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Academic Editor: Amanda N.
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Received: 7 July 2025
Revised: 11 August 2025
Accepted: 14 August 2025
Published: 20 August 2025
Citation: Morgan, K.H.; Lee, M.L.;
Barroso, C.S.; Anderson, J.G.; Lott, S.;
Reth, D.; Horn, C.; Dixson, M.
Associations of the MIND Diet with
Human Health Outcomes: A Scoping
Review. Nutrients 2025,17, 2687.
https://doi.org/10.3390/
nu17162687
Copyright: © 2025 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license
(https://creativecommons.org/
licenses/by/4.0/).
Review
Associations of the MIND Diet with Human Health Outcomes:
A Scoping Review
Katherine Hope Morgan 1,* , Michelle Lanphere Lee 2, Cristina S. Barroso 3,4 , Joel G. Anderson 1,
Shelley Lott 1, Danielle Reth 1, Chelsea Horn 1and Melanie Dixson 5
1College of Nursing, The University of Tennessee, 1200 Volunteer Blvd., Knoxville, TN 37996, USA;
jande147@utk.edu (J.G.A.); slott4@utk.edu (S.L.); btl757@vols.utk.edu (D.R.); chorn10@vols.utk.edu (C.H.)
2Department of Nutrition & Integrated Health Sciences, College of Health Sciences, East Tennessee State
University, P.O. Box 70260, Johnson City, TN 37614, USA; leeml2@mail.etsu.edu
3College of Public Health, East Tennessee State University, P.O. Box 70623, Johnson City, TN 37614, USA;
barrosoc@mail.etsu.edu
4Department of Health, Behavior, and Society, The University of Texas Health Science Center at San Antonio,
7703 Floyd Curl Drive, San Antonio, TX 78229, USA
5Health, Wellness, and Professional Programs, University Libraries, The University of Tennessee, 1015
Volunteer Boulevard, Knoxville, TN 37996, USA; melanie-dixson@utk.edu
*Correspondence: kmorgan3@utk.edu
Abstract
The MIND diet was designed as an intervention to delay neurodegeneration and has been
explored by systematic reviews for associations with cognition and, more recently, car-
diometabolic disease. Comparatively less is known about how the MIND diet is associated
with other health outcomes (e.g., all-cause mortality, anxiety, insomnia). This scoping re-
view included studies exploring associations between the MIND diet and health outcomes
other than cognition and cardiometabolic disease. Online databases were used to identify
4090 studies published between January 2015 and April 2024, from which 47 publications
were included for review. Associations between the MIND diet and health outcomes were
assessed as either favorable, unfavorable, or having no statistically significant association.
Overall, 47 studies were included in this scoping review, 46 were observational, and several
were conducted in large, established cohort studies. Across the 47 studies, 18 different
topics were explored. Higher adherence to the MIND diet was mostly associated with
favorable health outcomes (65%), while roughly one-third (33%) of studies found no sta-
tistically significant associations. One study, in Italy, found that increased adherence to
the MIND diet was associated with increased exposure to cadmium, a heavy metal. In
populations that may benefit from the MIND diet, we recommend additional observational
and exploratory studies to identify health associations. Studies exploring educational
interventions would help to identify facilitators and barriers to adopting the MIND diet.
This scoping review provides some evidence that higher adherence to the MIND diet
is associated with risk reduction for many diseases. Further research on environmental
exposures (e.g., cadmium) and other deleterious substances absorbed by food crops will be
crucial as we strive to enhance health and food security through plant-rich dietary patterns.
Keywords: Mediterranean-DASH intervention for neurodegenerative delay; MIND diet;
health outcomes; nutrition; risk reduction
Nutrients 2025,17, 2687 https://doi.org/10.3390/nu17162687
Nutrients 2025,17, 2687 2 of 27
1. Introduction
Morris and colleagues designed the MIND diet (or the Mediterranean-DASH inter-
vention for neurodegenerative delay diet) in 2015 [
1
,
2
] to delay the onset of Alzheimer’s
disease and related dementias. The MIND diet is a hybrid between the Mediterranean and
the Dietary Approaches to Stop Hypertension (DASH) diets. The MIND diet optimizes the
intake of nutrients such as flavonoids, antioxidants, vitamins, and minerals that protect
against inflammation and oxidation, which are key forces in neurodegeneration. Numerous
studies have been conducted to test associations between the MIND dietary pattern and
cognitive outcomes, and several research groups have conducted systematic reviews [
3
–
6
].
Likewise, the MIND diet has been systematically reviewed for associations with cardiovas-
cular disease [
7
]. Overall, these reviews present evidence that the MIND diet is protective
against dementia and beneficial to some domains of cognition and memory [
3
–
6
,
8
] and
healthier cardiometabolic outcomes [
7
]. Comparatively less is known about how the MIND
diet may influence other aspects of human health.
The MIND diet [
1
,
2
] consists of recommendations for quantities and types of foods
to be eaten during a week (e.g., eating six servings of leafy greens) (see Table 1). Eating
according to this dietary pattern provides ample plant materials (e.g., leafy greens), whole
grains and starches (e.g., oats, rice, barley, sweet potatoes), beans and legumes (e.g., black
beans, lentils), nuts (e.g., walnuts, cashews), berries (e.g., blueberries), seafood/fish (e.g.,
shrimp, fish), lean meats (e.g., chicken, turkey, venison), and plant oils (e.g., olive oil, canola
oil). Morris [
9
] recommends limiting the number of red meats, saturated fats (e.g., whole
dairy, lard, fried foods), and sweets consumed in a week, allowing for a few servings of
these foods. The original MIND diet included “no more than” one daily serving of wine for
women and two servings for men (i.e., 5 ounces of wine) [9].
Table 1. The MIND dietary pattern, adapted from descriptions by Morris [9].
10 Healthy Foods Servings/Frequency Examples
Leafy green vegetables 6+/week Kale, spinach, romaine lettuce
Other vegetables 1+/day Broccoli, green beans, squash
Whole grains 3+/day Oats, farro, wheat, brown rice
Berries 2+/week Blueberries, strawberries
Nuts 5+/week Walnuts, almonds, peanuts
Seafood 1+/week Fish, shrimp, scallops (fresh or saltwater fish)
Poultry 2+/week Chicken, turkey
Beans & legumes 4+/week Black beans, lentils
Olive oil as primary oil
Wine * 1/day for women
1–2/day for men
5 ounces of wine, 12 ounces of beer (5%
alcohol), or 1.5 ounces of liquor
5 Unhealthy Foods to Limit Servings/Frequency Examples
Sweets & pastries <5/week Cake, candy, ice cream, pie
Red meats & red-meat products <4/week Beef, pork, bacon, corn beef hash
Fried/fast foods <1/week Fries, burgers, chicken
Whole-fat cheese <1/week (1 to 2 ounces
per week) Cheddar, Colby, Swiss, American
Butter or trans-fat margarine <1 pat/day Butter, margarine
* The original MIND diet includes wine; however, people who do not consume alcohol are not encouraged
to begin.
Nutrients 2025,17, 2687 3 of 27
Morris [
9
] wrote that one should fill their plate with “antioxidants, B vitamins, and
healthy fats” (p. 35) to combat oxidative damage from free radicals or reactive species.
Oxygen, nitrogen, and sulfur form reactive species and non-radical oxidants [
10
], which
cause oxidative damage to DNA, lipids, and proteins [
11
]. Reactive species form naturally
in plants and animals as the result of processes such as digestion, breathing, growing, and
fighting infections [
9
]. Oxidative damage is associated with diseases including cancer,
diabetes, neurodegeneration, and chronic inflammatory diseases [
10
]. However, the human
body also produces antioxidants that offer protection against free radicals through a variety
of mechanisms such as delaying or obstructing oxidative reactions, even acting as stabilizing
agents by chelating metals [
10
]. Antioxidants include both antioxidant enzymes and
nutrients [
9
]. Antioxidant nutrients, primarily vitamin E, carotenoids, flavonoids, other
polyphenols, and vitamin C, are obtained through the foods that we eat [
9
]. The MIND diet
was designed as a dietary pattern providing a variety of healthy foods, high in antioxidants,
which support the body in its daily work of protecting against oxidative stress [1,2,9].
The bioavailability of dietary components depends in part upon the interplay between
the foods we eat, commensal gut microbiota, and byproducts (metabolites) made by gut
microbiota [
12
]. Changes in dietary patterns can quickly alter the community structure
of the trillions of microbes inhabiting the human gut (bacteria, viruses, fungi, protozoans,
and ancient Archaea) [
13
]. In a plant rich diet, the ample presence of flavonoids in the diet
alters microbial community structure such that flavonoids are considered by some to be a
prebiotic [
14
]. Recently, the microbially derived metabolite (produced by gut microorgan-
isms), imidazole propionate (ImP), has been associated with subclinical atherosclerosis in
mice and in humans, as well as multiple deleterious cardiometabolic measures such as dys-
lipidemia, visceral fat, and lower high-density lipoprotein (HDL) cholesterol, making ImP
a new target for therapeutic interventions [
15
]. Interestingly, ImP was inversely associated
with the Mediterranean dietary pattern, a largely plant-based diet and the foundation of
the MIND diet [
15
]. Thus, dietary patterns, microbial community structure, and microbial
byproducts may play important roles in disease prevention or progression.
Many noncommunicable diseases can be prevented or improved through lifestyle
changes, such as adopting a healthier diet and exercising regularly [
16
,
17
]. Adherence to the
MIND diet, especially in combination with physical activity, has been associated with cog-
nitive benefits [
18
]. Plant-based diets are associated with improved cardiovascular health
and all-cause mortality [
19
]. Understanding the extent to which the MIND diet may be ben-
eficial would strengthen the knowledge base for making evidence-based recommendations
about its use and adaptability to patient populations. For example, if a neuroprotective
dietary pattern like the MIND diet can protect against dementia [
1
,
2
], then it is reasonable
to suspect that it may be associated with benefits for other neurodegenerative diseases
(e.g., glaucoma, multiple sclerosis, peripheral neuropathies, and Parkinson’s disease). The
MIND diet promotes eating plant-based foods, including high fiber content, as well as
healthy unsaturated fats, and lean meats [
1
,
2
]. Thus, the MIND diet could be beneficial for
the prevention or treatment of many noncommunicable diseases such as hyperglycemia
and obesity. However, it is unclear what kind of information is available in the literature
about the MIND diet beyond the topics of cognition, dementia, and cardiovascular health.
The purpose of a scoping review is to map the studies published in an existing or new
line of inquiry, to determine whether a systematic review is needed, and to identify gaps
in knowledge [
20
]. In this scoping review, our aim was to identify peer-reviewed articles
exploring adherence to the MIND dietary pattern and associations with health-related
outcomes. Our primary research question was, in studies of humans in which adherence
to the MIND diet was assessed, what were the health-related treatment outcomes, and
did higher adherence to the MIND dietary pattern represent an improvement or a more
Nutrients 2025,17, 2687 4 of 27
favorable outcome than lower levels of adherence? Because the MIND dietary pattern
recommends foods rich in antioxidants, we hypothesized that higher adherence to the
MIND diet would be associated with improved health outcomes.
2. Materials and Methods
2.1. Protocol Registration
Our protocol followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) [
20
]. The scoping review
protocol was registered prospectively, prior to data abstraction, with Open Science Forum
(Copyright © 2011–2025) [see registration at https://osf.io/bsvcm/?view_only=30c9fb317
c30497892cd671be24ec5de (accessed on 12 December 2024)].
2.2. Information Sources
Collaborating with university research librarians, we designed search terms to identify
articles published in English between January 2015 (the MIND diet was published in 2015)
and April 2024 in peer-reviewed journals in which the MIND diet was the independent
variable and any health outcome was the dependent variable (see Table 2). The follow-
ing databases were queried: PubMed (including Medline; via the National Library of
Medicine), Scopus (Elsevier), Web of Science (Clarivate Analytics), CINAHL (EBSCOhost),
APA PsycINFO (ProQuest), and Google Scholar.
Table 2. Keywords used.
“MIND diet”
“MIND dietary pattern”
“Mediterranean DASH Intervention for Neurodegenerative Delay”
“Mediterranean Dietary Approaches to Stop Hypertension Intervention for
Neurodegenerative Delay”
Filters applied: Publication Date from 2015 to 2024
2.3. Selection of Sources of Evidence
To be included, a study must have been quantitative; published in English in a peer-
reviewed journal; and conducted on humans. It was required to evaluate associations
between the MIND diet score as the independent variable (e.g., where 0 is the lowest possi-
ble measure of adherence and 13 to 15 is the highest, depending on whether wine and olive
oil were counted), and dependent variables included measurable health outcomes (e.g.,
longevity, mood, biometrics, muscle strength). We followed the Population Intervention
Comparator Outcome (PICO) framework.
Excluded from this review were studies employing a modified Mediterranean-DASH
diet, which was altered for other populations (e.g., the Korean-MIND diet); studies in
which the dependent variables were the subject of previous systematic reviews related to
cognition or cardiometabolic outcomes (unless other dependent variables such as mood
were also measured); and studies where no health outcomes were measured, which have
been recently reviewed [
3
–
7
]. Conference proceedings, dissertations, editorials, protocols,
blogs, and reviews were excluded. Studies exploring only the Mediterranean diet or the
DASH diet [21] (not the MIND diet, which is a hybridization of the two) were excluded.
