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Mediterranean dietary pattern and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis of prospective cohort studies

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Abstract

Purpose

Previous meta-analyses assessed the association of adherence to the Mediterranean dietary pattern (MedDiet) with the risk of type 2 diabetes (T2D). Since then, new large-scale cohort studies have been published. In addition, dose–response relation was not previously investigated and the certainty of evidence was not assessed. We aimed to explore the dose–response relationship between adherence to the MedDiet and the risk of T2D.

Methods

We did a systematic search using PubMed, Scopus, and ISI Web of Science upto April 2021 for prospective cohort studies of the relationship between adherence to the MedDiet and the risk of T2D in the general population. The summary relative risks (RR) and 95%CI were estimated by applying a random-effects model.

Results

Fourteen prospective cohort studies (410,303 participants and 41,466 cases) were included. There was an inverse association for the highest versus lowest category of adherence to the MedDiet (RR: 0.79, 95%CI 0.72, 0.88; I2 = 82%, n = 14; Risk difference:  – 21 per 1000 person, 95%CI  – 28,  – 12; GRADE = moderate certainty), and for a 2-point increment in the MedDiet adherence score (RR: 0.86, 95%CI 0.82, 0.91; n = 13). The RR remained significant after controlling for important confounders and in almost all subgroups, especially subgroups defined by geographical region. We observed an inverse linear association between MedDiet adherence score and T2D incidence.

Conclusion

Adherence to the MedDiet was inversely related to T2D risk in a dose–response manner. Adherence to a Mediterranean-style diet may be a good advice for the primary prevention of T2D.

Registry and registry number

PROSPERO (CRD42021246589).

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Availability of data and material

All data indicated and analyzed for this study are available by request to the corresponding author.

Code availability

Not applicable.

Abbreviations

BMI:

Body mass index

DASH:

Dietary approaches to stop hypertension

GRADE:

Grading of recommendations assessment, development, and evaluation

MedDiet:

Mediterranean dietary pattern

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

ROBINS:

Risk of bias in non-randomized studies of interventions

RR:

Relative risk

SCFA:

Short-chain fatty acids

T2D:

Type 2 diabetes

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Authors and Affiliations

  1. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St., Keshavarz Blvd, Tehran, Iran

    Sheida Zeraattalab-Motlagh, Ahmad Jayedi & Sakineh Shab-Bidar

  2. Social Determinant of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

    Ahmad Jayedi

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  1. Sheida Zeraattalab-Motlagh
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  2. Ahmad Jayedi
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The author’s responsibilities were as follows-AJ: conducted the systematic search and data extraction; SZM and AJ: analyzed the data; SZM and AJ: wrote the first draft; AJ and SSB: entirely revised the manuscript draft; SSB, had main responsibility for the final manuscript; and all authors: read and affirmed the final manuscript.

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Correspondence to Sakineh Shab-Bidar.

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Motlagh SZ, Jayedi A and Shab-Bidar S: no conflict of interest.

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Zeraattalab-Motlagh, S., Jayedi, A. & Shab-Bidar, S. Mediterranean dietary pattern and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis of prospective cohort studies. Eur J Nutr 61, 1735–1748 (2022). https://doi.org/10.1007/s00394-021-02761-3

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  • DOI: https://doi.org/10.1007/s00394-021-02761-3

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