Intended for healthcare professionals


Adherence to Mediterranean diet and health status: meta-analysis

BMJ 2008; 337 doi: (Published 11 September 2008) Cite this as: BMJ 2008;337:a1344
  1. Francesco Sofi, researcher in clinical nutrition125,
  2. Francesca Cesari, researcher1,
  3. Rosanna Abbate, full professor of internal medicine15,
  4. Gian Franco Gensini, full professor of internal medicine3,
  5. Alessandro Casini, associate professor of clinical nutrition245
  1. 1Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
  2. 2Regional Agency for Nutrition, Azienda Ospedaliero-Universitaria Careggi, Florence
  3. 3Don Carlo Gnocchi Foundation, Onlus IRCCS, Impruneta, Florence
  4. 4Department of Clinical Pathophysiology, Unit of Clinical Nutrition, University of Florence
  5. 5Centro Interdipartimentale per la Ricerca e la Valorizzazione degli Alimenti (CeRA), University of Florence
  1. Correspondence to: F Sofi francescosofi{at}
  • Accepted 6 July 2008


Objective To systematically review all the prospective cohort studies that have analysed the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases in a primary prevention setting.

Design Meta-analysis of prospective cohort studies.

Data sources English and non-English publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1966 to 30 June 2008.

Studies reviewed Studies that analysed prospectively the association between adherence to a Mediterranean diet, mortality, and incidence of diseases; 12 studies, with a total of 1 574 299 subjects followed for a time ranging from three to 18 years were included.

Results The cumulative analysis among eight cohorts (514 816 subjects and 33 576 deaths) evaluating overall mortality in relation to adherence to a Mediterranean diet showed that a two point increase in the adherence score was significantly associated with a reduced risk of mortality (pooled relative risk 0.91, 95% confidence interval 0.89 to 0.94). Likewise, the analyses showed a beneficial role for greater adherence to a Mediterranean diet on cardiovascular mortality (pooled relative risk 0.91, 0.87 to 0.95), incidence of or mortality from cancer (0.94, 0.92 to 0.96), and incidence of Parkinson’s disease and Alzheimer’s disease (0.87, 0.80 to 0.96).

Conclusions Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson’s disease and Alzheimer’s disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.


  • Contributors: FS and AC contributed to conception and design. All authors were involved in analysis and interpretation of the data. FS and FC drafted the manuscript, which was critically revised for important intellectual content by RA, GFG, and AC. All authors approved the final version. FS provided statistical expertise and is the guarantor.

  • Funding: None.

  • Competing interests: None declared.

  • Ethical approval: Not needed.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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