2.4. Data Charting Process
References retrieved were downloaded from each database into EndNote™ version
21 (Clarivate), and then uploaded to Covidence
©
(Veritas Health Innovation, Melbourne,
Nutrients 2025,17, 2687 5 of 27
Australia, Available at www.covidence.org), an online systematic review software in which
research teams can conduct systematic and scoping reviews. While Covidence
©
auto-
matically removes most duplicates, some duplicates (e.g., a conference abstract and a
manuscript of the same study) were removed manually. Within Covidence
©
, DR and CH
independently conducted the initial review of titles and abstracts with KM serving as
tiebreaker. The full-text review and data abstraction were conducted by CB, ML, SL, JA,
and KM. Each text was reviewed independently by two reviewers, and in cases of a tie, a
third reviewer. Questions were discussed through emails and teleconferencing until the
full group reached consensus.
Data abstracted included the following for each selected article: country in which
the study was conducted; participants’ demographic characteristics (patient population,
disease, condition, age, gender); study design; who implemented the MIND diet or how
the intervention was implemented (if any); what the intervention was and the time interval
or duration of education about the MIND diet; how the MIND diet was scored and whether
wine was assessed and scored; what methods of assessment and correlational analysis were
used; and the covariates.
Critical appraisal is not recommended for a scoping review [
20
] and was not conducted.
Abstracted data were downloaded to a Microsoft Excel for Microsoft 365 MSO (Version 2504)
spreadsheet and organized into categories based on health outcome topics for evidence
synthesis. For each health outcome, it was noted whether an association with the MIND
diet was favorable, unfavorable, or no statistically significant association was found.
2.5. Synthesis of Results
All researchers conducted the evidence synthesis. Studies were grouped based upon
related topics (e.g., dependent variables related to Parkinson’s disease). The evidence
syntheses are presented in narrative format for each topic explored by two or more studies,
including the types of settings, populations, and study designs, along with the measures
used and broad findings.
3. Results
3.1. Identification and Selection
The identification and selection process are depicted in a PRISMA diagram in
Figure 1
.
The original search identified 4090 references. After removing duplicates and applying exclu-
sion criteria, 96 full texts were assessed for eligibility and 47 studies met the inclusion criteria.
Identification of studies via databases and registers
4090 studies imported for screening
PubMed (n = 155)
Scopus (n = 1278)
Web of Science (n = 342)
CINAHL (n = 101)
APA PsycINFO (n = 36)
Google Scholar (n=2178)
Duplicates removed (n = 1798)
identified by Covidence (n = 1708)
identified manually (n = 90)
Records screened (n = 2292) Records excluded (n = 2186)
Duplicates identified manually (n = 10)
Studies sought for retrieval (n = 96) Studies not retrieved (n = 0)
Full-text studies assessed for eligibility (n = 96)
Identification
Screening
Included
Studies included in the review (n = 47)
Reports excluded:
Wrong outcomes (n = 41)
Not peer reviewed (n = 7)
Wrong intervention (n = 1)
Identification of studies via databases and registers
4090 studies imported for screening
PubMed (n = 155)
Scopus (n = 1278)
Web of Science (n = 342)
CINAHL (n = 101)
APA PsycINFO (n = 36)
Google Scholar (n=2178)
Duplicates removed (n = 1798)
identified by Covidence (n = 1708)
identified manually (n = 90)
Records screened (n = 2292) Records excluded (n = 2186)
Duplicates identified manually (n = 10)
Studies sought for retrieval (n = 96) Studies not retrieved (n = 0)
Full-text studies assessed for eligibility (n = 96)
Identification
Screening
Included
Figure 1. PRISMA diagram depicting selection of sources included in the scoping review.
Nutrients 2025,17, 2687 6 of 27
3.2. Study Characteristics
Table S1 summarizes the characteristics of the 47 studies. Studies were conducted
in 10 different countries including Iran (n= 17), the U.S. (n= 10), China (n= 6), the U.K.
(n= 5), Italy (n= 4), Spain (n= 2), Australia (n= 1), Canada (n= 1), and the Netherlands
(n= 1) between 2018 and 2024. All but one [
22
] of the studies were observational. None
of the studies included dietary education regarding the MIND dietary pattern, while
one [
22
], using data collected by an ongoing cohort trial, provided an educational dietary
intervention for the Mediterranean diet, but not the MIND diet specifically. Study samples
ranged from 137 to 162,999 participants (median = 845, mean = 7824) and addressed
18 different health topics (see Figure 2).
0246810 12
telomere length
sleep
rheumatoid arthritis
quality of life (health-related )
Parkinson's Disease
non-alcoholic fatty liver disease
multiple sclerosis
migraine headaches
mental health
irritable bowel syndrome
headache-related disability
glaucoma (open-angle)
functional ability and strength
frailty
dietary exposures
diabetes and metabolism
cancer
auditory function
all-cause mortality
Number of Articles
Topics
Figure 2. Number of articles by topic that were identified by this scoping review.
Study designs included cross-sectional (49%), cohort (36%), and case–controls (15%).
Longitudinal cohort studies ranged in the duration from 1 to 25 years. Some analyzed
data from established cohort studies including the following: Australian Diabetes Obesity
and Lifestyle study (AusDiab) [
23
], Baltimore Longitudinal Study of Aging (BLSA) [
24
],
Framingham Offspring Cohort [
25
], National Health and Nutrition Examination Survey
(NHANES) [
26
], Prevention with Mediterranean Diet (PREDIMED)-plus-Cognition [
22
], Re-
serve against Disability in Early Multiple Sclerosis (RADIEMS) [
27
], Rotterdam Study [
28
],
Rush Memory and Aging Project (MAP) [
29
], Scottish Mental Survey [
30
], the Seguimiento
Universidad de Navarra (University of Navarra follow-up, SUN) project [
31
], and UK
Biobank [32].
To inventory food intake, most researchers relied upon validated food frequency
questionnaires (FFQs) completed by study participants. These FFQs quantify eating pat-
terns over a specified period, typically for the previous 12 months. Some researchers
Nutrients 2025,17, 2687 7 of 27
utilized FFQs that were validated specifically for cultural relevancy, such as the Chinese
FFQ used by Zhang, He [
33
]. Four research groups completed FFQs by interviewing
participants [22,34–36].
All but one research group calculated a MIND diet score (MDS) to measure adherence
by following the method published by Morris et al. [
1
], where the minimum (no adherence)
was 0 and the maximum score (highest adherence) was 15 (based on 15 food groups).
Within each of the 15 food groups, points (0, 0.5, or 1) were awarded based on meeting
the recommended servings/frequency of foods consumed for each food group per week.
Twenty-six research groups (55%) used the original 15-point scale. In some cases, the
FFQ did not adequately inventory dietary intake for some food groups (e.g., wine, olive
oil, butter, or fried foods). In other cases, there were cultural constraints against some
categories, such as wine. When one food category was not inventoried (e.g., wine), a
14-point MDS was employed (n= 13, 28%). Similarly, when two food groups were not
included, a 13-point scale (n= 5, 11%) was utilized. Two studies used a 9-point scale. One
study used a 14-point scale, but expanded the points awarded per food group to a range of
one to five (where 1 is lowest and 5 is highest adherence), instead of 0, 0.5, or 1 per food
group, for a possible range of 14–70 points.
For statistical analyses, research groups treated the MDS as an ordinal or a nominal
value by creating tertiles of low, medium, and high adherence (e.g., where 0–5 is low, 6–10
is medium, and 11–15 is high on a 15-point scale). Others binned data into quartiles or
quintiles. Research groups employed a variety of methods to test for statistically significant
associations and differences between the MIND diet and health outcomes of interest (see
Table S1).
The majority of health outcomes associated with higher adherence to the MIND
dietary pattern were favorable (65%), while one-third (33%) reported no association or only
a weakly favorable association. Only one of the studies included in this review identified
an unfavorable outcome associated with higher levels of adherence to the MIND dietary
pattern (i.e., increased urinary cadmium levels) [
37
]. Table 3summarizes the associations
between MDS and health outcomes reported in the 47 studies included in this review.
Among studies (n= 20) where it was possible to identify the lowest MDS necessary to
achieve a statistically favorable outcome, the average low score was 8.7 (median = 9.3;
range = 6.0 to 10.6).
Table 3. Statistically significant associations with the MIND diet.
Number
of Studies Health Outcome
Favorable
n (%)
Unfavorable
n (%)
No Association
n (%) Study Reference(s)
6 All-Cause mortality: 4 (67%) 0 2 (33%) *
Song [26]; Song [38];
Thomas [25]; Zupo [39];
Corley [30]; Chan [40]
All-cause mortality in a
diabetic population 1 0 0 Song [26]
All-cause mortality
(non-diabetic population) 1 0 0 Song [26]
All-cause mortality in a
hypertensive population 1 0 0 Song [38]
1 Auditory function 0 0 1 (100%) * Jin [41]
5 Cancer (Risk of):
Nutrients 2025,17, 2687 8 of 27
Table 3. Cont.
Number
of Studies Health Outcome
Favorable
n (%)
Unfavorable
n (%)
No Association
n (%) Study Reference(s)
Breast cancer 2 (67%) 0 1 (33%)
Mokhtari [36];
Aghamohammadi [42];
Sheikhhossein [43]
Glioma 2 (100%) 0 0 Zhang [33]; Soltani [44]
2 Diabetes and metabolism:
Metabolic health status 1 (100%) 0 0 Tirani [45]
Hypertension 1 (100%) 0 0 Tirani [45]
Hypertriglyceridemia 1 (100%) 0 0 Tirani [45]
Serum brain-derived
neurotrophic concentrations 0 0 1 (100%) Tirani [45]
Incident diabetes 1 (100%) 0 0 Tison [46]
3 Dietary exposures:
Sulfur content in food 1 (100%) 0 0 Passafiume [47]
Selenium exposure 1 (100%) 0 0 Urbano [48]
Cadmium exposure 0 1 (100%) 0 Urbano [37]
2 Frailty (risk of) 2 (100%) 0 0 Yao [32]; Tanaka [24]
6 Functional ability:
ADL disability 1 (100%) 0 0 Agarwal [49]
Instrumental ADL disability 1 (100%) 0 0 Agarwal [49]
Mobility disability 1 (100%) 0 0 Agarwal [49]
Grip strength 2 (100%) 0 0
Pasdar [
50
]; Talegawkar [
51
]
Physical function 1 (100%) 0 0 Talegawkar [51]
Psychological function 1 (100%) 0 0 Yeung [52]
1 Glaucoma (open-angle) 1 (100%) 0 0 Vergroesen [28]
1 Irritable bowel syndrome 0 0 1 (100%) Nouri-Majd [53]
10 Mental health:
Anxiety 2 (40%) 0 3 (60%)
Barkhordari [54];
Rostami [55];
Seifollahi [56];
Salari-Moghaddam [57];
Torabynasab [58]
Depression 3 (50%) 0 3 (50%) *
Barkhordari [54];
Cherian [29]; Fresan [31];
Seifollahi [56] *;
Salari-Moghaddam [57];
Rostami [55]
Impulsivity 0 0 1 (100%) Gomez-Martinez [22]
Mood 0 0 1 (100%) Ma [59]
Somatization 1 (100%) 0 0 Haghighatdoost [60]
Stress 1 (20%) 0 4 (80%)
Barkhordari [54];
Rostami [55];
Salari-Moghaddam [57];
Seifollahi [56]
Nutrients 2025,17, 2687 9 of 27
Table 3. Cont.
Number
of Studies Health Outcome
Favorable
n (%)
Unfavorable
n (%)
No Association
n (%) Study Reference(s)
1 Migraine headaches:
Severity 1 (100%) 0 0 Askarpour [34]
Frequency 1 (100%) 0 0 Askarpour [34]
Duration 1 (100%) 0 0 Askarpour [34]
Disability 0 0 1 (100%) Askarpour [34]
2 Multiple sclerosis:
Reduced odds of MS 1 (100%) 0 0 Noormohammadi [35]
Higher thalamic volume 1 (100%) 0 0 Noormohammadi [35]
Lesion volume 0 0 1 (100%) Katz Sand [27]
Gray matter volume 0 0 1 (100%) Katz Sand [27]
Normal appearing white
matter 0 0 1 (100%) Katz Sand [27]
1Non-alcoholic fatty liver
disease 1(100%) 0 0 Petermann-Rocha [61]
5 Parkinson’s disease:
Incidence 1 (100%) 0 0 Agarwal [62]
Later onset 1 (100%) 0 0 Metcalfe-Roach [63]
Motor symptoms 1 (100%) 0 0 Fox [64]
Nonmotor symptoms 1 (100%) 0 0 Fox [64]
Progression 1 (100%) 0 0 Agarwal [62]
Risk 0 0 1 (100%) Keramati [65]
Severity 0 0 2 (100%) Keramati [65]; Lawrie [66]
Total symptoms 1 (100%) 0 0 Fox [64]
1Quality of Life
(health-related) 1 (100%) 0 0 Ng [23]
1 Rheumatoid arthritis:
Oxidative stress indicators 0 0 1 (100%) Safaei [67]
Metabolic factors 1 (100%) 0 0 Safaei [67]
Disease activity 1 (100%) 0 0 Safaei [67]
Odds of disease 1 (100%) 0 0 Safaei [67]
1 Sleep:
Sleep quality 1 (100%) 0 0 Rostami [55]
Insomnia 1 (100%) 0 0 Rostami [55]
Sleepiness (daytime) 1 (100%) 0 0 Rostami [55]
1 Telomere length 0 0 1 (100%) Chan [68]
n= number. Percentages were calculated based on the number of studies reporting on the same health outcome.
