ||
2 | Feart C et al. (2012)a [16] | 1595 | 4.36 (1.67) | Moderate | 30.8 | 43.5 | 25.7 | ||
3 | Kesse-Guyot E et al. (2013)a [40] | 3083 | 4.6 (1.6) | Moderate | 27.0 | 45.6 | 27.3 | ||
4 | Barré A et al. (2017)a [36] | 64,052 | NR | 28.4 | 44.1 | 27.4 | |||
5 | Trebuchet A et al. (2019)b [50] | 94,113 | 9.61 (2.77) | Moderate | 23.3 | 50.9 | 25.7 | ||
6 | Adjibade M et al. (2018)b [51] | 3523 | NR | 30.4 | 41.0 | 28.5 | |||
7 | Lavalette C et al. (2018)b [52] | 41,543 | 8.4 (2.3) | Moderate | NR | ||||
8 | Lelong et al. (2016)a [41] | 11,302 | 4.3 (1.6) | Moderate | NR | ||||
9 | Lassale et al. (2012)a,b [42] | 3151 | MDS = 4.5 (1.6) rMED = 9 (2.8) | Moderate Moderate | NR | ||||
10 | Buckland et al. (2010)b [30] | 68,892 | 9.5 (2.6) | Moderate | NR | ||||
Greece | |||||||||
11 | Koustonida et al. (2021)d [63] | 1201 | 7.25 (1.74) | Moderate | 54.1 | NR | 45.9 | ||
12 | Mantzorou et al. (2021)c [8] | 2092 | 28 (11–42)j | Low | 52.1 | 24.9 | 23 | ||
13 | Mamalaki E et al. (2020)c [57] | 1993 | 33·3 (4·6) | Moderate | 32.9 | 33.5 | 30.5 | ||
14 | Mamalaki E et al. (2018)c [58] | 1639 | 33.4 (4.5) | Moderate | 32.2 | 34.3 | 33.5 | ||
15 | Maraki M et al. (2019)c [59] | 1731 | 33.2 (4.6) | Moderate | 26.7 | 45.5 | 24.5 | ||
16 | Panagiotakos D et al. (2015)c [26] | 2001–02: 3042 2006: 2101 2011–12: 2583 | 2001–02:26 (7) 2006:25 (7) 2011–12:25 (7) | 2001–02: Low 2006: Low 2011–15: Low | NR | ||||
10 | Buckland et al. (2010)b [30] | 25,984 | 12.9 (1.9) | High | NR | ||||
Spain | |||||||||
17 | Zazpe I et al. (2021)a,d [49] | 5515 | Baseline (1999): MEDAS: 6.2 (1.7) MDS: 4.3 (1.8) 10 years follow up: MEDAS: 7.2 (1.7) MDS: 4.4 (1.7) | Baseline (1999): MEDAS: Low MDS: Moderate 10 years follow up: MEDAS: Moderate MDS: Moderate | 35.8 | 54.2 | 10 | ||
18 | Gutiérrez-Carrasquilla L et al. (2019)d [64] | 3020 | NR | 12.4 | 80.1 | 7.4 | |||
19 | Navarrete-Muñoz E et al. (2018)b [53] | 1026 | NR | 25.3 | 50.1 | 24.6 | |||
20 | Galilea-Zabalza I et al. (2018)b [54] | 6430 | NR | 24.4 | 52.5 | 23.1 | |||
21 | Cornejo del Rio V et al. (2017)d [65] | 1586 | 8.6 (2.1) | Moderate | NR | NR | 18.7 | ||
22 | Ferreira-Pêgo C et al. (2017)d [66] | 1262 | NR | 24.3 | 41.0 | 34.7 | |||
23 | Domınguez et al. (2013)a [43] | 20,155 | NR | 22.0 | 62.9 | 15.1 | |||
24 | Mateo-Gallego R et al. (2017)a [44] | 2566 | NR | 16.9 | 60.4 | 22.7 | |||
25 | Olza J et al. (2019)a [45] | 2286 | NR | 44.8 | NR | 55.2 | |||
