Associations of the MIND Diet with Cardiometabolic Diseases and Their Risk Factors: A Systematic Review

Figures & data

Table 1 MIND Diet Components and Servings

Diet Component	Servings
Brain-healthy foods
Green leafy vegetables	≥6 servings per week
Other vegetables	≥1 serving per day
Berries	≥2 servings per week
Nuts	≥5 servings per week
Beans	>3 meals per week
Whole grains	≥3 servings per day
Fish (not fried)	≥1 meal per week
Poultry (not fried)	≥2 meals per week
Olive oil	Primary oil used
Wine	1 glass per day
Brain-unhealthy foods
Butter, margarine	<1 tablespoon per day
Cheese	<1 serving per week
Red meat and products	<4 meals per week
Fast fried foods	<1 time per week
Pastries and sweets	<5 servings per week

Note: Data from Morris et al.³²

Figure 1 Flow diagram of the identified and screened articles on the MIND diet in relation to cardiometabolic diseases and their risk factors.

Table 2 Characteristics of the Included Studies on the Associations of the MIND Diet with Cardiometabolic Diseases and Their Risk Factors

Reference		Country/Study Design/Follow-Up Length	Sample Size and Characteristics	Dietary Assessment Method and MIND Diet Range/Categories	Outcome Measure(s)	Results	Covariates
Cross-sectional studies (n=14)
[56]	Holthaus et al (2023)	USA	n=163 adults (95 women) Age: 33.8 ± 6.0 years	Monthly and yearly DHQII MIND diet score: 0-15	- Visceral adipose tissue - WC - TG - SBP - DBP - HDL-C - FBS	- Inverse association between the MIND diet and WC (p=0.009), TG (p=0.002), SBP (p=0.001), DBP (p<0.001), and FBS (p=0.02). - Positive association between MIND diet adherence and HDL-C (p=0.007).	Age, sex, income, physical activity.
[57]	Zare et al (2023)	Iran	n=60 adults with T2DM Age: ≥60 years	MIND dietary score questionnaire MIND diet score: 0-14 Wine excluded	- FBS - HbA1C - TG - Chol - LDL-C - HDL-C - CRP - SBP - DBP	- Inverse correlation between MIND diet score and blood pressure (r= −0.449 for SBP, r= −0.414 for DBP; p<0.001).	None.
[58]	Khadem et al (2023)	Iran	n=229 overweight and obese women (BMI ≥ 25 kg/m^2) Age: 18–48 years (36.2 ± 8.3 years)	147-item semi-quantitative FFQ; nutritionist administered MIND diet score: 0-14 Wine excluded	- Metabolically unhealthy overweight/obesity	- No significant association between overweight/obesity phenotypes and the MIND score (OR: 1.63; 95%CI 0.79−3.33, p=0.18).	Age, energy intake, BMI, physical activity, marital status.
[59]	Fateh et al (2023)	Iran	n=1328 adults (51.60% female) Age: 46.2 ± 7.9 years	168-item FFQ; dietitian administered MIND diet score: 0-13 Wine and olive oil excluded	- Serum TG - Serum HDL-C - General obesity	- No significant association between the highest MIND diet score and increased serum TG (OR: 0.60; 95%CI 0.43-1.11), reduced serum HDL-C (OR: 0.79; 95%CI 0.47−1.07), and general obesity (OR: 0.78; 95%CI 0.51-1.10) in the fully adjusted model.	Age, gender, energy intake, physical activity, SES, smoking, BMI.
[60]	Song et al (2023)	USA	n=6887 adults attending NHANES 2003-2006 Age: 20–85 years	FFQ MIND diet score 0-15: - MDS-low (<7.5) - MDS-medium (7.5–8.0) - MDS-high (≥8.5)	- HTN - SBP - ASCVD in HTN patients	- Positive association between MDS-high group and lower odds of HTN (OR: 0.76; 95%CI 0.58-0.97) and decreased SBP (β=−0.41, p=0.033). - Positive association between MDS-high group and lower odds of ASCVD in HTN participants (OR: 0.80; 95% CI 0.51−0.97).	Age, sex, race/ethnicity, smoking status, BMI, physical activity, DM, DLP, energy intake.
[61]	Ardekani et al (2023)	Iran	n=339 obese adults Age: 20–50 years	168-item FFQ and food diaries MIND diet score: 0-14 Wine excluded	- SBP - DBP - FBS - TC - LDL-C - HDL-C - TG - Insulin - HOMA-IR - QUICKI	- No significant association between MIND diet score and QUICKI in the fully adjusted model. - No significant association between MIND diet score and other cardiometabolic risk factors.	Age, sex, SES, physical activity, energy intake.
[47]	Gauci et al (2022)	Australia	n=141 (71 women) healthy middle-aged adults Age: 52.8 ± 6.9 years	Multiple 24-hour recalls (2-4) using ASA24 MIND diet score: 0-15	- Blood pressure - Blood lipids - Blood glucose - Anthropometric measures (BMI, WC) - MetSSS	- MIND diet adherence was negatively correlated with waist circumference (β=−0.28; p<0.01) and positively correlated with HDL-C (β=0.19; p<0.05). - MIND diet was not significantly related to MetSSS.	Age, gender, energy intake.
