Introduction
Methods
Data sources and search strategy
Inclusion criteria
Methodological quality
Credibility of the evidence
Identification of different MedDiet scores
Statistical analysis
Results
References | Outcome and summary of the estimates RR (95% CI) | No. studies included | Sample size, cases | Follow-up (years) | Predictive Interval (95% CI) | NutriGrade grading [26] | Modified AMSTAR rating [24] | Included MedDiet-scores* (ref.) | Results re-analyses RR (95% CI) and test for subgroup differences (random effects model) | Results re-analyses RR (95% CI) and test for subgroup differences (fixed effects model) |
---|---|---|---|---|---|---|---|---|---|---|
Jannasch et al. [16] | T2D incidence RR: 0.87 (0.82, 0.97) I2 = 26% | 6 cohort studies | 183,392, 17,561 | 10–20 | (0.77, 1.00) | Low | 18/22 | tMedDiet 4: [61] aMedDiet: [74] aMedDiet 2: [79] aMedDiet 4: [82] | High versus low adherence RR (tMedDiet): 0.87 (0.81, 0.93) RR (aMedDiet): 0.88 (0.75, 1.04) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.83 | High versus low adherence RR (tMedDiet): 0.87 (0.81, 0.93) RR (aMedDiet): 0.89 (0.84, 0.98) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.51 |
Schwingshackl et al. [40] | T2D incidence RR: 0.83 (0.74, 0.92) I2 = 56% | 8 cohort studies | 129,647, 19,463 | 3.2–20 | (0.61, 1.11) | Moderate | 17/22 | tMedDiet 4: [61] aMedDiet: [76] aMedDiet 2: [79] aMedDiet 4: [82] CA: [98] MedDiet 1: [83] | High versus low adherence RR (tMedDiet): 0.86 (0.74, 1.01) RR (aMedDiet): 0.82 (0.68, 1.00) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.70 | High versus low adherence RR (tMedDiet): 0.88 (0.81, 0.95) RR (aMedDiet): 0.79 (0.71, 0.87) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.11 |
Koloverou et al. [30] | T2D incidence RR: 0.77 (0.66, 0.89) I2 = 58% | 9 cohort studies | 135,168, 19,609 | 3.2–20 | (0.62, 1.15) | Low | 16/22 | tMedDiet 4: [61] aMedDiet: [76] aMedDiet 2: [79] aMedDiet 4: [82] CA: [98] MedDiet 1: [83] | High versus low adherence RR (tMedDiet): 0.88 (0.76, 1.02) RR (aMedDiet): 0.83 (0.67, 1.04) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.66 | High versus low adherence RR (tMedDiet): 0.88 (0.81, 0.95) RR (aMedDiet): 0.79 (0.71, 0.89) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.12 |
Esposito et al. [31] | T2D incidence RR: 0.80 (0.68, 0.93) I2 = 64% | 6 cohort studies | 95,384, 7129 | 3.2–20 | (0.50, 1.26) | Low | 17/22 | MedDiet 1: [83] aMedDiet 2: [79] aMedDiet: [76] aMedDiet 4: [82] | High versus low adherence RR (tMedDiet): 0.46 (0.09, 2.21) RR (aMedDiet): 0.82 (0.68, 1.00) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.47 | High versus low adherence RR (tMedDiet): 0.87 (0.77, 0.98) RR (aMedDiet): 0.79 (0.71, 0.87) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.21 |
Rosato et al. [32] | CHD/AMI incidence/mortality RR: 0.74 (0.66, 0.83) I2 = 27% | 9 cohort studies | 392,283, 4256 | 4.9–20 | (0.50, 0.99) | Moderate | 14/22 | MedDiet 6: [90] tMedDiet 4: [60] tMedDiet 2: [56] MedDiet 3: [85] mMedDiet: [96] aMedDiet: [77] MedDiet 7: [91] | NA | NA |
