Mediterranean Diet in Older Adults: Cardiovascular Outcomes and Mortality from Observational and Interventional Studies-A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis predominantly composed of observational cohort studies (26 cohort studies, 2 randomized controlled trials).
PubMed 39599734 · doi:10.3390/nu16223947
What was done
The authors conducted a systematic review and meta-analysis of PubMed literature published up to May 31, 2023. Eligible studies included randomized controlled trials and cohort studies published in English that evaluated Mediterranean diet adherence in populations with a mean age greater than 60 years. Main outcomes assessed were all-cause mortality, fatal cardiovascular events, and non-fatal cardiovascular events, along with a subgroup analysis for individuals older than 70 years. Quality was assessed following PRISMA and MOOSE guidelines, and pooled effect estimates were calculated using random-effects models.
What was found
The meta-analysis included 28 studies (26 observational cohort studies and 2 randomized controlled trials) comprising 679,259 participants. High adherence to the Mediterranean diet was associated with a 23% reduction in all-cause mortality risk (95% CI: 0.70 to 0.83) and a 27% reduction in cardiovascular mortality risk (95% CI: 0.64 to 0.84). The association with non-fatal cardiovascular events was a 23% reduction that touched the null (95% CI: 0.55 to 1.01).
Why it matters
This review synthesizes conflicting evidence by showing that high adherence to a Mediterranean diet is consistently associated with lower all-cause and cardiovascular mortality specifically in adults aged 60 and older.
Limits
The evidence is heavily dominated by observational cohort studies (26 of 28 studies), which are vulnerable to residual confounding and cannot establish causality. The database search was restricted solely to PubMed and English-language publications. The estimate for non-fatal cardiovascular events lacked statistical precision (95% CI crossed 1.00), and specific adherence measures and nutritional assessments varied across included studies.
Cited by
- supports A systematic review covering over 158,000 older adults found that high adherence to a Mediterranean-style dietary pattern reduced all-cause mortality by 23% and cardiovascular mortality by 27%.