[48]	Walker et al (2021)	USA	n=2,512; metabolically healthy Age: 66 ± 9 years (44.8% male)	Harvard semi-quantitative FFQ MIND diet score: 0-15	- Prevalent DM - TC/HDL-C - SBP - BMI	- Negative correlations (p <0.0001) between cumulative MIND diet score with TC/HDL-C (β=−0.14), BMI (β=−0.11) and DM status (β=−0.08). - MIND diet was not significantly related to SBP.	Age, sex, energy intake.
[41]	Khatibi et al (2021)	Iran	n=263 overweight and non-menopause women with a BMI ranging from 25 to 40 kg/m2. Age: >18 years	147-item semi-quantitative FFQ; self-administered MIND diet score: 0-15	- FBS - TG - TC - LDL-C - HDL-C - Weight - WC - WHR - BMI	- Significant interaction between MIND diet and genotype for metabolic dyslipidemia; subjects with dominant allele had a lower odds of dyslipidemia (β=−0.25±132; OR: 0.77; 95% CI 0.60–1.00; p=0.05).	Age, energy intake, BMI, physical activity.
[49]	Mohammad-pour et al (2020)	Iran	n=836 Iranian adults (70% female) with no pre-existing conditions Age: 20-59 years (47.7 ± 10 years)	168-item FFQ; dietitian administered via face-to-face interview MIND diet score: 0-14 - T1: <6 - T2: 6.5-7.5 - T3: >8 Wine excluded	- MetS - Anthropometric measurements (BMI, WC) - Blood pressure - FBS - Lipid profile	- No association between MIND diet score and MetS (OR: 0.88; 95%CI 0.62–1.24). - MIND diet score was inversely associated with reduced HDL-C (OR: 0.59; 95%CI 0.41–0.85; p=0.008) and general obesity (OR 1.19 0.80–1.78; 95% CI 0.80–1.78; p=0.02).	Age, gender, marital status, physical activity, education status, occupation, smoking, energy intake, BMI.
[50]	Wong et al (2020)	Australia	n=5,376 adults (2,749 men) with 295 CVD (191 IHD, 50 HF and 85 cerebrovascular disease) cases. Age: ≥18 years	Repeated 24 hr recall: Face-to-face multiple pass 24 h recall + second 24 h recall conducted over the phone Consumption of 15 food components separated into quintiles. MIND diet score ranged from 15-75 and was distributed into tertiles for analysis.	CVD including: - IHD, CHD and angina - HF - Cerebrovascular disease	- Third tertile (highest score) of the MIND score had an OR of 0.37 (95%CI 0.13-1.02; p-trend=0.044) for HF compared to the first tertile.	Age, sex, education, marital status, energy intake, BMI, SES, smoking, physical activity.
[39]	Aminianfar et al (2020)	Iran	n=6,724 adults Mean age: 36.8 ± 8.08 years	106-item DS-FFQ MIND diet score: 0-13 - T1: 0.5-<6 - T2: 6–7 - T3: >7–11.5 Wine and olive oil excluded	- General obesity - Central obesity	- No significant association between adherence to MIND diet and odds of general and central obesity. - High adherence to MIND diet (T3) negatively associated with abdominal obesity in women (OR: 0.81; 95%CI 0.67−0.98; p-trend=0.03).	Age, gender, energy intake, marital status, education, smoking status, family size, home ownership, physical activity, family size, breakfast skipping.
[42]	Chan et al (2019)	China	n=2,646 community-dwelling Chinese older adults (1332 men and 1314 women) Age: >65 years	280-item FFQ; self-administered MIND diet score: 0-9 - T1: 2-4 - T2: 4.5-5 - T3: 5.5-7.5 Lack of sufficient information on 6 components: olive oil, fish, beans, poultry, red meats and products, fast fried foods.	- hsCRP	- Higher MIND diet score was associated with lower hsCRP in men (T3 vs T1: OR: 0.68; 95%CI 0.52−0.90). - No associations found in women.	Baseline age, BMI, energy intake, current smoking status, current alcohol use, physical activity, number of diseases.
[51]	Woo et al (2018)	China	n=2,090 (993 men and 1097 women) Mean age: 51 years	280 food item FFQ; self-administered (past 12 months prior to the interview) MIND Diet Score: 0-9 Lack of sufficient information on 6 components: olive oil, fish, beans, poultry, red meats and products, fast fried foods.	- ABI reflecting atherosclerosis (ABI Score >0.9 indicates better vascular health)	- Low MIND diet scores associated with having ABI <0.9 (OR: 2.6; 95%CI 1.24−5.42).	Age, BMI, smoking, drinking, PASE score, energy intake, education level, medical history of HTN, DM and heart disease, season of blood taking, vitamin D supplementation, CRP, homocysteine (blood), tryptophan (blood).
Cohort studies (n=5)
