Mediterranean Diet Increases Endothelial Function in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Review article, 2020

Background: The endothelium plays a key role in the maintenance of vascular health and represents a potential physiological target for dietary and other lifestyle interventions designed to reduce the risk of cardiovascular diseases (CVD) including stroke or coronary heart disease. Objective: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effects of the Mediterranean dietary pattern (MedDiet) on endothelial function. Methods: Medline, Embase, and Scopus databases were searched from inception until January 2019 for studies that met the following criteria: 1) RCTs including adult participants, 2) interventions promoting the MedDiet, 3) inclusion of a control group, and 4) measurements of endothelial function. A random-effects meta-analysis was conducted. Metaregression and subgroup analyses were performed to identify whether effects were modified by health status (i.e., healthy participants versus participants with existing comorbidities), type of intervention (i.e., MedDiet alone or with a cointervention), study duration, study design (i.e., parallel or crossover), BMI, and age of participants. Results: Fourteen articles reporting data for 1930 participants were included in the meta-analysis. Study duration ranged from 4 wk to 2.3 y. We observed a beneficial effect of the MedDiet on endothelial function [standardized mean difference (SMD): 0.35; 95% CI: 0.17, 0.53; P <0.001; I-2 = 73.68%]. MedDiet interventions improved flow-mediated dilation (FMD)-the referencemethod for noninvasive, clinical measurement of endothelial function-by 1.66% (absolute change; 95% CI: 1.15, 2.17; P <0.001; I-2 = 0%). Effects of the MedDiet on endothelial function were not modified by health status, type of intervention, study duration, study design, BMI, or age of participants (P >0.05). Conclusions: MedDiet interventions improve endothelial function in adults, suggesting that the protective effects of the MedDiet are evident at early stages of the atherosclerotic process with important implications for the early prevention of CVD.

dietary patterns

healthy aging

cardiovascular disease

endothelial function

Mediterranean diet

flow-mediated dilation


Oliver M. Shannon

Newcastle University

Ines Mendes

Newcastle University

Christina Kochl

Newcastle University

Mohsen Mazidi

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Ammar W. Ashor

Mustansiriya University

Sofia Rubele

Verona University

Newcastle University

Anne-Marie Minihane

University of East Anglia

John C. Mathers

Newcastle University

Mario Siervo

University of Nottingham

Newcastle University

Journal of Nutrition

0022-3166 (ISSN) 1541-6100 (eISSN)

Vol. 150 5 1151-1159

Subject Categories

General Practice

Gerontology, specialising in Medical and Health Sciences

Public Health, Global Health, Social Medicine and Epidemiology





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