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

Nucci D, Ragusa FS, Mazza E, Veronese N, Gianfredi V, Volpe M, Maggi S, Onder G, Sieber C, Zanetti M, Silano M, Chernykh A, Lorenzo FD, Romiti GF, Schirò P, Ungar A (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Nutrition Elsevier

Book Volume: 147

Pages Range: 113189-

DOI: 10.1016/j.nut.2026.113189

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors with CRIS profile

Cornel Sieber Lehrstuhl für Innere Medizin (Geriatrie)

Involved external institutions

Saint Camillus International University of Health Sciences (UniCamillus) IT Italy (IT) University of Padua / Universita degli Studi di Padova IT Italy (IT) Università degli studi "La Sapienza" IT Italy (IT) Consiglio Nazionale delle Ricerche (CNR) / National Research Council of Italy IT Italy (IT) Catholic University of the Sacred Heart / Università Cattolica del Sacro Cuore IT Italy (IT) Università degli Studi di Trieste IT Italy (IT) Italian National Health Institute / Istituto Superiore di Sanità (ISS) IT Italy (IT) Fondazione Santa Lucia IRCCS IT Italy (IT) ASP Palermo IT Italy (IT) Università degli Studi di Firenze / University of Florence IT Italy (IT) Università degli Studi di Pavia IT Italy (IT) Università degli Studi di Palermo IT Italy (IT) Magna Græcia University of Catanzaro / Università degli studi Magna Græcia di Catanzaro IT Italy (IT)

How to cite

APA:

Nucci, D., Ragusa, F.S., Mazza, E., Veronese, N., Gianfredi, V., Volpe, M.,... Ungar, A. (2026). Adherence to the Mediterranean diet and all-cause mortality: A systematic review and meta-analysis within the Italian National Guidelines "La Dieta Mediterranea". Nutrition, 147, 113189-. https://doi.org/10.1016/j.nut.2026.113189

MLA:

Nucci, Daniele, et al. "Adherence to the Mediterranean diet and all-cause mortality: A systematic review and meta-analysis within the Italian National Guidelines "La Dieta Mediterranea"." Nutrition 147 (2026): 113189-.

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