Mediterranean, low-fat diets may reduce death, heart attack in adults at elevated risk
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Key takeaways:
- The Mediterranean and low-fat dietary programs were linked to reduced risk for death and heart attack.
- Five other dietary patterns showed little to no benefit in reduction of death or heart attack.
In patients at intermediate or high CV risk, compared with minimal intervention, the Mediterranean and low-fat dietary programs were associated with reduced risk for death and nonfatal MI, researchers reported in The BMJ.
Little to no benefits related to death and MI were observed with the very low fat, modified fat, combined low fat/low sodium, Ornish and Pritikin dietary patterns, according to the researchers.
Data were derived from Karam G, et al. BMJ. 2023;doi:10.1136/bmj-2022-072003.
Bradley C. Johnston, PhD, associate professor of nutrition and of epidemiology and biostatistics at Texas A&M University, and colleagues conducted a systematic review and meta-analysis of 40 randomized trials including 35,548 participants that evaluated death and MI outcomes in dietary patterns compared with minimal intervention. The dietary patterns evaluated were Mediterranean (12 trials), low-fat (18 trials), modified fat (six trials), combined low fat/low sodium (four trials), Ornish (three trials) and Pritikin (one trial).
At last reported follow-up, the Mediterranean dietary pattern was superior to minimal intervention for prevention of all-cause death (OR = 0.72; 95% CI, 0.56-0.92; risk difference in patients at intermediate risk, 17 fewer per 1,000 patients followed for 5 years), CV mortality (OR = 0.55; 95% CI, 0.39-0.78; risk difference in patients at intermediate risk, 13 fewer per 1,000 patients followed for 5 years), stroke (OR = 0.65; 95% CI, 0.46-0.93; risk difference in patients at intermediate risk, 7 fewer per 1,000 patients followed for 5 years) and nonfatal MI (OR = 0.48; 95% CI, 0.36-0.65; risk difference in patients at intermediate risk, 17 fewer per 1,000 patients followed for 5 years), according to the researchers, who wrote that the evidence was of moderate certainty.
The low-fat dietary pattern was superior to minimal intervention for prevention of all-cause death (OR = 0.84; 95% CI, 0.74-0.95; risk difference in patients at intermediate risk, 9 fewer per 1,000 patients followed for 5 years) and nonfatal MI (OR = 0.77; 95% CI, 0.61-0.96; risk difference in patients at intermediate risk, 7 fewer per 1,000 patients followed for 5 years) based on moderate-certainty evidence, the researchers wrote.
The data were similar for patients at high risk, according to the researchers.
There were no differences between the Mediterranean and low-fat dietary patterns for prevention of death or nonfatal MI, Johnston and colleagues wrote.
The other five dietary patterns did not show superiority to minimal intervention for reduction of outcomes, generally based on low to moderate certainty evidence, the researchers wrote.
“These findings with data presentations are extremely important for patients who are skeptical about the desirability of diet change,” Johnston and colleagues wrote.
Perspective
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Monica Aggarwal, MD, FACC
Comparing diets to determine which might be most effective is probably something we should not focus on. Instead, we should focus on whether nutrition intervention is effective or not. Is it enough to simply hand someone a brochure with nutrition information vs. intensive nutrition education? This study demonstrates that nutritional intervention that goes beyond a brochure makes a difference. A nutrition intervention is not about just giving people food or a little bit of education. It is about providing a comprehensive model where we provide long-term education to improve long-term adherence.
As physicians, we need to focus on more long-term interventions and advocate for coverage of nutrition education with dieticians, beyond the two disease states covered by Medicare — diabetes and chronic kidney disease. We know that with food insecurity and food deserts, outcomes are worse and obesity rates are higher. By emphasizing nutrition interventions and long-term nutrition education, patients benefit.
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