Unspecified stroke incidence/mortality RR: 0.77 (0.67, 0.90) I2 = 0% | 5 cohort studies | 107,074, 1210 | No follow-up to 20 | (0.61, 0.98) | Low | aMedDiet: [77] MedDiet 3: [85] MedDiet 8: [93] | NA | NA | ||
Ischemic stroke RR: 0.82 (0.73, 0.92) I2 = 0% | 5 cohort studies | 181,295, 2997 | 6.5–20 | (0.67, 1.00) | Low | tMedDiet: [41] tMedDiet 2: [56] tMedDiet 8: [67] aMedDiet: [71] MedDiet 7: [91] | NA | NA | ||
Haemorrhagic stroke RR: 1.01 (0.74, 1.37) I2 = 36% | 4 cohort studies | 178,727, 737 | 6.5–20 | (0.36, 2.82) | Low | tMedDiet: [41] tMedDiet 8: [67] aMedDiet: [71] MedDiet 7: [91] | NA | NA | ||
Unspecified CVD incidence/mortality RR: 0.81 (0.74, 0.88) I2 = 80% | 11 cohort studies | 831,642, 56 695 | 4.9–20 | (0.62, 1.06) | Moderate | tMedDiet 2: [56] tMedDiet 4: [59] MedDiet 3: [85] MedDiet 4: [87] MedDiet 7: [92] mMedDiet: [96] | High versus low adherence RR (tMedDiet): 0.69 (0.54, 0.89) RR (aMedDiet): 0.83 (0.74, 0.94) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.18 | High versus low adherence RR (tMedDiet): 0.70 (0.58, 0.86) RR (aMedDiet): 0.81 (0.79, 0.84) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.17 | ||
Grosso et al. [33] | CVD incidence RR: 0.73 (0.66, 0.80) I2 = 36% | 13 cohort studies | 274,023, 11,688 | 2–20 | (0.57, 0.92) | Moderate | 16/22 | tMedDiet 2: [56] tMedDiet 4: [60] aMedDiet: [71] iMedDiet: [41] MedDiet 5: [89] MAI: [105] | High versus low adherence RR (tMedDiet): 0.71 (0.60, 0.85) RR (MedDiet 3): 0.80 (0.66, 0.97) RR (sMedDiet): 0.22 (0.06, 0.82) Test for subgroup differences (tMedDiet vs MedDiet 3 vs sMedDiet): p = 0.13 | High versus low adherence RR (tMedDiet): 0.72 (0.63, 0.82) RR (MedDiet 3): 0.83 (0.74, 0.92) RR (sMedDiet): 0.21 (0.12, 0.37) Test for subgroup differences (tMedDiet vs MedDiet 3 vs sMedDiet): p < 0.01 |
CVD mortality RR: 0.75 (0.68, 0.83) I2 = 75% | 14 cohort studies | 786,279, 9563 | 5.8–40 | (0.53, 1.06) | Low | aMedDiet: [71] aMedDiet 1: [78] aMedDiet 3: [80] MAI: [105] MedDiet 3: [85] MedDiet 5: [89] rmMedDiet: [100] MedDiet 6: [90] mMedDiet: [96] | RR (tMedDiet): 0.76 (0.68, 0.85) RR (aMedDiet): 0.77 (0.68, 0.86) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.93 | RR (tMedDiet): 0.76 (0.68, 0.85) RR (aMedDiet): 0.77 (0.71, 0.84) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.93 | ||
CHD incidence RR: 0.72 (0.60, 0.86) I2 = NA | 4 cohort studies | 153,502, 2910 | 4.9–20 | (0.38, 1.36) | Low | tMedDiet 4: [60] aMedDiet: [71] | NA | NA | ||
MI incidence RR: 0.67 (0.54, 0.83) I2 = NA | 3 cohort studies | 44,428, 1364 | 9–14 | (0.17, 2.70) | Low | tMedDiet 2: [56] MedDiet 3: [85] MedDiet 5: [89] | NA | NA | ||
Stroke incidence RR: 0.76 (0.60, 0.96) I2 = 52% | 5 cohort studies | 159,995, 2444 | 7.9–20 | (0.37, 1.56) | Low | tMedDiet 2: [56] aMedDiet: [71] MedDiet 3: [85] MedDiet 5: [89] iMedDiet: [41] | NA | NA | ||
Martinez-Gonzalez and Bes-Rastrollo [34] | CVD incidence/mortality RR: 0.90 (0.86, 0.94) I2 = 78% | 12 cohort studies | 671,005, 15,909 | 4.9–40 | (0.79, 1.03) | Low | 11/22 | tMedDiet 2: [56] tMedDiet 4: [60] aMedDiet: [71] aMedDiet 1: [78] mMedDiet: [96] rmMedDiet: [100] MAI: [105] MedDiet 5: [89] MedDiet 3: [85] | Per 2-point increase RR(tMedDiet): 0.87 (0.81, 0.93) RR(aMedDiet): 0.91 (0.88, 0.95) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.22 | Per 2-point increase RR(tMedDiet): 0.87 (0.82, 0.92) RR(aMedDiet): 0.91 (0.89, 0.94) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.14 |
