Is the Mediterranean diet the healthiest diet?

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1. 1

   Mediterranean diet and health outcomes: a systematic meta-review

   European Journal of Public Health (Martínez-Lacoba et al.)Published Jun 7, 2018Checked Sep 30, 2026

   “Thirty-three articles were included, nine were systematic reviews and twenty-four were meta-analyses. Most of the diseases analysed are catalogued as non-communicable diseases (NCD), and the impact of these in populations may have major financial consequences for healthcare spending and national income. The results showed that the MeDi may improve health status, and it also may reduce total lifetime costs. MeDi has been shown to be a healthy dietary pattern that may reduce risk related to NCD. The effect is larger if the pattern is combined with physical activity, and tobacco and excessive alcohol consumption are avoided. Promoting the MeDi as a healthy dietary pattern presents challenges which need the collaboration of all levels of society.”

2. 2

   The Mediterranean Diet and Cardiovascular Health

   Circulation Research (Martínez‐González et al.)Published Feb 28, 2019Checked Sep 30, 2026

   “We addressed the existing controversies on methodology and other issues. Some departures from individual randomization in a subsample of the landmark Spanish trial (PREDIMED [Prevención con Dieta Mediterránea]) did not represent any clinically meaningful attenuation in the strength of its findings and the results of PREDIMED were robust in a wide range of sensitivity analyses. The criteria for causality were met and potential sources of controversies did not represent any reason to compromise the main findings of the available observational studies and randomized controlled trials. The available evidence is large, strong, and consistent. Better conformity with the traditional MedDiet is associated with better cardiovascular health outcomes, including clinically meaningful reductions in rates of coronary heart disease, ischemic stroke, and total cardiovascular disease.”

3. 3

   Adherence to Mediterranean diet and health status: meta-analysis

   BMJ (Sofi et al.)Published Sep 11, 2008Checked Sep 30, 2026

   “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). 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%).”

4. 4

   Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts

   New England Journal of Medicine (Estruch et al.)Published Jun 13, 2018Checked Sep 30, 2026

   “A primary end-point event occurred in 288 participants; there were 96 events in the group assigned to a Mediterranean diet with extra-virgin olive oil (3.8%), 83 in the group assigned to a Mediterranean diet with nuts (3.4%), and 109 in the control group (4.4%). In the intention-to-treat analysis including all the participants and adjusting for baseline characteristics and propensity scores, the hazard ratio was 0.69 (95% confidence interval [CI], 0.53 to 0.91) for a Mediterranean diet with extra-virgin olive oil and 0.72 (95% CI, 0.54 to 0.95) for a Mediterranean diet with nuts, as compared with the control diet. Results were similar after the omission of 1588 participants whose study-group assignments were known or suspected to have departed from the protocol. In this study involving persons at high cardiovascular risk, the incidence of major cardiovascular events was lower among those assigned to a Mediterranean diet supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet. (Funded by Instituto de Salud Carlos III, Spanish Ministry of Health, and others; Current Controlled Trials number, ISRCTN35739639 .).”

5. 5

   Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

   The Lancet (Afshin et al.)Published Apr 3, 2019Checked Sep 30, 2026

   “In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates. This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.”

6. 6

   Dietary approaches for glycemic management in type 1 diabetes: A systematic review of Mediterranean and low-carbohydrate diets.

   Primary care diabetes (Feeley et al.)Published Jul 7, 2026Checked Oct 4, 2026

   “After removal of duplicates and further evaluation, 22 studies (6 cohort studies and 16 clinical trials; total n = 3284) were included in this review. The search was initially completed in May 2024, and updated February 2026. Low-carbohydrate diets were associated with better glycemic management when compared to usual diets or baseline glycemic parameters. Studies using CGM were overall underpowered. The impact of Mediterranean diets was less clear, but generally appeared to be less effective at improving glycemic management than low-carbohydrate diets.DiscussionAlthough structured dietary interventions for T1D hold promise for improving glycemic outcomes, further research is needed to determine exactly which dietary intervention is most beneficial for this population. The evidence provided by included studies is limited by small sample sizes and short durations; better powered, longer-term studies are required to inform clinical recommendations.”

