Low-fat Mediterranean diets may reduce mortality and heart attacks in high-risk adults

Key points to remember:

• Mediterranean and low-fat diet programs were linked to a reduced risk of death and heart attack.
• Five other diets showed little or no benefit in reducing deaths or heart attacks.

In patients at intermediate or high CV risk, compared with minimal intervention, Mediterranean and low-fat diet programs were associated with a reduced risk of death and nonfatal MI, researchers reported in The BMJ.

According to the researchers, little or no death and myocardial infarction-related benefits were observed with the very low fat, modified fat, combined low fat and low sodium, Ornish and Pritikin diets. .

Bradley C. Johnston, PhD, associate professor of nutrition, 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 assessed death and MI in eating habits compared to minimal intervention. Diets assessed 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) .

Bradley C. Johnston

At last reported follow-up, the Mediterranean diet was superior to the minimum intervention for preventing death from any cause (OR=0.72; 95% CI 0.56-0.92; risk difference in intermediate risk patients 17 less per 1000 patients followed for 5 years), CV mortality (OR = 0.55; 95% CI, 0.39-0.78; risk difference in intermediate-risk patients, 13 fewer patients per 1000 patients followed for 5 years), stroke (OR=0.65; 95% CI, 0.46-0.93; risk difference in intermediate risk patients, 7 less per 1000 patients followed for 5 years) and Nonfatal MI (OR=0.48; 95% CI, 0.36-0.65; risk difference in intermediate-risk patients, 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 diet was superior to the minimum intervention for preventing death from all causes (OR = 0.84; 95% CI 0.74-0.95; risk difference in intermediate risk patients, 9 less to 1 000 patients followed for 5 years) and non-fatal MI (OR = 0.77; 95% CI, 0.61-0.96; risk difference in patients at intermediate risk, 7 fewer patients for 1 000 patients followed for 5 years) based on moderate-certainty evidence, the researchers wrote.

The data was similar for high-risk patients, the researchers said.

There was no difference between Mediterranean and low-fat diets for the prevention of death or nonfatal MI, Johnston and colleagues wrote.

The other five dietary patterns did not show superiority over minimal intervention for reduced 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 advisability of diet change,” Johnston and colleagues wrote.

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