* A weak but favorable association was found in one or more studies.
Nutrients 2025,17, 2687 10 of 27
3.3. Evidence Synthesis of Similar Studies
This section synthesizes the available evidence for which more than one study focused
on a similar health outcome (e.g., depressive symptoms) and an MDS was tested for
associations with the health outcome(s) of interest.
3.3.1. All-Cause Mortality
Six of the reviewed articles [
25
,
26
,
30
,
38
–
40
] examined associations between the MIND
diet and mortality. Four research groups [
25
,
26
,
38
] found a statistically significant relation-
ship with higher adherence to the MIND diet and a decrease in deaths or risk of mortality.
However, Zupo, Sardone [
39
] found only a borderline association. Chan, Yu [
40
] found no
association between MIND diet adherence and risk of mortality.
Three of the studies, examining the MIND diet and mortality, were based in the U.S.
using nationally representative samples. Song, Chang [
26
] included 6887 patients from
NHANES. The sample consisted of an average age of 47.13
±
0.45, approximately equal
numbers of males and females, more than 50% non-Hispanic Whites, approximately equal
proportions of Blacks (19.36%) and Mexican Americans (18.47%), and approximately 50%
nonsmokers, with 43.33% reporting hypertension, and 71.93% reporting hyperlipidemia.
In this prospective cohort study, patients were followed for 10 years to record all cause
and cerebrovascular (CV) deaths in patients with or without diabetes. Patients with a
comorbidity of diabetes and high MDS (i.e., >8) experienced the lowest risk of all-cause
mortality (HR = 0.75, 95% CI = 0.59–0.96, p= 0.021) and CV mortality (HR = 0.50, 95%
CI = 0.29–0.87, p= 0.014) compared with patients with diabetes and lower adherence to
the MIND diet. Patients without diabetes and high MDS also experienced a decrease in
all-cause mortality (HR = 0.83, 95% CI = 0.70–0.99, p< 0.0001) but no statistically significant
difference was found among patients without diabetes in terms of high MDS and CV
mortality. When adjusting for all covariates, non-diabetic and diabetic patients with high
MDS experienced the lowest risk of all-cause mortality.
In a similar analysis, Song, Chang [
38
] examined associations between hypertension,
mortality, and MDS in a subset of 2984 participants from NHANES. Those with hyperten-
sion and high MDS (
≥
8.5) experienced a decrease in risk of all-cause mortality
(HR = 0.69
,
95% CI = 0.58–0.81, p< 0.0001) and CV mortality (HR = 0.62, 95% CI = 0.46 –0.85, pfor
trend = 0.0001
) in comparison with participants with hypertension and low MDS (<7.5). For
every point increase in MDS, participants had a 10% decrease in all-cause death (
HR = 0.90
,
95% CI = 0.86–0.95, ptrend <0.001) and a 13% decrease in risk of CV death (
HR = 0.87
, 95%
CI = 0.79–0.96
,ptrend = 0.001). Those without hypertension displayed an inverse relation-
ship between MDS and all-cause death, but the relationship was not statistically significant.
Thus, the comorbidity of hypertension and diabetes and a low MDS was associated with a
significant increase in all-cause deaths in both studies.
Three research groups [
25
,
30
,
39
] also demonstrated a reduction in the risk of death
among participants with high MDS. Thomas, Ryan [
25
] examined 1644 participants, off-
spring of the Framingham Heart Study (an U.S. based cohort of participants studied since
1948) in a prospective cohort study for 20 years. The average age of the population was
69.6 ±6.9 years
, approximately equal female and Male, and 53.3% smokers. Fewer than
20% of participants had cardiovascular disease (18.6%) and/or diabetes (16.8%). MIND
diet scores were grouped into tertiles, low MDS (<6.5), moderate adherence (6.5–8) and
high MDS (>8). Like the previous U.S. population-based studies, a lower risk of mortality
correlated with higher MIND diet adherence (each 1 SD increase in MDS was linked to
47.3 [
−
74.8;
−
20] fewer deaths per 10,000 years of follow up). Thomas, Ryan [
25
] study
demonstrated a correlation of 57% of the MIND diet score on mortality risk was also
linked to the pace of age as measured by DunedinPACE (
βNDE
+ 20.1 [
−
47.2; 6.9] and
Nutrients 2025,17, 2687 11 of 27
βNIE
=
−
27.2 [
−
36.7;
−
18.8]). Thus, a slower pace of aging also impacts the risk of mortality
among patients with higher adherence to the MIND diet.
In terms of studies conducted outside the U.S., Corley [
30
] examined adherence to
the MIND diet over 12 years using the longitudinal Lothian Birth Cohort in Edinburgh,
Scotland. The average age of the sample was 69.6 years with equal proportions of males
and females and an average BMI of 27.1. The majority of the sample were smokers
(57.1%) and moderately active (65.6%). Roughly one in five reported a history of CVD
(21.4%), 37% hypertension, 5.2% diabetes, and 3.0% stroke. Those with the highest tertile
MDS had a reduced risk of death by 37% (HR = 0.63, 95% CI: 0.41–0.96, p= 0.03). An
inverse relationship was observed between adherence to the MIND diet and all-cause
mortality. After adjusting for covariates such as age, BMI, hypertension, CVD, diabetes,
and stroke, only the MIND diet had a significant association with mortality (HR = 0.88,
95% CI = 0.79–0.97, p= 0.01); the risk of death decreased by 12% per point increase in MDS.
Two other studies conducted outside the U.S. found borderline or no association
between the MIND diet and mortality. Zupo et al. [
39
] examined 2472 participants in
southern Italy in a retrospective cohort study. This sample consisted of 42.9% females
and 31.88% smokers, with an average BMI of 27.48
±
4.55. A small proportion (6.23%)
reported comorbidities (diabetes, hypertension, peptic ulcer, cholangiolithiasis, myocardial
infarction, hepatic cirrhosis, or other liver diseases). MDS demonstrated only a borderline
inverse association with mortality (HR = 0.95, 95% CI = 0.92–1.00).
Chan, Yu [
40
] examined the MIND diet and mortality among 2802 participants in
a prospective cohort study in Hong Kong and found no association between adherence
to the MIND diet and mortality. However, more women in the low adherence group
compared with the high MIND diet adherence reported higher incidence of diabetes
(n= 79, 17.0%;
n= 44, 9.4%
, respectively) and cardiovascular events (n= 91, 19.6%; n= 73,
15.7%, respectively).
3.3.2. Cancer/Oncology
Breast Cancer
Three case–control studies explored associations between adherence to the MIND diet
and the risk of developing breast cancer (BCA) [
36
,
42
,
43
]. Two studies found significant
associations [
36
,
42
], while one did not [
43
]. All were conducted in Iran—one in Isfahan [
42
]
and two in Tehran [
36
,
43
]. Aghamohammadi et al. [
42
] and Mokhtari et al. [
36
] studied
women
≥
30 years of age who had recently been diagnosed with BCA (cases) and healthy
women of the same age (controls). Aghamohammadi et al. enrolled 350 cases and 700 age-
matched controls, and Mokhtari et al. enrolled 136 cases and 272 age-matched controls.
Both studies found that higher adherence to the MIND diet lowered the odds of BCA
significantly. After adjusting for possible confounders, women with the highest adherence
to the MIND diet had 50% lower odds of BCA than those in the lowest tertile of MDS
(OR = 0.50; 95% CI = 0.34–0.72 [
42
] or 45% lower risk (OR = 0.55, 95% CI = 0.32–0.96) [
36
].
Post-menopausal women with the highest MDS were less likely to have BCA than those
in the bottom tertile, and there was an inverse association between high MDS and BCA
among women of normal weight [
42
]. High MDS was also significantly associated with a
lowered risk of BCA among women with a history of abortion [
69
]. Authors of both studies
noted that case–control studies cannot prove causality and can be subject to selection and
recall bias. By contrast, in a case–control study of 300 women (150 BCA cases and 150 age-
matched controls having no relation with the cases), Sheikhhossein, Imani [
43
] found no
significant association between high MDS and lower risk of BCA, even after controlling for
potentially confounding variables (OR = 1.32, 95% CI = 0.31–5.64, p-trend = 0.633).
Nutrients 2025,17, 2687 12 of 27
Gliomas
Gliomas are the most common type of malignant brain tumors found in adults [
70
].
Two research groups investigated associations between the MIND diet and the risk of
glioma [
33
,
44
]. Both were case–control studies. One was conducted in Tehran, Iran [
44
]
and the other in Beijing, China [
33
]. In Tehran, Soltani, Shayanfar [
44
] found that after
controlling for age, energy intake, and gender, those with an MDS in the highest tertile had
a 47% reduction in likelihood of having a glioma than those in the lowest tertile (
OR = 0.53
,
95% CI= 0.30–0.94). In their study of 1012 participants in Beijing, Zhang, He [
33
] found
that four of the five diets tested reduced the risk of glioma, including the MIND diet
(OR = 0.25; 95% CI= 0.14–0.44). The MIND diet also demonstrated a linear dose–response
relationship between increasing adherence and reduction in risk of glioma. Furthermore,
they discovered that certain diets, including the MIND diet, lowered the risk of various
subtypes of glioma.
3.3.3. Diabetes and Metabolism
Using different approaches and computational measures, two different research groups
found strong associations between high MDS and lowered odds of having either a metabol-
ically unhealthy phenotype [45] or type 2 diabetes [46].
Tirani, Poursalehi [
45
] examined the relationship between the MIND diet and
metabolic health status (hypertension, hypertriglyceridemia, hyperglycemia/insulin re-
sistance, and chronic inflammation) relative to serum concentrations of brain-derived
neurotrophic factor (BDNF) (a neurotrophic factor that may also play a role in systemic
energy metabolism [
71
]). This cross-sectional study with 527 adults (286 males, 241 females)
aged 20–65 conducted in Isfahan, Iran, utilized a validated 168-item FFQ to collect partici-
pants’ dietary intake and to estimate their MDS (0–14, wine not included). Participants also
were assessed for blood pressure, anthropometric measures (weight, height, BMI, waist
circumference, body composition) and biochemical parameters. Tirani, Poursalehi [
45
]
created a metabolically unhealthy phenotype based on hypertension, hypertriglyceridemia,
hyperglycemia/insulin resistance, and chronic inflammation. Logistic regression evaluated
the relationship between the MDS and the metabolically unhealthy phenotype. Tirani
et al. [
45
] reported 58% lower risk of a metabolically unhealthy phenotype in participants
with the highest MDS in their adjusted model (OR = 0.42, 95% CI = 0.20–0.90). This inverse
relationship conferred even less risk for females and normal weight participants (OR = 0.19,
95% CI= 0.04–0.83), while for males there was no significant relationship between MDS
and the metabolically unhealthy phenotype in the crude or adjusted models. Additionally,
Tirani et al. found significant inverse associations between high MDS and hypertension
(OR = 0.43, 95% CI = 0.19–0.94) and hypertriglyceridemia (OR = 0.21, 95% CI = 0.21–1.00).
No significant association was observed between high MDS and serum concentrations
of BDNF.
Tison, Shikany [
46
] compared dietary patterns (Mediterranean diet score, DASH diet
score, MIND diet score, dietary inflammation score [DIS], and dietary inflammatory index
[DII]) and risk of diabetes in a cohort of Black and White adults in the US using data
from the REasons for Geographic and Racial Differences in Stroke (REGARDS) prospective
cohort study. Demographic characteristics, cardiovascular risk profiles, blood pressure,
fasting blood glucose, urine samples, electrocardiogram, and medication inventory of
30,239 Black and White adults, aged 45 years and older, were collected at baseline (from
2003 to 2007), and from 14,448 Black and White adults at a second in-home visit (from 2013
to 2016). Only data from participants with information about diabetes status at the second
in-home visit were used (cross-sectional study design). Dietary assessment was conducted
using the 107-item Block98 FFQ. Participants’ mean age was 63.2
±
8.5 years, 56.2% were
Nutrients 2025,17, 2687 13 of 27
female, and 27.1% were Black. Most participants with diabetes were Black, male, had
lower levels of income, had fewer years of education, were smokers, and had elevated
waist circumference. Modified Poisson regression assessed the association between dietary
measures (MDS) and risk of incident type 2 diabetes, with models adjusted for total energy
intake, demographics, lifestyle factors, and waist circumference. Tison et al. [
46
] reported a
statistically significant association between the MDS and incident type 2 diabetes (
RR = 1.33
,
95% CI = 1.07, 1.65; p= 0.02). A low MDS was strongly associated with incident diabetes.