Sofi et al. [19] | CVD incidence/mortality RR: 0.90 (0.87, 0.92) I2 = 38% | 14 cohort studies | 752,293, 16,631 | 4.5–20 | (0.83, 0.97) | Moderate | 14/22 | MedDiet: [2] tMedDiet 2: [56] aMedDiet: [71] aMedDiet 1: [78] MedDiet 3: [85] MedDiet 4: [87] iMedDiet: [41] mMedDiet: [96] rmMedDiet: [100] | Per 2-point increase RR (tMedDiet): 0.87 (0.83, 0.91) RR (aMedDiet): 0.92 (0.89, 0.94) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.08 | Per 2-point increase RR (tMedDiet): 0.87 (0.83, 0.91) RR (aMedDiet): 0.92 (0.89, 0.94) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.06 |
Cancer incidence/mortality RR: 0.95 (0.93, 0.97) I2 = 65% | 14 cohort studies | 2,720,221, 83,111 | 7.9–16 | (0.88, 1.02) | Moderate | tMedDiet 5: [62] aMedDiet 1: [78] mMedDiet: [96] rmMedDiet: [100] iMedDiet: [97] | Per 2-point increase RR (tMedDiet): 0.96 (0.94, 0.99) RR (aMedDiet): 0.93 (0.93, 0.98) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.76 | Per 2-point increase RR (tMedDiet): 0.96 (0.96, 0.97) RR (aMedDiet): 0.95 (0.93, 0.98) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.42 | ||
Psaltopoulou et al. [35] | Stroke RR: 0.84 (0.74, 0.95) I2 = 0% | 4 cohort studies | 152,843, 2560 | 7.9–20 | (0.68, 1.03) | Low | 19/22 | tMedDiet: [41] tMedDiet 2: [56] aMedDiet: [71] MedDiet 3: [85] | NA | NA |
Schwingshackl et al. [17] | Cancer mortality RR: 0.86 (0.81–0.91) I2 = 82% | 14 cohort studies | 1,363,136, 54,569 | 6.3–40 | (0.70, 1.05) | Moderate | 18/22 | tMedDiet 3: [57] tMedDiet 9: [68] aMedDiet 3: [80] mMedDiet: [96] rmMedDiet: [100] MedDiet 2: [84] MedDiet 9: [94] FA: [99] | High versus low adherence RR (tMedDiet): 0.92 (0.74, 1.15) RR (aMedDiet): 0.80 (0.78, 0.83) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.22 | High versus low adherence RR (tMedDiet): 0.83 (0.78, 0.88) RR (aMedDiet): 0.80 (0.78, 0.83) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.31 |
Bloomfield et al. [36] | Cancer mortality RR: 0.86 (0.82, 0.91) I2 = 77% | 13 cohort studies | 991,306, 49,819 | 5.8–40 | (0.72, 1.04) | Low | 15/22 | tMedDiet 3: [57] aMedDiet 3: [80] mMedDiet: [96] FA: [99] rmMedDiet: [100] MedDiet 2: [84] AHEI: [102] | High versus low adherence RR (tMedDiet): 0.92 (0.64, 1.31) RR (aMedDiet): 0.81 (0.78, 0.85) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.48 | High versus low adherence RR (tMedDiet): 0.84 (0.69, 1.02) RR (aMedDiet): 0.81 (0.78, 0.83) Test for subgroup differences (tMedDiet vs aMedDiet): p = 0.68 |
Cancer incidence RR: 0.96 (0.95, 0.97) I2 = 0% | 3 cohort studies | 591, 002, 48,683 | 8.7–24 | (0.87, 1.05) | Low | tMedDiet 1: [53] AHEI: [101] | NA | NA | ||
Wu and Sun [37] | MCI incidence RR: 0.83 (0.75, 0.93) I2 = 0% | 5 cohort studies | 27,667, 2376 | 2.2–12 | (0.70, 1.00) | Moderate | 18/22 | tMedDiet 8: [106] aMedDiet 3: [81] MedDiet 4: [88] | NA | NA |
AD incidence RR: 0.60 (0.48, 0.77) I2 = 0% | 5 cohort studies | 7609, 838 | 4–12 | (0.41, 0.89) | Moderate | tMedDiet 7: [66] MedDiet4: [88] MedDiet 10: [95] | NA | NA | ||