	Golzarand et al (2023)	Iran Mean follow-up of 5.9 years	n=1299 adults Age: ≥19 years old	168 item FFQ; administered by qualified nutritionists MIND diet score: 0-13 - T1: <7.5 - T2: 7.5-8.5 - T3: >8.5 Olive oil and wine excluded	Metabolically unhealthy phenotypes (1 out of the 4): - FBS ≥ 100 mg/dL - HDL-C < 50 mg/dL in women and < 40 mg/dL in men - TG ≥ 150 mg/dL - SBP ≥ 130 mmHg - DBP ≥ 85 mmHg - or on medication for any of the above conditions	- Higher MIND scores were associated with 47% (HR: 0.53; 95%CI 0.34–0.83) lower risk of the metabolically unhealthy normal weight phenotype. - Higher MIND scores were associated with reduced risk of metabolically unhealthy overweight/obesity phenotypes (HR: 0.57; 95%CI 0.43–0.74).	Age, sex, WC, changes in weight from baseline, smoking, energy intake.
	Razmpoosh et al (2022)	Iran Median follow-up of 7.4 years	n=2706 adults without HTN at baseline. Age: 20-79 years Mean age: 37.9 ± 12.5 years	Semi-quantitative FFQ; dietitian administered MIND diet score: 0-13 Wine and olive oil excluded	- HTN	- No significant associations between MIND diet scores and risk of HTN.	Age, sex, physical activity, education, family history of CVD, smoking, BMI, CKD, DM, pre-HTN, DLP, aspirin intake, energy intake, caffeine intake, olive intake.
[55]	Tison et al (2022)	USA Prospective Cohort	n=8,750 adults (4,916 women) without diabetes at baseline. Age: ≥45 years Mean age (SD): 63.2 (8.5)	Block98 107-item FFQ; self-administered MIND diet score: - Q5: 9.5-13.5 - Q4: 8.5-9.0 - Q3: 7.5-8.0 - Q2: 6.0-7.0 - Q1: 2.0-5.5	- Type 2 DM	- High MIND diet scores were associated with lower DM incidence (Q1 vs. Q5 RR: 1.33).	Energy intake, age, race, sex, income, region, education, smoking, physical activity, alcohol consumption, WC.
[52]	Livingstone et al (2022)	Australia ≤19 years	n=10,009 participants (52% females) randomly selected from areas in Australia. Age: ≥25 (51.8 ± SD 14.3 years)	74 food item semi-quantitative FFQ; self-administered MIND diet score: 0-13 Butter/margarine and olive oil excluded	- Nonfatal cardiovascular events (MI and Stoke)	- Positive association between MIND diet and nonfatal CVD events (MI and stroke) (HR: 1.19; 95%CI 1.05−1.34). Significance lost after exclusion of deaths in the first 2 years of follow-up.	Age, sex, education, smoking, HTN, DM, physical activity.
[53]	Golzarand et al (2022)	Iran 10.6-years	n=2863 healthy adults Age: ≥19 years	168-item FFQ; dietitian administered MIND diet score: 0-13 - T1: ≤7.5 - T2: 8-9 - T3: ≥9.0 Olive oil and wine excluded	- Cardiovascular events - CHD - Stroke	- Negative association between MIND diet and the incidence of CVD (HR: 0.84; 95%CI 0.74−0.96).	Age, gender, BMI, smoking, SES, energy intake, DM, HTN.
Case-control studies (n=1)
[54]	Salari-Moghaddam et al (2022)	Iran	n=388 193 hospitalized stroke cases 195 hospital-based controls Age: >45 years	168-item FFQ; dietitian administered MIND diet score: 0-14 Wine excluded	- Stroke	- MIND diet score was inversely associated with the odds of stroke (T3 vs T1: OR 0.41; 95%CI 0.18−0.94).	Age, sex, energy intake, physical activity, smoking, HTN, DM, dyslipidemia, heart disease, BMI.
Randomized controlled trials (n=3)
[64]	Yau et al (2022)	China Single blind RCT (4-week intervention)	n=72; older adults (76.4% women) with hypertension. MIND group: n= 23 MIND + FB group: n= 25 Control group: n= 24 Age: 66 ± 9.7 years	Harvard semi-quantitative FFQ MIND diet score: 0-15	- SBP - Lipid panel (TC, HDL-C, TG, and LDL-C) - Glucose - BMI - WHR - BFP	- WHR decreased by 0.03 (p=0.050) in the MIND group - TC and LDL-C significantly decreased by 0.60 and 0.33 mmol/L (p<0.01) in the MIND group, respectively. - TG and glucose levels were significantly lower by 0.28 mmol/L and 0.68 mmol/L (p<0.05) in the MIND group, respectively. - MIND diet was not significantly related to SBP, HDL-C and BFP.	Adjustment was done for SBP analysis only: age, WHR, and SBP at baseline.
[40]	Arjmand et al (2022)	Iran Single-blind RCT (3 months)	n=37 healthy overweight and obese women with MMSE ≥24 Calorie-restricted MIND diet group (n = 22) Calorie-restricted control group (n = 15) Age: 40-60 years	168-item semi-quantitative FFQ MIND diet score: 0-14 Wine excluded	Anthropometric parameters: - PBF - FFM - BMI - WC	- Significant reduction in weight (−3.98±−0.29), BMI (−1.55±−0.11), PBF (-5.16±-0.82), and WC (−3.54±0.56) in the MIND diet group.	None.
[65]	Elsayed et al (2022)	Egypt RCT (12 weeks)	n=60 postmenopausal women, with mild cognitive impairment (MCI) Aerobic exercise + MIND-low calorie diet group (n= 30) MIND-low calorie diet control group (n = 30) Mean age: Exposure: 65.39 ± 2.83 Control: 65.13 ± 3.17	Perceived Dietary Adherence Questionnaire	Anthropometric measurements: - Weight - BMI	- The control group (participants on MIND diet only) had lower body weight and BMI after 12 weeks of intervention (p<0.05).	None.

