A Comparative Review of Mediterranean, DASH, and Ketogenic Diets in Reducing Chronic Disease Risk
Mediterranean, DASH, and Ketogenic Diets in Reducing Chronic Disease Risk
DOI:
https://doi.org/10.54393/df.v7i2.220Keywords:
Mediterranean Diet, DASH Diet, Ketogenic Diet, Chronic Disease, Cardiovascular Disease, Type 2 Diabetes, CancerAbstract
Dietary pattern is one of the modifiable factors for chronic non-communicable diseases (NCDs), which are the major contributors to morbidity and mortality around the world, including cardiovascular disease, type 2 diabetes mellitus, and several cancers. The current evidence base for dietary patterns associated with chronic disease prevention consists of three main diets: the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) diet, and the ketogenic diet. A narrative review was conducted to compare the effectiveness, mechanisms, and safety of these three dietary patterns on cardiovascular, metabolic, and oncological outcomes, as well as long-term adherence and safety, with an emphasis on recent randomized controlled trials, prospective cohort studies, and systematic reviews and meta-analyses published primarily from 2021 to 2025 and using earlier studies when they provided foundational insights. The CORDIOPREV trial led updated secondary-prevention trial evidence that further consolidates the cardioprotective, cancer-risk-reducing, and mortality benefits of the Mediterranean diet. Recent meta-analyses have validated the blood pressure-lowering efficacy of the DASH diet while demonstrating concurrent effects on lipid profile and metabolic risk factors, and it remains the most consistent diet proven to lower blood pressure. Comparative and network meta-analyses indicate that carbohydrate restriction might provide metabolic benefits in the short term, but the Mediterranean and DASH diets have greater evidence for long-term hard clinical outcomes. Therefore, no one single pattern of diet should be recommended as the best, but should be tailored to each individual's metabolic profile, any comorbidities, and their capacity to follow it.
References
1. Ma H, Wang M, Qin C, Shi Y, Mandizadza OO, Ni H et al. Trends in the Burden of Chronic Diseases Attributable to Diet-Related Risk Factors from 1990 to 2021 and the Global Projections Through 2030: A Population-Based Study. Frontiers in Nutrition. 2025 May; 12: 1570321. doi: 10.3389/fnut.2025.1570321.
2. Knudsen AK, Baravelli CM, Madsen C, Clarsen B, TopeAmobonye AE, Brauer M et al. The Burden of Dietary Risk Factors in the Nordic and Baltic Countries: A Systematic Analysis for the Global Burden of Disease Study 2023. The Lancet Regional Health–Europe. 2026 Feb; 61. doi: 10.1016/j.lanepe.2025.101543.
3. Wang M, Ma H, Qin C, Mandizadza OO, Ni H, Shi Y, Ji C. Burden of Diet-Related Chronic Diseases in Chinese and Japanese Adults Attributable to Dietary Risk Factors from 1990 To 2021: A Systematic Analysis of the Global Burden of Disease Study 2021. Frontiers in Nutrition. 2025 Jan; 11: 1472451. doi: 10.3389/fnut.2024.1472451.
4. Abrignani V, Salvo A, Pacinella G, Tuttolomondo A. The Mediterranean Diet, Its Microbiome Connections, and Cardiovascular Health: A Narrative Review. International Journal of Molecular Sciences. 2024 Apr; 25(9): 4942. doi: 10.3390/ijms25094942.
5. Furbatto M, Lelli D, Antonelli Incalzi R, Pedone C. Mediterranean Diet in Older Adults: Cardiovascular Outcomes and Mortality from Observational and Interventional Studies—A Systematic Review and Meta-Analysis. Nutrients. 2024 Nov; 16(22): 3947. doi: 10.3390/nu16223947.
6. Sebastian SA, Padda I, Johal G. Long-Term Impact of Mediterranean Diet on Cardiovascular Disease Prevention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Current Problems in Cardiology. 2024 May; 49(5): 102509. doi: 10.1016/j.cpcardiol.2024.102509.
7. Delgado-Lista J, Alcalá-Díaz JF, Torres-Peña JD, Quintana-Navarro GM, Fuentes F, García-Ríos A et al. Long-Term Secondary Prevention of Cardiovascular Disease with a Mediterranean Diet and a Low-Fat Diet (CORDIOPREV): A Randomized Controlled Trial. The Lancet. 2022 May; 399(10338): 1876-85.
8. Lari A, Sohouli MH, Fatahi S, Cerqueira HS, Santos HO, Pourrajab B et al. The Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet on Metabolic Risk Factors in Patients with Chronic Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrition, Metabolism and Cardiovascular Diseases. 2021 Sep; 31(10): 2766-78. doi: 10.1016/j.numecd.2021.05.030.