Based on their findings, the authors suggest that the MIND diet may be more effective
in reducing the risk of incident type 2 diabetes compared with the Mediterranean and
DASH diets.
3.3.4. Dietary Exposures
Through foods ingested, humans are exposed to advantageous or deleterious environ-
mental substances, based upon where and how a crop is grown (e.g., soil, water, fertilizer,
insecticides). Three studies were conducted in Italy regarding uptake of sulfur [
47
], sele-
nium [48], and cadmium [37] relative to MIND diet adherence.
Sulfur
Sulfur is an essential mineral required by humans daily. Passafiume, Rossetti [
47
]
measured sulfur content in food samples and assessed its habitual intake in relation to
adherence to the MIND diet among 719 adults in Northern Italy. Adherence to the MIND
diet had a positive association with sulfur intake. This study provided an overview of sulfur
content in foods composing the Italian diet (e.g., broccoli, kale), which are a significant
component of the MIND diet.
Selenium
Selenium is a trace element found in many chemical forms and has nutritional and
toxicological properties, some of which may play a role in the etiology of neurological
disease. Urbano, Filippini [
48
] investigated the extent to which adherence to the MIND diet
in a healthy non-smoking samples (n= 137) may be associated with selenium exposure,
as ascertained by dietary, urine, and serum measures. Their results suggest that a greater
adherence to the MIND diet is positively associated with lower circulating concentrations
of selenium and of two potentially neurotoxic species of selenium, selenoprotein P and
selenate. Researchers noted this may explain why adherence to the MIND dietary pattern
may reduce cognitive decline.
Cadmium
Cadmium is a toxic heavy metal with detrimental effects on human health. In the
U.S., the Food & Drug Administration regulates levels of cadmium in foods, especially
those consumed by young children such as breads and cereals [
72
]. The main exposures to
cadmium include diet (e.g., cereals, vegetables, and other plant-based foods), smoking, and
occupational factors. Cadmium is present in the soil in greater quantities when phosphate
fertilizers are applied, and in areas of heavy industry such as mining and smelting [
72
]. The
relationship between adherence to the MIND diet and cadmium exposure was assessed
for the first time and evaluated through urinary levels in an Italian cohort study of non-
smoking, healthy blood donors [
37
]. Urbano [
37
] reported that higher adherence to the
MIND diet was associated with higher cadmium exposure.
3.3.5. Frailty
Frailty is a recognized clinical condition, defined by meeting three out of five measures
of low function in the following criteria: energy, grip strength, walking speed, unintentional
Nutrients 2025,17, 2687 14 of 27
physical activity, and/or unintended weight loss [
73
]. Two studies assessed the MIND diet
for associations with frailty [
24
,
32
]. Yao, Jia [
32
] analyzed data from the UK Biobank (UKB)
for participants (mean age of 57.7 years) who had undergone two or more 24 h dietary
assessments and had frailty data (n= 124,261) as measured by the frailty phenotype and
the frailty index (FI_Frailty by Mitnitski, Mogilner [
74
]). The middle and upper tertiles of
MDS (and those of the other healthy diets they assessed) had significantly fewer cases of
frailty. For example, in their fully adjusted model, the highest tertile of MDS conferred
31% less risk of frailty compared with the lowest tertile, for frailty phenotype (OR = 0.47,
CI = 0.63–0.76, p< 0.001) and 26% lowered odds of frailty on the frailty index (
OR = 0.74
,
CI = 0.70–0.78), p< 0.001). This study also sought to determine whether metabolites
mediate the association between diet and frailty. Participants who were missing data for
plasma metabolites or creatinine were excluded from the mediation analysis (n= 97,991),
leaving 26,270 participants whose metabolomic data were analyzed. Yao, Jia [
32
] found that
metabolic signatures for each diet partially mediated the associations of dietary patterns
with frailty. In a previous study, Tanaka, Talegawkar [
24
] analyzed data from a subset of
participants (n= 806) aged
≥
65 years, from the Baltimore Longitudinal Study of Aging
(BLSA) cohort, which has been enrolling adults living in the community of the Washington,
DC-Baltimore area in the U.S. Frailty was measured by 44 variables selected from the
Frailty Index (described by Searle, Mitnitski [
75
]). Tanaka, Talegawkar [
24
] found that
for the healthy dietary indices tested, MIND, Alternative Healthy Eating Index [AHEI],
Mediterranean diet score, all were inversely associated with the Frailty Index (for MIND,
β
=
−
0.006
±
0.002, p= 0.005). They also found that metabolic signatures for MIND and
AHEI mediated the association between their respective dietary patterns and Frailty Index.
3.3.6. Functional Ability
Four different research groups found positive correlations between adherence to the
MIND diet and functional ability. In a study that followed participants for an average of
5.3 years, Agarwal, Wang [
49
] reported that participants in the second and third tertiles
of MDS had a lower risk of developing disability affecting activities of daily living (ADL)
compared with participants in the lowest tertile. They also discovered that the MIND
diet was inversely associated with disability in instrumental ADLs (as measured by the
Duke Instrumental ADL for independence with higher order tasks such as medication
management) and mobility (as assessed by the Rosow-Breslau mobility index, which
assesses the need for help with tasks such as walking up and down stairs and performing
heavy housework). A cross-sectional study performed by Pasdar, Moradi [
50
] found that a
higher MDS was associated with increased grip strength, and Talegawkar, Jin [
51
], another
study that assessed data from a longitudinal aging study found similar results. Talegawkar,
Jin [
51
] also reported that MDS was inversely associated with physical function impairment,
and that participants in the highest tertile of the MDS had a 57% lower chance of functional
impairment compared with the lowest tertile. In a cross-sectional study conducted in Hong
Kong, Yeung, Sin [
52
] found that a higher MDS was associated with greater psychological
function among participants.
3.3.7. Mental Health
Ten different studies addressed aspects of mental health including anxiety [
54
–
57
],
depression [
29
,
31
,
54
–
57
], impulsivity [
22
], mood [
59
], psychological stress [
54
,
57
], soma-
tization [
60
], and stress [
55
,
56
]. Overall, the findings were equivocal, with some finding
favorable associations between high MDS and the odds of a particular mental health out-
come and others finding no association. Nine of the studies were conducted among Iranian
cohorts, one in the U.S.; most were cross-sectional. Two studies focused on depression longi-
Nutrients 2025,17, 2687 15 of 27
tudinally [
29
,
31
]. Single studies were conducted regarding impulsivity [
22
] and mood [
59
],
and neither found a statistically significant association with the MIND diet. A single
study of somatization [
60
] conducted among 2818 adults in Isfahan, Iran, demonstrated a
favorable association between high MDS and a reduced risk of psychosomatic and some
somatic complaints.
Anxiety
Two research groups found significantly favorable associations, while three did not
find a significant association between high MDS and lowered odds of anxiety. All five stud-
ies were conducted in Iran among different study populations. Torabynasab, Shahinfar [
58
]
conducted a case–control study with 85 cases and 170 controls to explore associations
between MDS with odds and severity of anxiety disorders. Higher MDS had an inverse
association with severity of anxiety as measured by the Generalized Anxiety Disorder-7
(GAD-7) questionnaire (
β
=
−
3.63, p< 0.001) and a 97% reduction in odds of anxiety for
those in the top category of MDS (OR = 0.03, 95% CI = 0.01–0.09, p< 0.001). Barkhordari,
Namayandeh [
54
] conducted a cross-sectional study (n= 7165 participants) demonstrat-
ing a significantly lower odds of symptoms of anxiety [as measured by the Depression
Anxiety Stress Scale-21 (DASS-21)] for individuals with the highest MDS (OR = 0.61,
95% CI = 0.41–0.91, p-trend = 0.01). Studying male health professionals (n= 400), Rostami,
Parastouei [
55
] found no significant associations between MDS and odds of symptoms of
anxiety, depression, or stress, as measured by the DASS-21. In a cross-sectional study of
282 women without underlying diseases or malignancies in Tehran, Iran, Seifollahi, Sar-
dari [
56
] found no significant associations with symptoms of anxiety, depression [although
depression was close to significant in the adjusted model (p= 0.068)], or stress, while they
did find a significantly inverse association between highest MDS and psychological stress
(OR = 0.87, 95% CI = 0.7–1.09, p= 0.23). Salari-Moghaddam, Keshteli [
57
] conducted a
cross-sectional study with 3176 adults and used the Iranian version of the Hospital Anxiety
and Depression Scale (HADS) to assess the severity of anxiety and depression. In their
adjusted model, the highest MDS quartile was associated with a reduced odds of symptoms
of depression (OR = 068, 95% CI = 0.53–0.89) and psychological distress (OR = 0.68, 95%
CI = 0.52–0.89) compared with the lowest MDS quartile; however, they did not find a
significant association between MIND diet and level of anxiety.
Depression
Results for high MDS and reduced odds of depression were equivocal, with half of the
studies demonstrating a significant reduction in symptoms of depression [
29
,
54
,
57
] and
half finding no association [
31
,
55
,
56
]. Working with 7165 participants in the Yazd Health
and Yazd Nutrition study cohorts, Barkhordari, Namayandeh [
54
] found that the highest
quartile of MDS was associated with significantly lower odds of depressive symptoms
in the adjusted model (OR = 0.62, 95% CI = 0.40–0.96; p-trend = 0.02). In a longitudinal
study of 709 participants over 6.53 years within the Rush Memory and Aging Project
(MAP) in the U.S., Cherian, Wang [
29
] observed that the highest tertiles of MDS had lower
rates of symptoms of depression compared with those in the lowest tertiles (
β
=
−
0.12,
CI:
−
0.23,
−
0.0092). Seifollahi, Sardari [
56
] noted a trend demonstrating that the MIND
diet is inversely associated with odds of depression (p-trend = 0.068). By contrast, Fresan,
Bes-Rastrollo [
31
] found no association between high MDS and lower risk of depression in
a study of 15,980 adults who were free from depression at baseline and were followed over
a median of 10.4 years. Their participants were part of the Seguimiento Universidad de
Navarra (SUN) project. Rostami, Parastouei [
55
] also found no association between MIND
diet and symptoms of depression.
Nutrients 2025,17, 2687 16 of 27
Stress
Five studies addressed stress or psychological stress. One [
57
] study found that
higher MDS was associated with reduced risk of psychological stress, while four found no
association. Salari-Moghaddam, Keshteli [
57
] studied 3176 Iranian adults who worked in
50 health care centers, excluding those with insufficient or overly abundant caloric intakes
(below 800 or above 4200 kcal/d). They found that those in the highest quartile of MDS
had lower psychological distress (OR = 0.68; 95% CI: 0.52–0.89) than those in the lowest
quartile. However, Barkhordari, Namayandeh [
54
] did not observe a significant association
in their study sample, which enrolled overweight and obese women, nor did Seifollahi,
Sardari [
56
] who studied overweight and obese women (n= 282). Rostami, Parastouei [
55
]
also found no statistically significant association in a cohort of male health professionals
(n= 400).
3.3.8. Multiple Sclerosis
Multiple sclerosis (MS) is an autoimmune central nervous system disease with varying
symptoms, such as weakness, numbness, visual disturbance, dizziness, bladder dysfunc-
tion, fatigue, and/or bowel dysfunction. Some patients accrue disability over time and
may be wheelchair dependent. Thus, this disabling disease may cause a significant impact
on their quality of life and the patient’s ability to perform self-care.
Two research groups [
27
,
35
] examined the effect of the MIND diet on clinical measures
of MS. Katz Sand, Fitzgerald [
27
] studied the Reserve and Disability in Early Multiple Scle-
rosis (RADIEMS) cohort, a longitudinal study of risk and protective factors for disability in
early MS (<5.0 years). The RADIEMS cohort is based in the U.S. and includes 185 patients,
either with relapsing remitting or clinically isolated syndrome, reflecting a typical epidemi-
ology of MS. The sample was primarily female (66.6%) and White (72.2%). The average
disease course was 2.2 years, with 21.7% receiving high efficacy disease modifying therapy,
and low disability (Expanded Disability Status Scale 1.0). Key MRI variables of the sample
population included thalamic volume 21.1 mL (1.7), lesion volume 0.4 mL (1.4), normal
appearing white matter 0.0 (0.9) and gray matter volume 804.6 mL (47.8). The MRI of the
brain may be used as a diagnostic tool or a measure of the progression of MS. Katz Sand,
Fitzgerald examined multiple MRI outcomes. Only participants with high MDS (10–11)
experienced a statistically significant correlation with higher thalamic volumes (r = 0.22;
95% CI: 0.07–0.35; p= 0.004) even when adjusted for covariates such as disease duration
and high-efficacy disease modifying therapy [
27
]. It should be noted that higher adherence
to the MIND diet was an extremely high score of (10–11) compared with other articles that
classified a high compliance with the MIND diet as a score ≥8.
