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Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors
Authors:Nordmann Alain J  Suter-Zimmermann Katja  Bucher Heiner C  Shai Iris  Tuttle Katherine R  Estruch Ramon  Briel Matthias
Institution:aBasel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland;bS. Daniel Abraham Center of Health and Nutrition and Department of Epidemiology, Ben-Gurion University of the Negev, Beer Sheva, Israel;cThe Heart Institute of Spokane and Providence Medical Research Center, Spokane, Wash.;dDepartment of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, and CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain;eDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Abstract:

Background

Evidence from individual trials comparing Mediterranean to low-fat diets to modify cardiovascular risk factors remains preliminary.

Methods

We systematically searched MEDLINE, EMBASE, Biosis, Web of Science, and the Cochrane Central Register of Controlled Trials from their inception until January 2011, as well as contacted experts in the field, to identify randomized controlled trials comparing Mediterranean to low-fat diets in overweight/obese individuals, with a minimum follow-up of 6 months, reporting intention-to-treat data on cardiovascular risk factors. Two authors independently assessed trial eligibility and quality.

Results

We identified 6 trials, including 2650 individuals (50% women) fulfilling our inclusion criteria. Mean age of enrolled patients ranged from 35 to 68 years, mean body mass index from 29 to 35 kg/m2. After 2 years of follow-up, individuals assigned to a Mediterranean diet had more favorable changes in weighted mean differences of body weight (−2.2 kg; 95% confidence interval CI], −3.9 to −0.6), body mass index (−0.6 kg/m2; 95% CI, −1 to −0.1), systolic blood pressure (−1.7 mm Hg; 95% CI, −3.3 to −0.05), diastolic blood pressure (−1.5 mm Hg; 95% CI, −2.1 to −0.8), fasting plasma glucose (−3.8 mg/dL, 95% CI, −7 to −0.6), total cholesterol (−7.4 mg/dL; 95% CI, −10.3 to −4.4), and high-sensitivity C-reactive protein (−1.0 mg/L; 95% CI, −1.5 to −0.5). The observed heterogeneity across individual trials could, by and large, be eliminated by restricting analyses to trials with balanced co-interventions or trials with restriction of daily calorie intake in both diet groups.

Conclusion

Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers.
Keywords:Low-fat diet  Mediterranean diet  Meta-analysis
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