9. Lei L, Huang J, Zhang L, Hong Y, Hui S, Yang J. Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors in Overweight and Obese Adults: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Nutrition. 2022 Aug; 9: 935234. doi: 10.3389/fnut.2022.935234.
10. Silverii GA, Cosentino C, Santagiuliana F, Rotella F, Benvenuti F, Mannucci E et al. Effectiveness of Low‐Carbohydrate Diets for Long‐Term Weight Loss in Obese Individuals: A Meta‐Analysis of Randomized Controlled Trials. Diabetes, Obesity and Metabolism. 2022 Aug; 24(8): 1458-68. doi: 10.1111/dom.14709.
11. Ghasemi P, Jafari M, Maskouni SJ, Hosseini SA, Amiri R, Hejazi J et al. Impact of Very Low Carbohydrate Ketogenic Diets on Cardiovascular Risk Factors among Patients with Type 2 Diabetes; GRADE-Assessed Systematic Review and Meta-Analysis of Clinical Trials. Nutrition and Metabolism. 2024 Jul; 21(1): 50. doi: 10.1186/s12986-024-00824-w.
12. Gregg EW, Chen H, Bancks MP, Manalac R, Maruthur N, Munshi M et al. Impact of Remission from Type 2 Diabetes on Long-Term Health Outcomes: Findings from the Look AHEAD Study. Diabetologia. 2024 Mar; 67(3): 459-69. doi: 10.1007/s00125-023-06048-6.
13. Norwitz NG, Soto-Mota A, Feldman D, Parpos S, Budoff M. Case Report: Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet. Frontiers in Endocrinology. 2022 Apr; 13: 830325. doi: 10.3389/fendo.2022.830325.
14. Hernandez AV, Marti KM, Marti KE, Weisman N, Cardona M, Biello Jr DM et al. Effect of Mediterranean Diets on Cardiovascular Risk Factors and Disease in Overweight and Obese Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of the American Nutrition Association. 2025 Jul; 44(5): 387-404. doi: 10.1080/27697061.2024.2440051.
15. Sarsangi P, Salehi-Abargouei A, Ebrahimpour-Koujan S, Esmaillzadeh A. Association Between Adherence to the Mediterranean Diet and Risk of Type 2 Diabetes: An Updated Systematic Review and Dose–Response Meta-Analysis of Prospective Cohort Studies. Advances in Nutrition. 2022 Sep; 13(5): 1787-98. doi: 10.1093/advances/nmac046.
16. Kotzakioulafi E, Bakaloudi DR, Chrysoula L, Theodoridis X, Antza C, Tirodimos I et al. High versus Low Adherence to the Mediterranean Diet for Prevention of Diabetes Mellitus Type 2: A Systematic Review and Meta-Analysis. Metabolites. 2023 Jun; 13(7): 779. doi: 10.3390/metabo13070779.
17. Zhu Q, Shu L, Zhou F, Chen LP, Feng YL. Adherence to the Mediterranean Diet and Risk of Gastric Cancer: A Systematic Review and Dose–Response Meta-Analysis. Frontiers in Nutrition. 2023 Sep; 10: 1259453. doi: 10.3389/fnut.2023.1259453.
18. Du H, Cao T, Lu X, Zhang T, Luo B, Li Z. Mediterranean Diet Patterns in Relation to Lung Cancer Risk: A Meta-Analysis. Frontiers in Nutrition. 2022 Apr; 9: 844382. doi: 10.3389/fnut.2022.844382.
19. Nur I, Tetra DF, Ema M. Blood Pressure Impact of Dietary Practices Using the DASH Method: A Systematic Review and Meta-Analysis. Clinical Hypertension. 2025 Apr; 31: 0-. doi: 10.5646/ch.2025.31.e12.
20. Monfared V, Sheikhi L, Hashemi M, Kiani F, Javid R, Nikoumanesh M, Ghelichi Y, Hatami A, Hasani M. The Effect of Dietary Approaches to Stop Hypertension (DASH Diet) on Overweight or Obese Patients with Hypertension: An Updated Systematic Review and Meta-Analysis with GRADE-Assessed Approach. Jorjani Biomedicine Journal. 2025 Dec; 13(4): 10-22.
21. Khan TA, Field D, Chen V, Ahmad S, Mejia SB, Kahleova H et al. Combination of Multiple Low-Risk Lifestyle Behaviors and Incident Type 2 Diabetes: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Diabetes Care. 2023 Mar; 46(3): 643-56. doi: 10.2337/dc22-1024.
