The comparison group received either no intervention, minimal intervention, usual care or another dietary intervention. The intervention could be dietary advice, provision of relevant foods, or both. Additional components included: low to moderate red wine consumption high consumption of whole grains and cereals low consumption of meat and meat products and increased consumption of fish moderate consumption of milk and dairy products. Both of the following key components were required to reach our definition of a Mediterranean-style diet: high monounsaturated/saturated fat ratio (use of olive oil as main cooking ingredient and/or consumption of other traditional foods high in monounsaturated fats such as tree nuts) and a high intake of plant-based foods, including fruits, vegetables and legumes. We selected randomised controlled trials (RCTs) in healthy adults and adults at high risk of CVD (primary prevention) and those with established CVD (secondary prevention). We searched trial registers and applied no language restrictions. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 9) MEDLINE (Ovid, 1946 to 25 September 2018) Embase (Ovid, 1980 to 2018 week 39) Web of Science Core Collection (Thomson Reuters, 1900 to 26 September 2018) DARE Issue 2 of 4, 2015 (Cochrane Library) HTA Issue 4 of 4, 2016 (Cochrane Library) NHS EED Issue 2 of 4, 2015 (Cochrane Library). To determine the effectiveness of a Mediterranean-style diet for the primary and secondary prevention of CVD. Later observational studies have confirmed the benefits of adherence to a Mediterranean dietary pattern on cardiovascular disease (CVD) risk factors but clinical trial evidence is more limited. ![]() The Seven Countries study in the 1960s showed that populations in the Mediterranean region experienced lower coronary heart disease (CHD) mortality probably as a result of different dietary patterns.
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