Adherence to the Mediterranean diet and all-cause mortality: A systematic review and meta-analysis within the Italian National Guidelines "La Dieta Mediterranea".

Authors

Daniele Nucci, Francesco Saverio Ragusa, Elisa Mazza, Nicola Veronese, Vincenza Gianfredi, Massimo Volpe, Stefania Maggi, Graziano Onder, Cornel Sieber, Michela Zanetti, Marco Silano, Anastasia Chernykh, Francesco Di Lorenzo, Giulio Francesco Romiti, Piero Schirò, Andrea Ungar, Mediterranean Diet Guideline Group

Published in

Nutrition (Burbank, Los Angeles County, Calif.). Volume 147. Pages 113189. Mar 04, 2026. Epub Mar 04, 2026.

Abstract

The Mediterranean diet (MD) is a dietary pattern associated with reduced chronic disease risk and increased longevity. This systematic review and meta-analysis aimed to evaluate the association between adherence to the MD and all-cause mortality in adult populations.
A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Embase, and Scopus (search date: February 28, 2024) without date restrictions. Prospective and retrospective cohort studies examining the association between MD adherence (measured by any validated score) and all-cause mortality were included. Study selection and data extraction were performed independently by pairs of reviewers using Covidence. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted, estimating pooled relative risks (RRs) per 1-point increment in MD adherence score. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated by funnel plot. Certainty of evidence was graded using the NUTRIGRADE approach.
Out of 5229 screened records, 54 cohort studies were included, comprising 1 833 267 participants and 346 034 deaths. Studies spanned diverse populations and geographic regions, with follow-up ranging from 2 to 60 y. The pooled RR for all-cause mortality per 1-point increase in MD adherence was 0.96 (95% CI: 0.95-0.97), indicating a statistically significant protective effect. The overall certainty of evidence was rated as moderate.
Higher adherence to the MD is associated with a reduced risk of all-cause mortality. These findings support public health strategies promoting the MD as a sustainable dietary model for longevity.

PMID:
41930792
Bibliographic data and abstract were imported from PubMed on 03 Apr 2026.

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