22. Chen S, Su X, Feng Y, Li R, Liao M, Fan L et al. Ketogenic Diet and Multiple Health Outcomes: An Umbrella Review of Meta-Analyses. Nutrients. 2023 Sep; 15(19): 4161. doi: 10.3390/nu15194161.
23. Supe AF, San Juan A, Sy R, Chiu HH. The Effect and Safety of Ketogenic Diets on LDL-C and Other Metabolic Parameters Compared with Non-Ketogenic Diets among Adults with BMI Greater than 25 with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Circulation. 2025 Nov; 152(Suppl_3): A4363699-. doi: 10.1161/circ.152.suppl_3.4363699.
24. Das R, Mohammad N, Islam MS, Das S, Abdullah F, Kader MA et al. Long-Term Efficacy and Safety of a Low-Carbohydrate Diet in Type 2 Diabetes Remission: A Systematic Review. Cureus. 2025 Sep; 17(9). doi: 10.7759/cureus.93340.
25. Norwitz NG, Mindrum MR, Giral P, Kontush A, Soto-Mota A, Wood TR et al. Elevated LDL-Cholesterol Levels among Lean Mass Hyper-Responders on Low-Carbohydrate Ketogenic Diets Deserve Urgent Clinical Attention and Further Research. Journal of Clinical Lipidology. 2022 Nov; 16(6): 765-8. doi: 10.1016/j.jacl.2022.10.010.
26. Crosby L, Davis B, Joshi S, Jardine M, Paul J, Neola M et al. Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks. Frontiers in Nutrition. 2021 Jul; 8: 702802. doi: 10.3389/fnut.2021.702802.
27. Churuangsuk C, Hall J, Reynolds A, Griffin SJ, Combet E, Lean ME. Diets for Weight Management in Adults with Type 2 Diabetes: An Umbrella Review of Published Meta-Analyses and Systematic Review of Trials of Diets for Diabetes Remission. Diabetologia. 2022 Jan; 65(1): 14-36. doi: 10.1007/s00125-021-05577-2.
28. Zhao H, Jin H, Xian J, Zhang Z, Shi J, Bai X. Effect of Ketogenic Diets on Body Composition and Metabolic Parameters of Cancer Patients: A Systematic Review and Meta-Analysis. Nutrients. 2022 Oct; 14(19): 4192. doi: 10.3390/nu14194192.
29. Lichtenstein AH, Khera A, Anderson CA, Appel LJ, DeSilva DM, Gardner C et al. 2026 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement from the American Heart Association. Circulation. 2026 May; 153(18): e1285-95. doi: 10.1161/CIR.0000000000001435.
30. Jiang R, Wang T, Han K, Peng P, Zhang G, Wang H et al. Impact of Anti-Inflammatory Diets on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis. Frontiers in Nutrition. 2025 Mar; 12: 1549831. doi: 10.3389/fnut.2025.1549831.
31. Lv J, Jiao S, Li W, Ding S, Ma L, Zhang Q. Network Meta-Analysis of the Effects of Different Dietary Patterns on Patients with Metabolic Syndrome. Frontiers in Nutrition. 2025 Oct; 12: 1634545. doi: 10.3389/fnut.2025.1634545.
32. Córdova R, Kim J, Thompson AS, Noh H, Shah S, Dahm CC, Jensen CF, Mellemkjær L, Tjønneland A, Katzke V, Le Cornet C. Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis. The Lancet Healthy Longevity. 2025 Aug 1;6(8). doi: 10.1016/j.lanhl.2025.100742.
33. Sun Y, Shang M, Zhang Y, Hu J, Wang H. Comparative Effect of Dietary Patterns on Selected Cardiovascular Risk Factors: A Network Study. Scientific Reports. 2025 Aug; 15(1): 28749. doi: 10.1038/s41598-025-13596-x.
34. Palumbo P, Di Betto G, Menozzi R, Koek GH, Buzzetti E. Pros and Cons of Different Dietary Patterns for the Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease. Metabolism. 2025 Oct: 156425. doi: 10.1016/j.metabol.2025.156425.
35. Alsaqer NS, Almutairi ST, Alfaraj ZA, Alshehri SA, Alshammri WA, Othman AA et al. Heart-Healthy Eating: Dietary Approaches to Preventing and Managing Cardiovascular Disease. Nouf Saad Alsaqer1, Samirah Talaq Alm. TPM–Testing, Psychometrics, Methodology in Applied Psychology. 2025 Aug; 32(S3 (2025): Posted 07 July): 703-16.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 DIET FACTOR (Journal of Nutritional and Food Sciences)
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
