TY - JOUR
T1 - Effect of Mediterranean Diets on Cardiovascular Risk Factors and Disease in Overweight and Obese Adults
T2 - A Systematic Review and Meta-Analysis of Randomized Controlled Trials
AU - Hernandez, Adrian V.
AU - Marti, Katherine M.
AU - Marti, Kristen E.
AU - Weisman, Nissen
AU - Cardona, Michelle
AU - Biello, Domenic M.
AU - Pasupuleti, Vinay
AU - Benites-Zapata, Vicente A.
AU - Roman, Yuani M.
AU - Piscoya, Alejandro
N1 - Publisher Copyright:
© 2025 American Nutrition Association.
PY - 2025
Y1 - 2025
N2 - We systematically evaluated effects of Mediterranean diets (MED) on cardiovascular (CV) disease and risk factors in overweight or obese adults. Five engines and two registries were searched until October 2023 for randomized controlled trials (RCTs) evaluating any type of MED compared to other diets or advice in adults. Outcomes of interest were clinical outcomes and CV risk factors (anthropometric, lipids, blood pressure, glucose metabolism, liver function). Inverse variance random effects models were used for meta-analyses; effects of MED were described as mean differences (MDs) and their 95% confidence intervals (CIs). Quality of evidence (QoE) per outcome was evaluated using GRADE methodology. Twenty-six RCTs (n = 10,352) were included. Four RCTs evaluated only obese patients and 22 evaluated overweight and obese patients. Clinical outcomes were only described in the revised 2018 PREDIMED trial where MED was associated with 35% lower risk of myocardial infarction, stroke, or CV death vs advice (hazard ratio, 0.65; 95% CI, 0.50–0.85). MED significantly reduced the values of body mass index (MD, −0.61 kg/m2; 95% CI, −1.14 to −0.09; 17 RCTs), waist circumference (MD, −2.48 cm; 95% CI, −3.99 to −0.96; 17 RCTs), triglycerides (MD, −7.93 mg/dL; 95% CI, −13.48 to −2.39; 19 RCTs), and fatty liver index (MD, −12.26; 95% CI, −23.96 to −0.56; 3 RCTs) compared with controls. MED did not significantly change any other CV risk factors. QoE was very low for most of the outcomes; 85% of RCTs had some concerns or high risk of bias. In overweight or obese adults, MED significantly decreased body mass index, waist circumference, triglycerides, and fatty liver index score but no other CV risk factors when compared with other diets or advice. There was paucity of data on effects of MED on clinical outcomes.
AB - We systematically evaluated effects of Mediterranean diets (MED) on cardiovascular (CV) disease and risk factors in overweight or obese adults. Five engines and two registries were searched until October 2023 for randomized controlled trials (RCTs) evaluating any type of MED compared to other diets or advice in adults. Outcomes of interest were clinical outcomes and CV risk factors (anthropometric, lipids, blood pressure, glucose metabolism, liver function). Inverse variance random effects models were used for meta-analyses; effects of MED were described as mean differences (MDs) and their 95% confidence intervals (CIs). Quality of evidence (QoE) per outcome was evaluated using GRADE methodology. Twenty-six RCTs (n = 10,352) were included. Four RCTs evaluated only obese patients and 22 evaluated overweight and obese patients. Clinical outcomes were only described in the revised 2018 PREDIMED trial where MED was associated with 35% lower risk of myocardial infarction, stroke, or CV death vs advice (hazard ratio, 0.65; 95% CI, 0.50–0.85). MED significantly reduced the values of body mass index (MD, −0.61 kg/m2; 95% CI, −1.14 to −0.09; 17 RCTs), waist circumference (MD, −2.48 cm; 95% CI, −3.99 to −0.96; 17 RCTs), triglycerides (MD, −7.93 mg/dL; 95% CI, −13.48 to −2.39; 19 RCTs), and fatty liver index (MD, −12.26; 95% CI, −23.96 to −0.56; 3 RCTs) compared with controls. MED did not significantly change any other CV risk factors. QoE was very low for most of the outcomes; 85% of RCTs had some concerns or high risk of bias. In overweight or obese adults, MED significantly decreased body mass index, waist circumference, triglycerides, and fatty liver index score but no other CV risk factors when compared with other diets or advice. There was paucity of data on effects of MED on clinical outcomes.
KW - cardiovascular risk factor
KW - Mediterranean diet
KW - meta-analysis
KW - obesity
KW - primary prevention
UR - http://www.scopus.com/inward/record.url?scp=85214695757&partnerID=8YFLogxK
U2 - 10.1080/27697061.2024.2440051
DO - 10.1080/27697061.2024.2440051
M3 - Artículo de revisión
AN - SCOPUS:85214695757
SN - 2769-7061
JO - Journal of the American Nutrition Association
JF - Journal of the American Nutrition Association
ER -