Noormohammadi, Ghorbani [
35
] also examined the relationship between the MIND
diet and patients with early MS. The authors performed a hospital-based, case–control
study in Tehran, Iran, over three years. Newly diagnosed patients with relapsing remitting
MS (n= 80) were compared with 148 healthy individuals. Most patients were included
in the study within the first month of diagnosis of MS and the most common disease
modifying therapy was rituximab. To be included, patients must have been diagnosed with
MS within the last year, 18–50 years of age, and have an Expanded Disability Status Scale
(EDSS) score < 5. Patients were excluded if they experienced a MS relapse within the prior
month or lived with another chronic disease (such as chronic kidney disease) that required
a specific diet. The study divided adherence to the MIND diet into tertiles: low, medium,
or high adherence (actual total score per tertile was not provided). Noormohammadi
et al. found that participants with high MDS experienced a 95% reduction in the risk of
developing MS compared with participants with low MDS (OR = 0.05, 95% CI = 0.01–0.36,
pfor trend < 0.0001) [35].
Nutrients 2025,17, 2687 17 of 27
Both research groups [
27
,
35
] examined the effects of certain foods, such as the propor-
tion of green leafy vegetables or high fat meats, on MS brain metrics and risk of developing
MS. The categories of food were vast and difficult to find common ground for compar-
ison. In conclusion, Katz Sand, Fitzgerald [
27
] found some benefits of the MIND diet
associated with only one brain metric, thalamic volume. Noormohammadi, Ghorbani [
35
]
found the MIND diet to have a significantly favorable association with the reduced risk of
developing MS.
3.3.9. Parkinson’s Disease
Parkinson’s disease (PD) is the second most common neurodegenerative disorder,
and several researchers have explored the impact of the MIND diet on the incidence,
progression, and symptoms of PD [
62
–
66
]. To date, the findings are equivocal. While earlier
studies indicated that greater adherence to the MIND diet was associated with a reduction
in the incidence and progression of PD [
62
], more recent studies have reported no significant
association between risk and severity of MIND diet scores and PD [
65
]. Greater adherence
to the MIND diet was associated with later onset of PD (17.4 years; p< 0.001) among
women [
63
]. Women reported the highest levels of adherence to the MIND diet. Among
men, only adherence to the Greek Mediterranean diet was associated with later onset of
PD (8.4 years; p= 0.002). Parkinson’s disease is characterized by both motor and nonmotor
symptoms. Motor symptoms include tremor, bradykinesia, rigidity, and postural instability.
Nonmotor symptoms associated with PD include fatigue, depression, anxiety, apathy, sleep
problems, daytime sleepiness, and cognitive impairment. Greater adherence to the MIND
diet was associated with decreased total symptom (R
2
= 0.2207,
p< 0.001
), motor symptom
(R
2
= 0.2344,
p< 0.001
), and nonmotor symptom scores
(R2= 0.1849
,
p< 0.001
) as measured
by the Patient-Reported Outcomes in Parkinson’s disease Scale [
64
]. However, the evidence
to support the positive impact of adherence to the MIND diet on nonmotor symptoms
of PD is equivocal given that other studies have found no correlation between MIND
diet scores and severity of these symptoms [
66
]. Most of these studies [
63
–
66
] relied on
cross-sectional designs and FFQs. In addition to the limitations inherent in cross-sectional
research, FFQs underrepresent the berry food group essential to the MIND diet and have
limitations related to recall bias.
3.4. Health Outcomes from Single Studies
At the time of this review (early April 2024), each of the health outcomes described
below were represented by one article or research group.
3.4.1. Auditory Function
An eight-year longitudinal study of possible associations between diet (as measured by
four dietary indices including MIND) and hearing status was conducted by Jin, Tanaka [
41
]
using data from the BLSA. Oxidative stress can promote hearing loss, and diets higher
in antioxidants have been linked to preservation of better hearing [
76
]. The MIND diet
recommends foods that optimize antioxidants, so a significant association was anticipated
between MDS and hearing. Surprisingly, while Jin et al. found that MDS was linearly
correlated with better hearing function, the correlation was weak (p< 0.1). While the MIND
and Mediterranean diets promote the use of olive oil and fish, the indices do not identify
and evaluate the fatty acids as explicitly as the AHEI and the Healthy Eating Index (HEI):
healthier diets as measured by both AHEI and HEI were significantly correlated with lower
risk of hearing loss.
Nutrients 2025,17, 2687 18 of 27
3.4.2. Glaucoma (Open-Angle)
Glaucoma is a neurodegenerative eye disease resulting in blindness. Plant-based diets
have been associated with a lower risk of glaucoma most likely due to higher antioxidant
and flavonoid content [
28
]. Vergroesen, de Crom [
28
] tested the MIND diet, the Mediter-
ranean diet, and the Dutch dietary guidelines for potential associations with incidence of
open angle glaucoma (iOAG) in the Rotterdam Study in the Netherlands. Using a nested
case–control design (n= 170 cases and n= 850 controls), they began enrollment in 1991 and
followed up approximately every five years. After 10 years of follow up, participants in
the highest quartile of adherence to the MIND Diet (mean adherence in Q1 = 58.8%) had
significantly lower risk of iOAG (OR = 0.54; 95% CI = 0.30–0.95) compared with those in
the lowest quartile (mean adherence in Q4 = 32.2%). There was not a significant association
between the Mediterranean and Dutch dietary guidelines and reduced iOAG.
3.4.3. Irritable Bowel Syndrome
Nouri-Majd, Salari-Moghaddam [
53
] conducted a cross-sectional study with adults in
Iran using data from the Study on the Epidemiology of Psychological, Alimentary Health
and Nutrition (SEPAHAN) (n= 748) and found no association between the highest levels
of adherence to the MIND diet and symptoms of irritable bowel syndrome (IBS). The
researchers suspected that participants with IBS (22.2% of the study population) may have
avoided some of the foods in the MIND diet, because these foods are high in fermentable
oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). FODMAPs
can increase symptoms of IBS, and it is common in clinical practice to recommend a
low FODMAP diet to people with IBS. Nouri-Majd, Salari-Moghaddam recommend a
prospective study to further explore potential associations between the MIND diet and IBS.
3.4.4. Migraine Headaches
Migraine headaches cause significant pain and disability. Askarpour, Yarizadeh [
34
]
studied 266 women from neurology clinics in Tehran, Iran, who suffer from migraines and
had a BMI between 18.5 and 30. Using a cross-sectional study design and validated inven-
tories for food intake and migraine symptom, they identified that the odds of having severe
headaches were reduced by 36% among those with the highest quartile MDS
(OR = 0.64
,
95% CI = 0.45–0.91; p= 0.01) compared with the lowest quartile. Higher adherence to the
MIND diet was also significantly associated with a reduction in the frequency and duration
of headaches using linear regression analysis in both crude and adjusted models [
34
]. While
higher adherence to the MIND diet was associated with decreased frequency, duration,
and severity of migraine headaches, it was not found to have a significant relationship
with disability.
3.4.5. Non-Alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) is characterized by excessive accumulation
of fat in the liver, often driven by an unhealthy high-calorie diet. In a study of severe NAFLD
with patients who were hospitalized or died from NAFLD, diet was measured using five
different dietary indices including MDS [
61
]. As MIND dietary adherence improved,
the risk of severe NAFLD significantly decreased using Cox proportional hazard models
(p< 0.05) [
61
]. In the first adjusted model, adherence to the MIND diet was significantly
associated with lower risk of severe NAFLD in the highest quartile MDS (HR = 0.67, 95%
CI = 0.57–0.78, p< 0.001). Neither the Mediterranean nor the MIND diets demonstrated
statistically significant associations in the third model, which was further adjusted for
metabolic phenotypes, while the Mediterranean Diet Adherence Screener, the Recom-
mended Food Score, and the Healthy Diet Indicator demonstrated significant associations.
Nutrients 2025,17, 2687 19 of 27
3.4.6. Quality of Life (Health-Related)
A longitudinal study over 12 years was conducted [
23
] to identify changes in dietary
quality over time as measured by three indices including the MIND diet, the Dietary
Inflammatory Index (DII), and the Dietary Guideline Index for Australian Dietary Guide-
lines (DGI). Analyzing data from the Australian Diabetes, Obesity and Lifestyle study
(AusDiab), researchers tested associations between healthier diets and improvement in
health-related quality of life (HR-QoL) as defined by the World Health Organization [
77
].
Ng et al. [
23
] identified 2844 participants with complete data for baseline, year five and year
12. For all participants, higher MDS was correlated with improved global QoL (
β= 0.28
,
95% CI = 0.007–0.55). The association between MIND diet and improved HR-QoL was
more pronounced among women, who saw improvements in global QoL (
β
= 0.62, 95%
CI = 0.38–0.85), the mental component summary (
β
= 0.75, 95% CI = 0.29–1.22) and the
physical component summary (
β
= 0.75, 95% CI = 0.29–1.22) [
23
]. This study demonstrated
that increasing adherence to the MIND diet was associated with improved global quality of
life. The authors advise that public policies encouraging Australians to implement healthy
diets would promote better HR-QoL.
3.4.7. Rheumatoid Arthritis
In a cross-sectional, observational study conducted by Safaei, Kheirouri [
67
] with
202 total participants (155 women and 47 men), there were 101 participants (mean age
44.79 ±9.05 years
) with rheumatoid arthritis (RA) and 101 healthy subjects (mean age
40.93
±
7.85). While there was no association between MDS and oxidative stress factors
(
p> 0.05
), participants with higher MDS had significantly lower odds of RA than those
with lower scores
(p< 0.001)
. Additionally, disease activity was lower among those with
higher MDS (p< 0.05). The findings indicate that following the MIND diet may decrease
disease activity and the odds of RA. For patients with RA, a higher adherence to the MIND
diet may improve metabolic factors such as lipid profiles and blood glucose levels [67].
3.4.8. Sleep
In a cross-sectional study of health professionals [
55
], greater adherence to the MIND
diet was associated with lower odds of poor sleep (OR = 0.58, 95% CI = 0.34–0.98, p= 0.042),
daytime sleepiness (OR = 0.58, 95% CI = 0.34–0.98, p= 0.044), and insomnia (OR = 0.54,
95% CI = 0.31–0.93, p= 0.031), after adjusting for age, BMI, energy intake, smoking status,
level of physical activity, marital status, and level of education. However, in addition to
the limitations inherent in the cross-sectional design, the study only included male health
professionals, limiting generalizability.
3.4.9. Telomere Length
Chan, Leung [
68
] examined the association of various dietary patterns (Diet Quality
Index-International, DASH, MIND diet, Mediterranean diet, Okinawan diet, and Hong
Kong diet) with telomere length among Chinese older adults, whose dietary habits and
practices differ from those of White populations. They conducted a cross-sectional observa-
tional study using multivariate linear regression with available data from 1981 (965 males,
1016 females) of community-dwelling Chinese adults aged 66 years and older living in
Hong Kong. Data from an interviewer-administered questionnaire estimated dietary in-
take and generated dietary patterns. Demographic information, lifestyle factors, and
self-reported medical history were also collected. Quantitative real-time PCR was used to
measure telomere length. Chan, Leung [
68
] used a maximum score of 9 instead of 15 for the
MIND diet score because they had insufficient information on olive oil as the primary oil
source and consumption of fish, beans, poultry, red meat, and fast/fried foods. Participants
Nutrients 2025,17, 2687 20 of 27
were primarily female (51.3%), never smokers (65%), never used alcohol (85.3%), had a
mean age of 72.4 years, a mean body mass index of 23.6 kg/m
2
, and had primary-school
level of education or below (71.8%). The MDS was not associated with telomere length.
Chan, Leung [
68
] speculated that no association between the MIND diet (and the other
dietary patterns) and telomere length was observed because the dietary pattern assessment
included diluted nutrients or food groups unrelated to telomere length. They suggested
that previous studies reported stronger associations between individual nutrients (or food
groups) and telomere length, compared with studies examining the association between
dietary patterns and telomere length, because the studies on dietary patterns included
participants with a broader age range (20–80 years).
4. Discussion
In this scoping review, we mapped the extent to which the MIND dietary pattern has
been studied relative to health outcomes beyond its original purpose (delaying dementia)
and excluding cardiovascular outcomes, which have already been the subject of systematic
reviews. The 47 articles included in this review explored 18 different health topics and
tested at least 81 different possible associations between high adherence to the MIND
dietary pattern and health outcomes (e.g., sleep quality). Sixty-five percent of the tested
associations demonstrated a favorable association, representing an improvement in some
measure of human health for people who ate at higher levels of adherence to the MIND
diet, compared with those people whose MDS were in the lowest tertile, quartile, or other
categorical bin.
4.1. Associations with the MIND Dietary Pattern
Mostly favorable associations were identified for high adherence to the MIND diet and
the following health outcomes: all-cause mortality, BCA, diabetes and metabolic disorders,
frailty, functional ability, and PD. The findings from studies included in this review of
the MIND dietary pattern are similar to outcomes associated with the Mediterranean diet.
This is not surprising, given that the MIND diet is based on the Mediterranean and DASH
diets. Systematic reviews of the Mediterranean diet also have demonstrated beneficial
outcomes (e.g., reduced incidence or better clinical outcomes) associated with all-cause
mortality [
78
,
79
], BCA (especially post-menopausal risk reduction) [
80
], type 2 diabetes [
81
],
frailty [82], physical performance [83], and PD [84].