Abbreviations: ABI, Ankle-Brachial Index; ASA24, Automated Self-Administered 24-Hour Dietary Assessment Tool; ASCVD, Atherosclerotic Cardiovascular Disease; BFP, Body Fat Percentage; BMI, Body Mass Index; CHD, Coronary Heart Disease; CKD, Chronic Kidney Disease; CVD, Cardiovascular Disease; DHQII, Dietary History Questionnaire Version II; DM, Diabetes mellitus; DS-FFQ, Dish-based Semi-quantitative Food Frequency Questionnaire; FFM, Fat Free Mass; FFQ, Food Frequency Questionnaire; Forest Bathing, FB; FBS, Fasting Blood Sugar; Glu, Glucose; HDL-C, High-Density Lipoprotein Cholesterol; HF, Heart Failure; hsCRP, High-Sensitivity C-Reactive Protein; HTN, Hypertension; IHD, Ischemic Heart Disease; LDL-C, Low-Density Lipoprotein Cholesterol; MetSSS, Metabolic syndrome severity score; MIND, Mediterranean-DASH Intervention for Neurodegenerative Delay; MMSE, Mini-Mental State Examination; OR, Odds Ratio; PASE, Physical Activity Scale for Elderly; PBG, Percent Body Fat; QUICKI, Quantitative Insulin-Sensitivity Check Index; RCT, Randomized Controlled Trial; SBP, Systolic Blood Pressure; SES, Socioeconomic Status; TC, Total Cholesterol; TC/HDL-C, Total cholesterol to HDL-cholesterol ratio; TEE, Total Energy Expenditure; TG, Triglycerides; WC, Waist Circumference; WHR, Waist-to-Hip ratio.

Figure 2 (a) Risk of bias summary of studies examining the effects of the MIND diet. (b) Risk of bias graph of studies examining the effects of the MIND diet.

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