Mediterranean diet versus low-fat diet on cardiovascular disease (CVD) risk factors and outcomes: A systematic review of RCTs

Background: The Mediterranean diet (MD) and low-fat diet (LFD) were well-known dietary interventions for cardiovascular disease prevention. However, there is an ongoing debate about the relative efficacy of improving cardiovascular (CV) risk factors and clinical outcomes between the 2. This systematic review aims to evaluate and summarize findings from randomized controlled trials (RCTs) that directly compare the MD and LFD concerning CV risk factors and clinical outcomes. Methods: Per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a comprehensive literature search was conducted across PubMed, Google Scholar, SCOPUS, Science Direct, and RCTs that compared MD and LFD in adults, and reported data on CV risk factors or clinical outcomes were included. Results: Our systematic review includes 11 RCTs with 5942 participants. MD significantly reduced the formation of procoagulant and prothrombotic microvesicles. Studies have also reported that MD has resulted in greater reductions in total cholesterol, cholesterol-high-density lipoproteins ratios, insulin levels, blood glucose levels, leukocyte count, and body mass index compared to LFD. Conclusion: MD demonstrates superior efficacy over LFD in improving CV risk factors and outcomes. These findings could support the preferential recommendation of MD over LFD for the secondary prevention of cardiovascular diseases. Further research should explore the long-term adherence and implementation of these dietary interventions in diverse populations.