Public Health Nutrition

Nutrition and health

Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score

Francesco Sofia1a2a3 c1, Claudio Macchia3, Rosanna Abbatea1, Gian Franco Gensinia1a3 and Alessandro Casinia1a2

a1 Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy

a2 Agency of Nutrition, University Hospital of Careggi, Florence, Italy

a3 Don Carlo Gnocchi Foundation Italy, IRCCS, Florence, Italy


Objective To update previous meta-analyses of cohort studies that investigated the association between the Mediterranean diet and health status and to utilize data coming from all of the cohort studies for proposing a literature-based adherence score to the Mediterranean diet.

Design We conducted a comprehensive literature search through all electronic databases up to June 2013.

Setting Cohort prospective studies investigating adherence to the Mediterranean diet and health outcomes. Cut-off values of food groups used to compute the adherence score were obtained.

Subjects The updated search was performed in an overall population of 4 172 412 subjects, with eighteen recent studies that were not present in the previous meta-analyses.

Results A 2-point increase in adherence score to the Mediterranean diet was reported to determine an 8 % reduction of overall mortality (relative risk = 0·92; 95 % CI 0·91, 0·93), a 10 % reduced risk of CVD (relative risk = 0·90; 95 % CI 0·87, 0·92) and a 4 % reduction of neoplastic disease (relative risk = 0·96; 95 % CI 0·95, 0·97). We utilized data coming from all cohort studies available in the literature for proposing a literature-based adherence score. Such a score ranges from 0 (minimal adherence) to 18 (maximal adherence) points and includes three different categories of consumption for each food group composing the Mediterranean diet.

Conclusions The Mediterranean diet was found to be a healthy dietary pattern in terms of morbidity and mortality. By using data from the cohort studies we proposed a literature-based adherence score that can represent an easy tool for the estimation of adherence to the Mediterranean diet also at the individual level.

(Received February 21 2013)

(Revised July 05 2013)

(Accepted October 15 2013)

(Online publication November 29 2013)


  • Mediterranean diet;
  • Meta-analysis;
  • Update;
  • Score


c1 Corresponding author: Email