Dementia RR: 1.07 (0.81,1.42) I2 = 0% | 3 cohort studies | 9811, 632 | 5–12 | (0.17, 6.61) | Low | tMedDiet 7: [66] aMedDiet 3: [81] MedDiet 4: [88] | NA | NA | ||
Cao et al. [38] | MCI incidence RR: 0.69 (0.57, 0.84) I2 = 1% | 4 cohort studies | 766, 6294 | 2.2–5 | (0.49, 0.96) | Low | 10/22 | tMedDiet 7: [66] | NA | NA |
Singh et al. [39] | MCI incidence RR: 0.73 (0.56, 0.96) I2 = 0% | 2 cohort studies | 2626, 438 | 2.2–4.5 | NA | Low | 17/22 | NA | NA | |
AD incidence RR: 0.64 (0.46, 0.89) I2 = 0% | 2 cohort studies | 3668, 328 | 4–5 | NA | Low | tMedDiet 7: [66] tMedDiet 6: [65] | NA | NA |
Methodological quality
Credibility of the evidence
Description of the different scores
Vegetables | Legumes | Fruits/nuts | Cereals | Fish | Meat | Dairy products | Alcohol | Fat intake | Extras | Cited | |
---|---|---|---|---|---|---|---|---|---|---|---|
MedDiet | 1 | 1 | 2 | 3 | – | 1 | 1 | n.d. | 1 | – | [2] |
tMedDiet | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | – | |
tMedDiet 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 4 | – | |
tMedDiet 2 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 3 | 1 | – | [56] |
tMedDiet 3 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 4 | 1 | – | [57] |
tMedDiet 4 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 2 | – | |
tMedDiet 5 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | – | 2 | – | [62] |
tMedDiet 6 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 16 | 1 | – | |
tMedDiet 7 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 14 | 1 | – | [66] |
tMedDiet 8 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 17 | 1 | – | |
tMedDiet 9 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 | 1 | [68] | |
aMedDiet | 1 | 1 | 2, 3 | 2 | 1 | 2 | – | 5 | 1 | – | |
aMedDiet 1 | 1 | 1 | 2, 3 | 2 | 1 | 2 | – | 15 | 1 | – | [78] |
aMedDiet 2 | 1 | 1 | 2, 3 | 2 | 1 | 2 | – | 6 | 1 | – | [79] |
aMedDiet 3 | 1 | 1 | 2, 3 | 2 | 1 | 2 | – | 7 | 1 | – | |
aMedDiet 4 | 1 | 1 | 2, 3 | 2 | 1 | 2 | 2 | 6 | 1 | – | [82] |
MedDiet 1 | 2, 3 | – | 2 | 2 | 1 | – | – | – | 2 | – | [83] |
MedDiet 2 | 1, 4 | – | 2 | 2 | 1 | 3 | 3 | 8 | 3 | – | [84] |
MedDiet 3 | 1 | 2 | 2 | 1 | 1 | 1 | 1 | 13 | 4 | – | |
MedDiet 4 | 5* | * | 2 | 3 | 1 | 1 | 1 | 1 | 6 | – | |
MedDiet 5 | 1 | – | 2 | 1 | 1 | 4 | 1 | 2 | 4 | – | [89] |
MedDiet 6 | 1 | 2 | 2 | 2 | 1 | 2, 5 | 2 | 14 | 5 | – | [90] |
MedDiet 7 | 8** | 2 | ** | 2 | 1 | 2 | 11 | 5 | 11 | – | |
MedDiet 8 | 1, 8 | 2, 3 | 1 | 2 | 1 | 3, 6, 9, 10 | 3 | – | 2 | 2, 5-10 | [93] |
MedDiet 9 | 1 | – | 2, 3 | 9 | 1 | 2, 3 | 12 | 5 | 1 | 4 | [94] |
MedDiet 10 | 1 | 1 | 2 | 2 | 1 | 2, 5 | 2 | 18 | 2 | 3 | [95] |
mMedDiet | 6 | 3 | – | 1 | 1 | 1 | 1 | – | 1 | – | [96] |
iMedDiet | 7 | 1 | 2 | 4 | 1 | 6 | 4 | 9 | 2 | 1, 2 | |
CA | 1 | – | 2 | 5, 6 | – | – | 5, 6 | 8, 10 | – | – | [98] |
FA | 1 | – | – | 4, 7 | 1 | – | – | – | 7 | 3 | [99] |
rmMedDiet | 6 | – | 4 | 2 | 1 | 1 | 1 | 2 | 4 | – | [100] |
AHEI | 1 | 2 | 5 | 2 | – | 2 | – | 11 | 8–10 | 2, 4 | |
sMedDiet | 1 | 1 | 1 | 2 | 1 | 2, 5, 7 | 2, 7 | 12 | 2 | 3 | |
MAI | 1 | 1 | 2 | 1 | 1 | 1, 7 | 8–10 | 8 | 2 | 2, 3, 5 | [105] |