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The Mediterranean diet has the most consistent associations with lower risk of chronic diseases and mortality. Adding more evidence in that direction, a large-scale prospective epidemiological cohort study of 25,315 women from the US with a 25-year follow-up showed that higher adherence to the Mediterranean diet was associated with approximately one fifth relative risk reduction in all-cause mortality, CVD and non-CVD mortality. In addition, the authors quantified the contribution of traditional and novel biological biomarkers to this association. The analysis showed that the association between the Mediterranean diet and all-cause mortality risk reduction was partially explained by potential mediation through metabolites (e.g. alanine), inflammatory biomarkers, triglyceride rich lipoprotein measures, adiposity and insulin resistance markers.
As demonstrated in the previous study, adiposity could be a potential mediator in the association between the Mediterranean diet and reduced mortality. Therefore, it would be most interesting to demonstrate the effect of a Mediterranean diet intervention on weight management in the long term. In this sense, the PREDIMED-Plus trial has assessed the effect of a multifactorial intervention with an energy-reduced Mediterranean diet, physical activity promotion, and behavioral support, on changes in body composition components after 3 years. Compared to the control group (only Mediterranean diet) individuals in the intervention group showed greater reductions in the percentage of total fat and visceral fat and a greater increase in the percentage of total lean mass at 1 year and 3 years of the intervention.
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