In this review, where evidence was limited to only one study on a topic, benefits
were associated with the MIND diet for the following conditions: glaucoma, migraine
headaches, severe NAFLD, HR-QoL, RA, and sleep. Similarly, beneficial associations also
have been found between the Mediterranean diet and NAFLD [
85
], HR-QoL in adults [
86
]
and in children and adolescents [
87
,
88
], RA [
89
], and sleep [
90
]. The DASH diet also has
been found to have beneficial associations with reduction in frequency and severity of
migraine headaches [
91
]. In this review, most of the studies addressing mental health were
conducted in Iranian populations, and findings were equivocal for anxiety and depression,
whereas there was more evidence for no association between the MIND diet and stress.
We recommend that additional studies be conducted in different populations to ascertain
whether there is a relationship between the MIND diet and symptoms of anxiety and
depression. Previous systematic reviews have identified inverse associations between the
Mediterranean diet and incidence and symptoms of anxiety and depression [92].
4.2. What Is a High MDS?
Although a meta-analysis was not conducted, it was noted that across the included
studies, the average MDS for the highest category of adherence to MIND diet was often
Nutrients 2025,17, 2687 21 of 27
modest (e.g., mean of 8.6) when compared with the highest possible score (maximum of 9
to 15) in 46 out of 47 studies that used the original scoring system by Morris, Tangney [
2
].
This means that people adhering to the MIND dietary pattern approximately 60% of the
time, are likely protecting their health more than those who are eating by the MIND dietary
pattern less than 50% of the time. It appears that one need not perfectly adhere to the
MIND dietary pattern to benefit. By contrast, other associations were only detected at high
levels of MDS, such as a mean MDS of 10.68 (
±
0.81) [
27
]. The inability to quantify the use
of olive oil in some studies may have contributed to lower MDSs and makes comparisons
between study outcomes more difficult to achieve. Wine was commonly omitted, and its
benefits and risks are debatable [
93
]. Some studies also identified the unfavorable outcomes
associated with the lowest levels of adherence to the MIND dietary pattern; these included
diets higher in unhealthy foods (e.g., saturated fats, red meat, and sweets). Finally, several
of the studies were conducted in countries (e.g., Iran and China) with common dietary
patterns that differ from the MIND diet, such as consumption of wine and the use of olive
oil, which affect scoring. In future reviews of the MIND diet, we recommend that data
extraction includes noting the average and range of MDS for the bins (e.g., highest tertile or
quartile) demonstrating a statistically significant effect (akin to a minimal score necessary
to achieve positive results).
4.3. Environmental Exposure
In this scoping review, one study identified a deleterious or unfavorable association
with the MIND diet: higher cadmium levels in the urine of people with higher adherence
to the MIND dietary pattern in an Italian cohort [
37
]. People are exposed to cadmium
primarily through food and cigarette smoke [
72
,
94
]. Cadmium occurs naturally, but it
is also dispersed by burning fossil fuels, volcanoes, and forest fires [
94
]. Plants absorb
cadmium from the soil and water where they are grown. It would be interesting to know
whether environmental exposures of the food supply to cadmium, are relatively higher in
that region of Italy where the study was conducted [
37
]. Many countries monitor foods that
may contain cadmium in elevated levels and are consumed by children, such as breakfast
cereals, breads, vegetables, and potatoes [
72
,
94
,
95
]. Public health measures should seek
ways to reduce exposure to cadmium and other undesirable environmental contaminants
(e.g., lead) in healthy foods that are considered beneficial to human health.
4.4. MIND Dietary Interventions
Notably missing from the studies included in this scoping review were prospective
cohort trials in which the MIND dietary pattern was taught as an intervention. While such
studies have been performed to test for effects on cognitive outcomes (i.e., Liu, Morris [
96
]),
the MIND diet has not yet been taught as an educational dietary intervention in the
patient populations included in this scoping review. Given the favorable health outcomes
associated with the MIND dietary pattern, this is a reasonable next step in scientific and
clinical practice, the aim being to learn how to teach and implement the MIND dietary
pattern to individuals as well as incorporate healthy eating recommendations into public
policy. The MIND dietary pattern guides what and how much to eat from various food
groups across the course of a week (e.g.,
≥
6 servings of leafy greens per week). This
simplified guidance may lend itself well to public and clinical translation.
4.5. Suggestions for Future Research
We recommend that additional studies in large cohort trials be conducted on the asso-
ciations identified in this review, particularly with different populations and geographical
regions. The MIND diet is a hybrid of two well respected diets, the Mediterranean and
DASH diets, and is optimized to increase intake of antioxidants to prevent neurodegen-
Nutrients 2025,17, 2687 22 of 27
eration and inflammation. There were no prospective cohort trials identified in which
the MIND diet was taught as an intervention. In populations that could benefit from
healthy dietary intervention, we recommend interventional and translational studies for
the purposes of disease prevention and health maintenance. This review included many
case–control studies, for which odds ratios (ORs) are often calculated, while studies of
different designs measured relative risk or risk ratios (RRs). Odds ratios usually report
larger values compared to risk ratios (RRs) [
97
]. For example, in this review, the average
RR was around 25% while the average OR was 50%. Given the type of analysis and the
study design, it may be that case–control studies overestimate the impact of the MIND
diet. Thus, more prospective studies are needed to confirm the impact of the MIND dietary
pattern on the health outcomes included in this review.
4.6. Limitations of the Review
This study has some limitations. As with other reviews, we concluded our search
of the literature to conduct the review, such that articles published since April 2024 were
not included. Most of the studies included relied upon FFQs to calculate MDS. While
some of the various FFQs used were culturally appropriate to specific populations, FFQs
have fallen under strong criticism for their potential inaccuracies and biases, namely recall,
social desirability, response, and misclassification biases that can significantly impact the
conclusions drawn [
98
]. The decision was made not to replicate what had already been
addressed by previous systematic reviews, so articles addressing cognition, dementia, and
cardiovascular health were omitted, unless these studies addressed other health outcomes
such as all-cause mortality. It is possible that we missed several important studies by
excluding these topics. At the time of writing, we learned that a cardiovascular review
had been retracted by the publisher due to errors in methods and analyses. From this
experience, we learned that when only one systematic review has been published on a
topic, there could be a benefit to duplicating the work, even though a scoping review is
considered less rigorous. Finally, we followed the methodology of a scoping review as
defined by PRISMA-ScR [
20
], which means that no quality analyses or meta-analyses were
conducted. At the time of this project, there were insufficient studies published on any
single topic to conduct a systematic review. We anticipate opportunities for additional
systematic reviews of the MIND diet in the future.
4.7. Conclusions
This scoping review identified new lines of inquiry concerning MIND dietary adher-
ence and human health. The findings of the present study provide preliminary evidence
that the MIND diet may be associated with lowering the odds of developing several differ-
ent chronic diseases and/or lessening the symptoms associated with some diseases and
conditions (all-cause mortality, BCA, diabetes and metabolism, functional ability, and PD).
High adherence to the MIND dietary pattern was associated with only one unfavorable out-
come, cadmium exposure, which depended upon environmental conditions and farming
practices where plants were grown. This risk is not unique to the MIND diet. It is essential
worldwide to ensure a safe supply of healthy foods that are beneficial to human health.
Supplementary Materials: The following supporting information can be downloaded at: https:
//www.mdpi.com/article/10.3390/nu17162687/s1, Table S1: Characteristics of included articles.
Author Contributions: Conceptualization, K.H.M.; Methodology, K.H.M., M.D., J.G.A., M.L.L.,
C.S.B. and M.D.; Investigation, K.H.M., M.D., M.L.L., C.S.B., J.G.A., S.L., D.R. and C.H.; Data
Curation, K.H.M.; Writing—Original Draft Preparation, K.H.M., M.L.L., C.S.B., J.G.A., S.L., M.D.
and D.R.; Writing—Reviewing and Editing, K.H.M., M.L.L., C.S.B., J.G.A., S.L., M.D., D.R. and C.H.;
Nutrients 2025,17, 2687 23 of 27
Visualization, K.H.M.; Project Administration, K.H.M.; Funding Acquisition, K.H.M. All authors
have read and agreed to the published version of the manuscript.
Funding: Funding for open access to this research was provided by University of Tennessee’s Open
Publishing Support Fund.
Acknowledgments: The authors would like to thank Niki Cobb and Jeanine Williamson Fletcher
at the University of Tennessee Libraries for their guidance and expertise regarding Covidence and
EndNote, respectively.
Conflicts of Interest: The authors declare no conflicts of interest.
References
1.
Morris, M.C.; Tangney, C.C.; Wang, Y.; Sacks, F.M.; Barnes, L.L.; Bennett, D.A.; Aggarwal, N.T. MIND diet slows cognitive decline
with aging. Alzheimers Dement. 2015,11, 1015–1022. [CrossRef]
2.
Morris, M.C.; Tangney, C.C.; Wang, Y.; Sacks, F.M.; Bennett, D.A.; Aggarwal, N.T. MIND diet associated with reduced incidence
of Alzheimer’s disease. Alzheimers Dement. 2015,11, 1007–1014. [CrossRef] [PubMed]
3.
Chen, X.; Maguire, B.; Brodaty, H.; O’Leary, F. Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. J.
Alzheimers Dis. 2019,67, 583–619. [CrossRef] [PubMed]
4.
Devranis, P.; Vassilopoulou, E.; Tsironis, V.; Sotiriadis, P.M.; Chourdakis, M.; Aivaliotis, M.; Tsolaki, M. Mediterranean Diet,
Ketogenic Diet or MIND Diet for Aging Populations with Cognitive Decline: A Systematic Review. Life 2023,13, 173. [CrossRef]
5.
Kheirouri, S.; Alizadeh, M. MIND diet and cognitive performance in older adults: A systematic review. Crit. Rev. Food Sci. Nutr.
2022,62, 8059–8077. [CrossRef]
6.
van Soest, A.P.; Beers, S.; van de Rest, O.; de Groot, L.C. The Mediterranean-Dietary Approaches to Stop Hypertension Intervention
for Neurodegenerative Delay (MIND) Diet for the Aging Brain: A Systematic Review. Adv. Nutr. 2024,15, 100184. [CrossRef]
7.
Akbar, Z.; Fituri, S.; Ouagueni, A.; Alalwani, J.; Sukik, A.; Al-Jayyousi, G.F.; Bassil, M.; Tayyem, R. Associations of the MIND Diet
with Cardiometabolic Diseases and Their Risk Factors: A Systematic Review. Diabetes Metab. Syndr. Obes. 2023,16, 3353–3371.
[CrossRef]
8.
Gong, Y.; Chen, H.; Gu, Y.; Shen, J.; Shen, T.; Ding, Y.; Lu, M.; Huang, L.; Yan, M.; Song, P.; et al. Healthy dietary patterns
in relation to cognitive performance and Alzheimer’s disease mortality. J. Prev. Alzheimers Dis. 2025,12, 100100. [CrossRef]
[PubMed]
9.
Morris, M.C. Diet for the MIND: The Latest Science on What to Eat to Prevent Alzheimer’s and Cognitive Decline—From the Creator of the
MIND Diet; Little, Brown Spark: New York, NY, USA, 2017.
10.
Ali, S.S.; Ahsan, H.; Zia, M.K.; Siddiqui, T.; Khan, F.H. Understanding oxidants and antioxidants: Classical team with new players.
J. Food Biochem. 2020,44, e13145. [CrossRef]
11.
Pallavi, S.; Bhushan, J.A.; Shanker, D.R.; Mohammad, P. Reactive oxygen species, oxidative damage, and antioxidative defense
mechanism in plants under stressful conditions. J. Bot. 2012,2012, 217037. [CrossRef]
12.
Perler, B.K.; Friedman, E.S.; Wu, G.D. The role of the gut microbiota in the relationship between diet and human health. Annu.
Rev. Physiol. 2023,85, 449–468. [CrossRef]
13.
David, L.A.; Maurice, C.F.; Carmody, R.N.; Gootenberg, D.B.; Button, J.E.; Wolfe, B.E.; Ling, A.V.; Devlin, A.S.; Varma, Y.;
Fischbach, M.A.; et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature 2014,505, 559–563. [CrossRef]
14.
Chen, L.; Cao, H.; Huang, Q.; Xiao, J.; Teng, H. Absorption, metabolism and bioavailability of flavonoids: A review. Crit. Rev.
Food Sci. Nutr. 2022,62, 7730–7742. [CrossRef]
15.
Mastrangelo, A.; Robles-Vera, I.; Mañanes, D.; Galán, M.; Femenía-Muiña, M.; Redondo-Urzainqui, A.; Barrero-Rodríguez, R.;
Papaioannou, E.; Amores-Iniesta, J.; Devesa, A.; et al. Imidazole propionate is a driver and therapeutic target in atherosclerosis.
Nature 2025, Epub ahead of print. [CrossRef]
16.
Hu, F. Diet strategies for promoting healthy aging and longevity: An epidemiological perspective. J. Intern. Med. 2024,295,
508–531. [CrossRef]
17.
Santos, L. The impact of nutrition and lifestyle modification on health. Eur. J. Intern. Med. 2022,97, 18–25. [CrossRef] [PubMed]
18.
