Table 1.
A priori dietary indexes and main results of the studies that evaluated the relationship between the Mediterranean Diet and CVD, CHD and cerebrovascular disease.
| Authors (Year) (Reference) | A priori Index | Subjects, Number, Age | Study’s Name, Type of Study and Follow-Up | Main Results |
|---|---|---|---|---|
| Bilenko et al., (2005) [10] ° | MDS | Israeli Jewish population, 1159 adults, ≥35 year | NNS, transverse study | In men for each MDS decrease significant increased risk for MI, CABG, PTCA, CVD. In women similar trend, but not statistical significance. |
| Hoşcan et al., (2015) [11] ° | MDS | Turkish population, 900 adults, 25–70 year | Cohort, (5.1 year) | Men with a lower adherence to the Mediterranean Diet had a significantly higher risk of CHD morbidity compared to men with a higher adherence. No association was found in women. |
| Trichopoulou et al., (2003) [12] | t-MED | Greek population, 22,043 adults, 20–86 year | EPIC, cohort, (3.7 year) | A 2-point increase in t-MED is associated with a CHD mortality reduction by 33%. |
| Dilis et al., (2012) [13] | t-MED | Greek population, 23,572 adults, 20–86 year | EPIC, cohort, (10 year) | A 2-point increase in t-MED was associated with a decrease in CHD mortality by 22% (p = 0.003) and a non-significant reduction in CHD incidence |
| Misirli et al., (2012) [14] | t-MED | Greek population, 23,601 adults 20–86 year | EPIC, cohort, (10.6 year) | A 2-point increase in t-MED was associated with a significant decrease in cerebrovascular disease incidence and a non-significant decrease in cerebrovascular disease mortality |
| Tsivgoulis et al., (2015) * [15] | t-MED | U.S. population, 20,197 adults, 65 ± 9 year | REGARDS, cohort, (6.5 year) | A 1-point increase in t-MED was independently associated with a 5% reduction in the risk of incident ischemic stroke. No association with incident hemorrhagic stroke |
| Martínez-González et al., (2011) [16] | t-MED | Spanish population, 13,609 young, mean 38 year | SUN, cohort, (4.9 year) | A 2-point increase in t-MED was associated with a 20% decrease in total CVD risk and to a 26% reduction in CHD risk |
| Gardener et al., (2011) * [17] | t-MED | U.S. population, 2568 adult, mean 69 ± 10 year | NOMAS, cohort (9 year) | A 1-point increase in t-MED was associated with a 9% (p < 0.05) decrease in risk of vascular death. No association was found for vascular events (ischemic stroke and MI) |
| Agnoli et al., (2011) [18] | t-MED | Italian population, 40,681 adults, 35–74 year | EPICOR, cohort , (7.89 year) | t-MED was inversely associated with the risk of ischemic stroke and positively with the risk of hemorrhagic stroke without statistical significance |
| Turati et al., (2015) [19] | t-MED | Italian population, 760 patients with a first episode of non-fatal MI/682 controls, 16–79 year | Case-control | A 1-point increase in the t-MED was associated with a reduced risk of a first episode of MI by 9% |
| Knoops et al., (2004) [20] | The score according to Knoops | European population (11 European countries), 2339 elderly people, 70–90 year | HALE study, cohort, (10 year) | A score of at least four points reduced the CHD mortality by 39% and the CVD mortality by 29% |
| Agnoli et al., (2011) [18] | The Italian Mediterranean Index | Italian population, 40,681 adults, 35–74 year | EPICOR, cohort, (7.89 year) | The Italian Mediterranean Index was inversely associated with ischemic stroke (p for trend = 0.001) and hemorrhagic stroke (p for trend = 0.07) |
| Fung et al., (2009) [21] | a-MED | U.S. population, 74,886 females nurses, 38–63 year | NHS, cohort, (20 year) | Women in the highest a-MED quintile were at lower risk for both total CHD and total stroke compared with those in the lowest quintile (p for trend = 0.001 and = 0.03, respectively) |
| Mitrou et al., (2007) [22] | a-MED | U.S. population, 380,296 adults, median age 62 year | NIH-AARP Diet and Health Study, cohort (5 year) | The risk of mortality for CVD was lower in men and women with higher adherence to the Mediterranean Diet compared to those with a lower adherence (p < 0.001 and p = 0.01, respectively) |
| Buckland et al., (2009) [23] | r-MED | Spanish population, 41,078 adults, 29–69 year | EPIC, cohort, (10.4 year) | A 1-point increase in the r-MED was associated with a 6% lower risk of total CHD (p for trend < 0.001) |
| Hoevenaar-Blom et al., (2012) [24] | m-MED | Dutch population, 34,708 adults, 20–70 year | EPIC, cohort, (10–15 year) | A 2-point increase in the m-MED was inversely and significantly associated with fatal CVD, composite CVD, incident MI, incident stroke, and pulmonary embolism |