26 | Sayon-Orea et al. (2015)d [37] | 8954 | 7.6 (2.0) | Moderate | 47.6 | 35.7 | 16.7 | ||
27 | León-Muñoz et al. (2012)d [18] | 11,742 | 6.34 (0.03) | Low | 46.0 | NR | 12.0 | ||
28 | Campanini M et al. (2017)d [67] | 1596 | 7.55 (1.65) | Moderate | 48.7 | 22.9 | 28.3 | ||
29 | Alemán et al. (2016)e [24] | 1732 | 4.6 (3.3–6.0)j | Moderate | NR | ||||
30 | León-Muñoz et al. (2014)a,d [46] | 1815 | MEDAS: 7.18 MDS: 4.93 | Moderate Moderate | NR | ||||
31 | Rodríguez-Mireles S et al. (2018)e [27] | 2009: n = 4160 2015: n = 4143 | 2009: 5.20 (1.66) 2015: 5.17 (1.84) | 2009: Moderate 2015: Moderate | NR | ||||
32 | Moreno-Agostino D et al. (2019)d [68] | 2397 | 8.55 (1.95) | Moderate | NR | ||||
33 | Garcıa-Arenzana et al. (2012)a [38] | 3564 | 5 (4–6)j | Moderate | NR | ||||
10 | Buckland et al. (2010)b [30] | 40,641 | 11 (2.4) | High | NR | ||||
Italy | |||||||||
34 | Dinu M et al. (2020)i [69] | 1820 | 12.18 (2.40) | Moderate | NR | ||||
35 | Ruggiero E et al. (2019)c [17] | 7430 | 29.6 (5.4) | Low | 33.8 | 29.7 | 36.5 | ||
36 | Barrea L et al. (2017)d [70] | 1013 | 7.1 (3.0) | Moderate | 37.7 | 39.3 | 23 | ||
37 | Limongi F et al. (2017) h [71] | 4232 | NR | 31.9 | 26.1 | 41.7 | |||
38 | Zappala G et al. (2019)b [55] | 1936 | NR | 86.6 | NR | 14.1 | |||
39 | Marventano S et al. (2018)b [56] | 1937 | NR | 23.8 | 61.9 | 14.2 | |||
40 | Bertoli et al. (2015)d [72] | 4388 | 7.0 (5.0–8.0) | Moderate | NR | NR | 13.6 | ||
41 | Bonaccio et al. (2012)a,e [47] | 13,262 | MDSa: 4.44 (1.64) IMIe: 3.26 (1.71) | Moderate Moderate | NR | ||||
10 | Buckland et al. (2010)b [30] | 45,201 | 11 (2.3) | High | NR | ||||
Multinational (Malta, Cyprus, Croatia, Lebanon, Israel and MD islands) | |||||||||
42 | Cuschieri S et al. (2021)i [73] | 3947 | 7.19 (1.91) | Low | 40 | 37.7 | 24.3 | ||
43 | Kyprianidou et al. (2020)c [62] | 1123 | 15 (13–18)j | Low | 32.6 | 36.7 | 30.5 | ||
44 | Quarta S et al. (2021)d [74] | 2163 | 7.08 (1.96) | Moderate | 20.7 | 68.3 | 11 | ||
45 | Foscolou A et al. (2018)c [60] | 3131 | 32.5 (5.0) | Low | NR | ||||
46 | Cherfan M et al. (2018)c [61] | 2014 | 30.9 (4.6) | Low | NR | ||||
47 | Kolčić et al. (2016)f [75] | 2768 | 11 (8–13)j | Moderate | NR | ||||
48 | Naja et al. (2015)a,b,c,e [32] | 2048 | LMDg:17.38 (3.40) MedDietScorec: 27.23 (4.65) IMIe: 3.56 (1.76) rMEDb: 8.27 (2.49) MDSa: 4.18 (1.49) | Moderate Low Moderate Moderate Moderate | NR | ||||
49 | Zbeida et al. (2014)a [48] | 1786 | NR | 26.7 | 62.1 | 11.2 |