Ahn, S.; Lingerfelt, C.; Lee, C.; Lee, J.; Raynor, H.; Anderson, J. Association of adherence to high-intensity physical activity and
the Mediterranean-dietary approaches to stop hypertension intervention for neurodegenerative delay diet with cognition: A
cross-sectional study. Int. J. Nurs. Stud. 2022,131, 104243. [CrossRef]
19.
Salehin, S.; Rasmussen, P.; Mai, S.; Mushtaq, M.; Agarwal, M.; Hasan, S.M.; Salehin, S.; Raja, M.; Gilani, S.; Khalife, W.I. Plant
based diet and its effect on cardiovascular disease. Int. J. Environ. Res. Public Health 2023,20, 3337. [CrossRef] [PubMed]
Nutrients 2025,17, 2687 24 of 27
20.
Tricco, A.C.; Lillie, E.; Zarin, W.; O’Brien, K.K.; Colquhoun, H.; Levac, D.; Moher, D.; Peters, M.D.J.; Horsley, T.; Weeks, L.;
et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann. Intern. Med. 2018,169, 467–473.
[CrossRef] [PubMed]
21.
Appel, L.J.; Moore, T.J.; Obarzanek, E.; Vollmer, W.M.; Svetkey, L.P.; Sacks, F.M.; Bray, G.A.; Vogt, T.M.; Cutler, J.A.; Windhauser,
M.M.; et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N. Engl. J.
Med. 1997,336, 1117–1124. [CrossRef]
22.
Gómez-Martínez, C.; Babio, N.; Júlvez, J.; Nishi, S.; Fernández-Aranda, F.; Martínez-González, M.; Cuenca-Royo, A.; Fernández,
R.; Jiménez-Murcia, S.; Torre, R.d.l.; et al. Impulsivity is longitudinally associated with healthy and unhealthy dietary patterns in
individuals with overweight or obesity and metabolic syndrome within the framework of the PREDIMED-Plus trial. Int. J. Behav.
Nutr. Phys. Act. 2022,19, 101. [CrossRef]
23.
Ng, L.H.; Hart, M.; Dingle, S.E.; Milte, C.M.; Livingstone, K.M.; Shaw, J.E.; Magliano, D.J.; McNaughton, S.A.; Torres, S.J.
Prospective associations between diet quality and health-related quality of life in the Australian Diabetes, Obesity and Lifestyle
(AusDiab) study. Br. J. Nutr. 2023,130, 83–92. [CrossRef]
24.
Tanaka, T.; Talegawkar, S.A.; Jin, Y.; Candia, J.; Tian, Q.; Moaddel, R.; Simonsick, E.M.; Ferrucci, L. Metabolomic profile of different
dietary patterns and their association with frailty index in community-dwelling older men and women. Nutrients 2022,14, 2237.
[CrossRef] [PubMed]
25.
Thomas, A.; Ryan, C.P.; Caspi, A.; Liu, Z.; Moffitt, T.E.; Sugden, K.; Zhou, J.; Belsky, D.W.; Gu, Y. Diet, pace of biological aging,
and risk of dementia in the Framingham Heart Study. Ann. Neurol. 2023,95, 1069–1079. [CrossRef]
26.
Song, Y.; Chang, Z.g.; Song, C.; Cui, K.; Shi, B.; Zhang, R.; Dong, Q.; Dou, K. Association between MIND diet adherence and
mortality: Insights from diabetic and non-diabetic cohorts. Nutr. Diabetes 2023,13, 18. [CrossRef]
27.
Sand, I.K.; Fitzgerald, K.C.; Gu, Y.; Brandstadter, R.; Riley, C.S.; Buyukturkoglu, K.; Leavitt, V.M.; Krieger, S.; Miller, A.; Lublin, F.;
et al. Dietary factors and MRI metrics in early multiple sclerosis. Mult. Scler. Relat. Disord. 2021,53, 103031. [CrossRef]
28.
Vergroesen, J.E.; de Crom, T.O.E.; van Duijn, C.M.; Voortman, T.; Klaver, C.C.W.; Ramdas, W.D. MIND diet lowers risk of
open-angle glaucoma: The Rotterdam Study. Eur. J. Nutr. 2023,62, 477–487. [CrossRef]
29.
Cherian, L.; Wang, Y.; Holland, T.; Agarwal, P.; Aggarwal, N.; Morris, M.C. DASH and Mediterranean-Dash Intervention for
Neurodegenerative Delay (MIND) diets are associated with fewer depressive symptoms over time. J. Gerontol. A Biol. Sci. Med.
Sci. 2021,76, 151–156. [CrossRef] [PubMed]
30.
Corley, J. Adherence to the MIND diet is associated with 12-year all-cause mortality in older adults. Public Health Nutr. 2022,25,
358–367. [CrossRef] [PubMed]
31.
Fresán, U.; Bes-Rastrollo, M.; Segovia-Siapco, G.; Sanchez-Villegas, A.; Lahortiga, F.; de la Rosa, P.A.; Martínez-Gonzalez, M.A.
Does the MIND diet decrease depression risk? A comparison with Mediterranean diet in the SUN cohort. Eur. J. Nutr. 2019,58,
1271–1282. [CrossRef] [PubMed]
32.
Yao, Z.; Jia, X.; Chen, Z.; Zhang, T.; Li, X.; Zhang, L.; Chen, F.; Zhang, J.; Zhang, Z.; Liu, Z.; et al. Dietary pattern, metabolomics
and frailty in a large cohort of 120,000 participants. Food Funct. 2024,15, 3174–3185. [CrossRef]
33.
Zhang, W.; He, Y.; Wang, C.; Chen, F.; Jiang, B.; Li, W. Adherence to healthy dietary patterns and glioma: A matched case-control
study. Nutrients 2023,15, 4886. [CrossRef]
34.
Askarpour, M.; Yarizadeh, H.; Sheikhi, A.; Khorsha, F.; Mirzaei, K. Associations between adherence to MIND diet and severity,
duration and frequency of migraine headaches among migraine patients. BMC Res. Notes 2020,13, 341. [CrossRef]
35.
Noormohammadi, M.; Ghorbani, Z.; Moghadasi, A.N.; Saeedirad, Z.; Shahemi, S.; Ghanaatgar, M.; Rezaeimanesh, N.; Hekmat-
doost, A.; Ghaemi, A.; Jahromi, S.R. MIND diet adherence might be associated with a reduced odds of multiple sclerosis: Results
from a case-control study. Neurol. Ther. 2022,11, 397–412. [CrossRef]
36.
Mokhtari, E.; Jamshidi, S.; Farhadnejad, H.; Teymoori, F.; Rashidkhani, B.; Mirmiran, P.; Tehrani, F.R.; Heidari, Z. The relationship
between Mediterranean-DASH diet intervention for the neurodegenerative delay (MIND) Diet and risk of breast Cancer: A
case-control study among iranian adult women. BMC Nutr. 2022,8, 123. [CrossRef] [PubMed]
37.
Urbano, T.; Verzelloni, P.; Malavolti, M.; Sucato, S.; Polledri, E.; Agnoli, C.; Sieri, S.; Natalini, N.; Marchesi, C.; Fustinoni, S.; et al.
Influence of dietary patterns on urinary excretion of cadmium in an Italian population: A cross-sectional study. J. Trace Elem. Med.
Biol. 2023,80, 127298. [CrossRef] [PubMed]
38.
Song, Y.; Chang, Z.g.; Cui, K.; Song, C.; Cai, Z.; Shi, B.; Dong, Q.; Dou, K. The value of the MIND diet in the primary and
secondary prevention of hypertension: A cross-sectional and longitudinal cohort study from NHANES analysis. Front. Nutr.
2023,10, 1129667. [CrossRef] [PubMed]
39.
Zupo, R.; Sardone, R.; Donghia, R.; Castellana, F.; Lampignano, L.; Bortone, I.; Misciagna, G.; De Pergola, G.; Panza, F.; Lozupone,
M.; et al. Traditional dietary patterns and risk of mortality in a longitudinal cohort of the Salus in Apulia study. Nutrients 2020,
12, 1070. [CrossRef]
Nutrients 2025,17, 2687 25 of 27
40.
Chan, R.S.M.; Yu, B.W.M.; Leung, J.; Lee, J.S.W.; Auyeung, T.W.; Kwok, T.; Woo, J. How dietary patterns are related to
inflammaging and mortality in community-dwelling older Chinese adults in Hong Kong—A prospective analysis. J. Nutr. Health
Aging 2019,23, 181–194. [CrossRef]
41.
Jin, Y.; Tanaka, T.; Reed, N.S.; Tucker, K.L.; Ferrucci, L.; Talegawkar, S.A. Associations between dietary indices and hearing
status among middle-older aged adults—Results from the Baltimore Longitudinal Study of Aging. Am. J. Clin. Nutr. 2024,119,
1338–1345. [CrossRef]
42.
Aghamohammadi, V.; Salari-Moghaddam, A.; Benisi-Kohansal, S.; Taghavi, M.; Azadbakht, L.; Esmaillzadeh, A. Adherence to
the MIND diet and risk of breast cancer: A case-control study. Clin. Breast Cancer 2021,21, E158–E164. [CrossRef]
43.
Sheikhhossein, F.; Imani, H.; Amini, M.R.; Hosseini, F.; Shab-Bidar, S. The association between adherence to MIND diet and risk
of breast cancer: A case-control study. Int. J. Clin. Pract. 2021,75, e14780. [CrossRef]
44.
Soltani, S.; Shayanfar, M.; Benisi-Kohansal, S.; Mohammad-Shirazi, M.; Sharifi, G.; Djazayeri, A.; Esmaillzadeh, A. Adherence to
the MIND diet in relation to glioma: A case-control study. Nutr. Neurosci. 2022,25, 771–778. [CrossRef]
45.
Tirani, S.; Poursalehi, D.; Lotfi, K.; Shahdadian, F.; Hajhashemy, Z.; Rouhani, P.; Saneei, P. Adherence to Mediterranean-Dietary
Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet in relation to serum brain-derived neurotrophic
factor concentrations and metabolic health status in adults. Curr. Dev. Nutr. 2024,8, 102082. [CrossRef]
46.
Tison, S.E.; Shikany, J.M.; Long, D.L.; Carson, A.P.; Cofield, S.S.; Pearson, K.E.; Howard, G.; Judd, S.E. Differences in the association
of select dietary measures with risk of incident type 2 diabetes. Diabetes Care 2022,45, 2602–2610. [CrossRef] [PubMed]
47.
Passafiume, A.; Rossetti, A.; Vescovi, L.; Malavolti, M.; Baraldi, C.; Rovesti, S.; Vinceti, M.; Filippini, T. Sulfur content in foods
consumed in an Italian population and impact of diet quality on sulfur intake. J. Food Compost. Anal. 2023,123, 105543. [CrossRef]
48.
Urbano, T.; Filippini, T.; Malavolti, M.; Fustinoni, S.; Michalke, B.; Wise, L.A.; Vinceti, M. Adherence to the Mediterranean-DASH
Intervention for Neurodegenerative Delay (MIND) diet and exposure to selenium species: A cross-sectional study. Nutr. Res.
2024,122, 44–54. [CrossRef] [PubMed]
49.
Agarwal, P.; Wang, Y.; Buchman, A.S.; Bennett, D.A.; Morris, M.C. Dietary patterns and self-reported incident disability in older
adults. J. Gerontol. B Psychol. Sci. Soc. Sci. 2019,74, 1331–1337. [CrossRef] [PubMed]
50.
Pasdar, Y.; Moradi, S.; Saedi, S.; Moradinazar, M.; Rahmani, N.; Hamzeh, B.; Najafi, F. Mediterranean-DASH Intervention for
Neurodegenerative Delay (MIND) diet in relation to age-associated poor muscle strength; a cross-sectional study from the
Kurdish cohort study. Sci. Rep. 2022,12, 11866. [CrossRef]
51.
Talegawkar, S.; Jin, Y.; Simonsick, E.; Tucker, K.; Ferrucci, L.; Tanaka, T. The Mediterranean-DASH Intervention for Neurodegener-
ative Delay (MIND) diet is associated with physical function and grip strength in older men and women. Am. J. Clin. Nutr. 2022,
115, 625–632. [CrossRef]
52.
Yeung, S.S.Y.; Sin, D.; Yu, R.; Leung, J.; Woo, J. Dietary patterns and intrinsic capacity in community-dwelling older adults: A
cross-sectional study. J. Nutr. Health Aging 2022,26, 174–182. [CrossRef]
53.
Nouri-Majd, S.; Salari-Moghaddam, A.; Keshteli, A.H.; Esmaillzadeh, A.; Adibi, P. The association between adherence to the
MIND diet and irritable bowel syndrome. Dig. Dis. 2022,40, 198–205. [CrossRef] [PubMed]
54.
Barkhordari, R.; Namayandeh, M.; Mirzaei, M.; Sohouli, M.H.; Hosseinzadeh, M. The relation between MIND diet with
psychological disorders and psychological stress among Iranian adults. BMC Psychiatry 2022,22, 496. [CrossRef] [PubMed]
55.
Rostami, H.; Parastouei, K.; Samadi, M.; Taghdir, M.; Eskandari, E. Adherence to the MIND dietary pattern and sleep quality,
sleep related outcomes and mental health in male adults: A cross-sectional study. BMC Psychiatry 2022,22, 167. [CrossRef]
56.