7. 7

   Association of the Mediterranean Diet, Physical Activity and Related Lifestyle Factors on the Mortality and Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease: A Systematic Review and Meta-Analysis.

   Nutrients (Mo et al.)Published Aug 7, 2026Checked Oct 4, 2026

   “The 40 reports represented 34 data sources and at least 260,354 unique patients, comprising six randomized trials, 30 observational reports, and four comparative nonrandomized studies. In one randomized comparison of Mediterranean and low-fat diets, the HR for MACE was 0.72 (95% CI 0.54 to 0.96; moderate certainty). Observational findings supported inverse associations of closer dietary adherence with all-cause mortality (HR 0.74, 95% CI 0.60 to 0.90; I2 = 44%) and MACE, whereas cardiovascular mortality remained uncertain. HRs for maintained or continued physical activity relative to persistent inactivity were 0.64 for all-cause mortality (95% CI 0.55 to 0.74; I2 = 29%) and 0.42 for cardiovascular mortality (95% CI 0.28 to 0.64; I2 = 72%). MACE findings for diet adherence and habitual physical activity generally favored lower risk. Randomized evidence on exercise or combined dietary and activity programs was sparse. Greater Mediterranean diet adherence and habitual physical activity were associated with more favorable CHD outcomes. Standardized, adequately powered trials are needed, especially for exercise and combined strategies.”

8. 8

   A Structured Narrative Review of Contemporary Dietary Strategies Following Acute Coronary Syndromes.

   Journal of cardiovascular development and disease (Cheung et al.)Published Aug 26, 2026Checked Oct 4, 2026

   “Despite the emergence and popularity of other diets, the Mediterranean diet demonstrated the strongest and most consistent evidence for reducing recurrent cardiovascular events and improving cardiovascular risk factors following ACS. DASH and plant-based dietary patterns improved cardiovascular risk factors but lacked robust post-ACS outcome data. Evidence supporting intermittent fasting, low-carbohydrate/ketogenic, Palaeolithic, Atkins, and Carnivore diets was limited, with few randomized studies and insufficient evidence to support their routine use in secondary prevention.ConclusionsA Mediterranean-style diet remains the dietary pattern supported by the strongest evidence for secondary prevention following ACS. Until further pragmatic randomized trials are available, clinicians should continue recommending Mediterranean-style dietary patterns while individualising dietary advice according to patient preferences, cultural practices, and long-term adherence.”

9. 9

   Comparative effects of ketogenic diets and mediterranean diets on obesity and metabolic outcomes: a systematic review and meta-analysis.

   Reviews in endocrine & metabolic disorders (Kun et al.)Published Sep 21, 2026Checked Oct 4, 2026

   “KD significantly reduced body weight (WMD: -3.56 kg; 95% CI: -5.62, - 1.49), body mass index (BMI) (WMD: -1.86 kg/m²; 95% CI: -2.73, - 0.98), waist circumference (WC) (WMD: -4.25 cm; 95% CI: -7.46, - 1.04), total body fat (TBF) percentage (WMD: -2.09%; 95% CI: -3.98, - 0.20), and insulin levels (WMD: -3.15 µU/ml; 95% CI: -5.02 to - 1.28) compared with MD. In contrast, no significant differences were observed between KD and MD regarding fasting blood sugar, HbA1c, LDL-C, HDL-C, triglycerides, systolic blood pressure, diastolic blood pressure, or C-reactive protein levels. However, KD significantly reduced total cholesterol (TC) compared with MD (WMD: -9.71 mg/dl; 95% CI: -17.79, - 1.62). Publication bias was detected for triglycerides and LDL-C outcomes. KD demonstrated superior effects on anthropometric outcomes compared with MD, particularly for weight loss and body composition improvement. However, both dietary approaches showed largely comparable effects on glycemic control, lipid profile, blood pressure, and inflammatory biomarkers. While KD may provide greater short-term weight reduction, MD may remain a sustainable dietary strategy for long-term cardiometabolic health.”