AdherencetotheMediterraneanDiet,Five-Year WeightChange,andRiskofOverweightand Obesity:ASystematicReviewandDose–Response Meta-AnalysisofProspectiveCohortStudies

Abstract

FindingsfromearlierstudiesontheassociationbetweenadherencetoaMediterraneandietandriskofoverweight/obesitywereinconsistent.We summarizedcohortstudiesinvestigatingtheassociationbetweentheMediterraneandietandriskofoverweightand/orobesityandweightchange inadults.AsystematicsearchofPubMed,Scopus,ISIWebofScience,andGoogleScholarwasconducteduptoMay2021.Prospectivecohortsthat examined the Mediterranean diet adherence in adults as the exposure, and overweight and/or obesity or weight change as the outcomes, and reported RRs or β coefficients and 95% CIs as the effect sizes were included. Seven prospective cohort studies were included of which 6 studies (with 244,678 adult participants) reported the risk of overweight and/or obesity, and 4 cohorts (with 436,617 participants) reported the weight change (3 cohorts reported both overweight and/or obesity risk and weight change). Combining 15 effect sizes from 6 cohorts revealed that greater adherence to the Mediterranean diet was significantly associated with a 9% decreased risk of overweight and/or obesity (RR: 0.91; 95% CI: 0.88,0.94;I2=44.7%;PQ-test=0.031).Thisassociationwassignificantinthecaseofstudiesinvestigatingcombinedoverweightandobesity(RR:0.92; 95% CI: 0.88, 0.96; I2=29.4%; PQ-test=0.166), but not for studies that reported on obesity (RR: 0.68; 95% CI: 0.43, 1.10, I2=50.6%, PQ-test=0.132). Lineardose–responseanalysisof6studiesshoweda2%decreasedriskofoverweightand/orobesityfor1additionalMediterraneandietscore(RR: 0.98;95%CI:0.96,0.99).EachunitincreaseintheMediterraneandietscorewasassociatedwith0.04kglessweightgainover5y(−0.04kg;95%CI: −0.07,−0.02kg;13effectsizesfrom4cohorts).Inconclusion,Mediterraneandietadherenceisinverselyassociatedwithriskofoverweightand/or obesityaswellas5-yweightgainandthushaspracticalimportanceforpublichealth