Seifollahi, A.; Sardari, L.; Yarizadeh, H.; Mirzababaei, A.; Shiraseb, F.; Clark, C.; Mirzaei, K. Associations between adherence to
the MIND diet and prevalence of psychological disorders, and sleep disorders severity among obese and overweight women: A
cross-sectional study. Nutr. Health 2022,30, 513–519. [CrossRef]
57.
Salari-Moghaddam, A.; Keshteli, A.H.; Mousavi, S.M.; Afshar, H.; Esmaillzadeh, A.; Adibi, P. Adherence to the MIND diet and
prevalence of psychological disorders in adults. J. Affect. Disord. 2019,256, 96–102. [CrossRef]
58.
Torabynasab, K.; Shahinfar, H.; Jazayeri, S.; Effatpanah, M.; Azadbakht, L.; Abolghasemi, J. Adherence to the MIND diet is
inversely associated with odds and severity of anxiety disorders: A case-control study. BMC Psychiatry 2023,23, 330. [CrossRef]
59.
Ma, X.; Li, Y.; Xu, Y.; Gibson, R.; Williams, C.; Lawrence, A.J.; Nosarti, C.; Dazzan, P.; Rodriguez-Mateos, A. Plant-based dietary
patterns and their association with mood in healthy individuals. Food Funct. 2022,14, 2326–2337. [CrossRef]
60.
Haghighatdoost, F.; Feizi, A.; Esmaillzadehc, A.; Keshtelid, A.; Roohafzaf, H.; Afshar, H.; Adibi, P. The MIND (Mediterranean-
DASH Diet Intervention for Neurodegenerative Delay) and Mediterranean Diets are differently associated with psychosomatic
complaints profile in adults: Results from SEPAHAN cross-sectional study. Med. J. Nutr. Metab. 2020,13, 341–359. [CrossRef]
61.
Petermann-Rocha, F.; Carrasco-Marin, F.; Boonpor, J.; Parra-Soto, S.; Shannon, O.; Malcomson, F.; Phillips, N.; Jain, M.; Deo, S.;
Livingstone, K.M.; et al. Association of five diet scores with severe NAFLD incidence: A prospective study from UK Biobank.
Diabetes Obes. Metab. 2024,26, 860–870. [CrossRef] [PubMed]
62.
Agarwal, P.; Wang, Y.; Buchman, A.S.; Holland, T.M.; Bennett, D.A.; Morris, M.C. MIND diet associated with reduced Incidence
and delayed progression of parkinsonism in old age. J. Nutr. Health Aging 2018,22, 1211–1215. [CrossRef]
Nutrients 2025,17, 2687 26 of 27
63.
Metcalfe-Roach, A.; Cirstea, M.; Yu, A.; Golz, E.; Sundvick, K.; Kliger, D.; Finlay, B.; Appel-Cresswell, S. Higher adherence to
MIND diet associated with later onset of Parkinson’s disease. Mov. Disord. 2020,35, S335–S336.
64.
Fox, D.J.; Park, S.J.; Mischley, L.K. Comparison of associations between MIND and Mediterranean diet scores with patient-reported
outcomes in Parkinson’s disease. Nutrients 2022,14, 5185. [CrossRef]
65.
Keramati, M.; Kheirouri, S.; Etemadifar, M. Dietary approach to stop hypertension (DASH), but not Mediterranean and MIND,
dietary pattern protects against Parkinson’s disease. Food Sci. Nutr. 2024,12, 943–951. [CrossRef]
66.
Lawrie, S.; Coe, S.; Mansoubi, M.; Welch, J.; Hu, M.T.; Dawes, H. Dietary patterns and nonmotor symptoms in Parkinson’s
disease: A cross-sectional analysis. J. Am. Nutr. Assoc. 2023,42, 393–402. [CrossRef]
67.
Safaei, M.; Kheirouri, S.; Alizadeh, M.; Pirovi, A. Association between Mediterranean-dietary approaches to stop hypertension
intervention for neurodegenerative delay diet and biomarkers of oxidative stress, metabolic factors, disease severity, and odds of
disease in rheumatoid arthritis patients. Food Sci. Nutr. 2024,12, 3973–3981. [CrossRef]
68.
Chan, R.; Leung, J.; Tang, N.; Woo, J. Dietary patterns and telomere length in community-dwelling Chinese older men and
women: A cross-sectional analysis. Eur. J. Nutr. 2020,59, 3303–3311. [CrossRef] [PubMed]
69.
Ardekani, A.M.; Vahdat, S.; Hojati, A.; Moradi, H.; Tousi, A.Z.; Ebrahimzadeh, F.; Farhangi, M.A. Evaluating the association
between the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, mental health, and cardio-metabolic
risk factors among individuals with obesity. BMC Endocr. Disord. 2023,23, 29. [CrossRef] [PubMed]
70.
Miller, K.D.; Ostrom, Q.T.; Kruchko, C.; Patil, N.; Tihan, T.; Cioffi, G.; Fuchs, H.E.; Waite, K.A.; Jemal, A.; Siegel, R.L.; et al. Brain
and other central nervous system tumor statistics, 2021. CA Cancer J. Clin. 2021,71, 381–406. [CrossRef]
71.
Rothman, S.M.; Griffioen, K.J.; Wan, R.; Mattson, M.P. Brain-derived neurotrophic factor as a regulator of systemic and brain
energy metabolism and cardiovascular health. Ann. N. Y. Acad. Sci. 2012,1264, 49–63. [CrossRef] [PubMed]
72.
U.S. Food & Drug Administration. Cadmium in Food and Foodwares. Available online: https://www.fda.gov/food/
environmental-contaminants-food/cadmium-food-and-foodwares (accessed on 13 June 2025).
73.
Fried, L.P.; Tangen, C.M.; Walston, J.; Newman, A.B.; Hirsch, C.; Gottdiener, J.; Seeman, T.; Tracy, R.; Kop, W.J.; Burke, G.; et al.
Frailty in older adults: Evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci. 2001,56, M146–M156. [CrossRef]
74.
Mitnitski, A.B.; Mogilner, A.J.; Rockwood, K. Accumulation of deficits as a proxy measure of aging. Sci. World J. 2001,1, 323–336.
[CrossRef] [PubMed]
75.
Searle, S.D.; Mitnitski, A.; Gahbauer, E.A.; Gill, T.M.; Rockwood, K. A standard procedure for creating a frailty index. BMC Geriatr.
2008,8, 24. [CrossRef] [PubMed]
76.
Curhan, S.G.; Halpin, C.; Wang, M.; Eavey, R.D.; Curhan, G.C. Prospective study of dietary patterns and hearing threshold
elevation. Am. J. Epidemiol. 2019,189, 204–214. [CrossRef]
77.
The WHOQOL Group. The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World
Health Organization. Soc. Sci. Med. 1995,41, 1403–1409. [CrossRef]
78.
Karam, G.; Agarwal, A.; Sadeghirad, B.; Jalink, M.; Hitchcock, C.L.; Ge, L.; Kiflen, R.; Ahmed, W.; Zea, A.M.; Milenkovic, J.; et al.
Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients
at increased cardiovascular risk: Systematic review and network meta-analysis. BMJ 2023,380, e072003. [CrossRef] [PubMed]
79.
Chen, G.; Leary, S.; Niu, J.; Perry, R.; Papadaki, A. The Role of the Mediterranean Diet in Breast Cancer Survivorship: A Systematic
Review and Meta-Analysis of Observational Studies and Randomised Controlled Trials. Nutrients 2023,15, 2099. [CrossRef]
80.
González-Palacios Torres, C.; Barrios-Rodríguez, R.; Muñoz-Bravo, C.; Toledo, E.; Dierssen, T.; Jiménez-Moleón, J.J. Mediterranean
diet and risk of breast cancer: An umbrella review. Clin. Nutr. 2023,42, 600–608. [CrossRef]
81. Milenkovic, T.; Bozhinovska, N.; Macut, D.; Bjekic-Macut, J.; Rahelic, D.; Velija Asimi, Z.; Burekovic, A. Mediterranean diet and
type 2 diabetes mellitus: A perpetual inspiration for the scientific world. A review. Nutrients 2021,13, 1307. [CrossRef]
82.
Poursalehi, D.; Lotfi, K.; Saneei, P. Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: A
systematic review and dose-response meta-analysis with GRADE assessment. Ageing Res. Rev. 2023,87, 101903. [CrossRef]
83.
Coelho-Júnior, H.J.; Trichopoulou, A.; Panza, F. Cross-sectional and longitudinal associations between adherence to Mediterranean
diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis. Ageing Res. Rev.
2021,70, 101395. [CrossRef] [PubMed]
84.
Zhao, J.; Peng, Y.; Lin, Z.; Gong, Y. Association between Mediterranean diet adherence and Parkinson’s disease: A systematic
review and meta-analysis. J. Nutr. Health Aging 2025,29, 100451. [CrossRef] [PubMed]
85.
Haigh, L.; Kirk, C.; El Gendy, K.; Gallacher, J.; Errington, L.; Mathers, J.C.; Anstee, Q.M. The effectiveness and acceptability of
Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis.
Clin. Nutr. 2022,41, 1913–1931. [CrossRef] [PubMed]
86.
Godos, J.; Guglielmetti, M.; Ferraris, C.; Frias-Toral, E.; Domínguez Azpíroz, I.; Lipari, V.; Di Mauro, A.; Furnari, F.; Castellano, S.;
Galvano, F.; et al. Mediterranean diet and quality of life in adults: A systematic review. Nutrients 2025,17, 577. [CrossRef]
87.
López-Gil, J.F.; Victoria-Montesinos, D.; García-Hermoso, A.; López-Moreno, M.; Ezzatvar, Y.; Gutiérrez-Espinoza, H.; Quesada-
Fernández, G.; Stubbs, B.; Smith, L.; Kales, S.N. Is greater adherence to the Mediterranean diet related to higher health-related
Nutrients 2025,17, 2687 27 of 27
quality of life among children and adolescents? A systematic review and meta-analysis. Eur. J. Pediatr. 2025,184, 498. [CrossRef]
[PubMed]
88.
Romero-Robles, M.A.; Ccami-Bernal, F.; Ortiz-Benique, Z.N.; Pinto-Ruiz, D.F.; Benites-Zapata, V.A.; Casas Patiño, D. Adherence
to Mediterranean diet associated with health-related quality of life in children and adolescents: A systematic review. BMC Nutr.
2022,8, 57. [CrossRef]
89.
Hu, P.; Lee, E.K.; Li, Q.; Tam, L.S.; Wong, S.Y.; Poon, P.K.; Yip, B.H. Mediterranean diet and rheumatoid arthritis: A nine-year
cohort study and systematic review with meta-analysis. Eur. J. Clin. Nutr. 2025. [CrossRef]
90.
Arab, A.; Lempesis, I.G.; Garaulet, M.; Scheer, F. Sleep and the Mediterranean diet: A systematic review and meta-analysis. Sleep.
Med. Rev. 2025,80, 102071. [CrossRef]
91.
Roldán-Ruiz, A.; Bertotti, G.; López-Moreno, M. Effects of dietary interventions in patients with migraine: A systematic review.
Nutr. Rev. 2025,83, e1815–e1827. [CrossRef]
92.
Madani, S.; Ahmadi, A.; Shoaei-Jouneghani, F.; Moazen, M.; Sasani, N. The relationship between the Mediterranean diet and Axis
I disorders: A systematic review of observational studies. Food Sci. Nutr. 2022,10, 3241–3258. [CrossRef]
93.
Hrelia, S.; Di Renzo, L.; Bavaresco, L.; Bernardi, E.; Malaguti, M.; Giacosa, A. Moderate wine consumption and health: A narrative
review. Nutrients 2022,15, 175. [CrossRef] [PubMed]
94.
UK Health Security Agency. Guidance Cadmium: General Information. Available online: https://www.gov.uk/government/
publications/cadmium-properties-incident-management-and-toxicology/cadmium-general-information (accessed on 26
June 2025).
95.
EUR-Lex: Access to European Union law. Maxiumum Levels for Certain Contaminants in Food. Available online: https://eur-lex.
europa.eu/EN/legal-content/summary/maximum-levels-for-certain-contaminants-in-food.html?fromSummary=30 (accessed
on 26 June 2025).
96.
Liu, X.; Morris, M.; Dhana, K.; Ventrelle, J.; Johnson, K.; Bishop, L.; Hollings, C.; Boulin, A.; Laranjo, N.; Stubbs, B.; et al.
Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) study: Rationale, design and baseline characteristics of
a randomized control trial of the MIND diet. Contemp. Clin. Trials 2021,102, 106270. [CrossRef] [PubMed]
97.
George, A.; Stead, T.S.; Ganti, L. What’s the risk: Differentiating risk ratios, odds ratios, and hazard ratios? Cureus 2020,12, e10047.
[CrossRef] [PubMed]
98.
Archer, E.; Marlow, M.L.; Lavie, C.J. Controversy and debate: Memory-based methods paper 1: The fatal flaws of food frequency
questionnaires and other memory-based dietary assessment methods. J. Clin. Epidemiol. 2018,104, 113–124. [CrossRef]
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