| Sjögren et al., (2010) [25] | The score according to Sjogren | Swedish men, 924 elderly, 71 ± 1 year | Cohort, (10.2 year) | A higher adherence to the Mediterranean Diet was associated with a lower risk of CVD mortality as compared to lower adherence (p for trend = 0.009) |
| Tognon et al., (2012) [26] | The score according to Tognon 2012 | Sweden population, 77,151 adults, 30–70 year | VIP, cohort , (median 9 year) | The score according to Tognon 2012 was significantly associated only in women but not in men with mortality for CVD and mortality for MI. No association was found with stroke mortality in both genders. |
| Tognon et al., (2014) [27] | The score according to Tognon 2014 | Danish population, 1849 adults | MONICA project, longitudinally | The score according to Tognon 2014 was inversely associated with CVD incidence and mortality. The strength of the associations depended on the way in which the score was built (see text) |
| Panagiotakos et al., (2015) [28] | DS | Greek population, 2583 adults, 18–89 year | ATTICA study, cohort, (10 year) | A 1-point increase in the DS decreased CVD risk by 4% |
| Panagiotakos et al., (2015) [29] | DS | Greek population, 848 patients with a first symptom of CHD/1078 controls | CARDIO 2000, case-control | An 11/55 unit increase in DS was associated with a reduced odds of having a first acute coronary syndrome by 27% |
| Kastorini et al., (2011) [30] | DS | Greek population, 250 patients with a first episode of acute coronary syndrome and 250 patients with a first ischemic stroke/500 controls | Case-control | A 1-point increase in the DS reduced the odds of having acute coronary syndrome by 9% and of having a stroke by 12% |
| Kastorini et al., (2012) [31] | DS | Greek population, 250 patients with a first ischemic stroke/250 controls | Case-control | A 1-point increase in DS reduced the odds of having a first ischemic stroke by 17% in non-hypercolesterolemic participants and by 10% in hypercolesterolemic participants |
| Fidanza et al., (2004) [32] | MAI | USA, Europe, Japan, 12,763 men, 40–59 year | Seven Countries Study, cohort, (25 year) | The MAI was inversely correlated with death rates from CHD (p = 0.001) in 16 cohorts of Seven Countries Study |
| Menotti et al., (2012) [33] | MAI | Italian population, 1139 men, 45–64 year | Seven Countries Study, two Italian cohorts, (20–40 year) | The hazard ratio for 2.7 units of MAI was associated with a CHD mortality reduction of 26% in 20y and 21% in 40y of follow-up |
| Martínez-González et al., (2002) [7] | a priori Mediterranean Dietary Pattern | Spanish population, 171 patients with a first MI/171 controls, <80 year | Case-control | A 1-point increase in the a priori Mediterranean Dietary Pattern was associated with a reduced risk of 8% for a first MI (p < 0.01) |
| Estruch et al., (2013) [34] | PREDIMED score | Spanish population, 7447 adults, 50–80 year | Randomized trial (4.8 year) | The rate of major CVD events was reduced by 30% (p = 0.01) in the group assigned to the Mediterranean Diet with extra-virgin olive oil and by 28% (p = 0.03) in the group assigned to the Mediterranean Diet with nuts compared with the control group. In subgroup analyses the supplemented Mediterranean Diet was significantly protective towards stroke but not towards MI and CVD deaths in comparison with the control diet |
MDS, Mediterranean Diet Score; t-MED, Trichoupoulou Mediterranean Diet Index; a-MED, alternate Mediterranean Diet Index; r-MED, relative Mediterranean Diet Index; m-MED, modified Mediterranean Diet Index; DS, Dietary Score; MAI, Mediterranean Adequacy Index; PREDIMED, PREvencion con DIeta MEDiterranea; NNS, Negev Nutrition Study; EPIC, European Prospective Investigation into Cancer and Nutrition; REGARDS, Reasons for Geographic and Racial Differences in Stroke; SUN, Seguimiento Universidad de Navarra; NOMAS, Northern Manhattan Study; HALE, Healthy Ageing: a Longitudinal study in Europe; NHS, Nurses Health Study; NIH-AARP Diet and Health Study, National Institutes of Health-AARP Diet and Health Study; MONICA, MONItoring trends and determinants of CArdiovascular disease. MI, myocardial infarction; CABG, coronary artery bypass grafting; PTCA, percutaneus transluminal coronary angioplasty; CVD, cardiovascular disease; CHD, coronary heart disease; ° In this study, the food group of cereals was not clearly defined (bread and potatoes); * With the exception of potatoes, the used dietary and t-MED scores had the same components in this study but were built differently.