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Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial
Martínez-Lapiscina EH, Clavero P, Toledo E, Estruch R, Salas-Salvadó J, San Julián B, Sanchez-Tainta A, Ros E et al.. Journal of neurology, neurosurgery, and psychiatry, 2013-05-13
Topic: Risk, prevention and care in population studies
Objective Previous observational studies reported beneficial effects of the Mediterranean diet (MedDiet) on cognitive function, but results were inconsistent. We assessed the effect on cognition of a nutritional intervention using MedDiets in comparison with a low-fat control diet. Methods We assessed 522 participants at high vascular risk (44.6% men, age 74.6 ± 5.7 years at cognitive evaluation) enrolled in a multicentre, randomised, primary prevention trial (PREDIMED), after a nutritional intervention comparing two MedDiets (supplemented with either extra-virgin olive oil (EVOO) or mixed nuts) versus a low-fat control diet. Global cognitive performance was examined by Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) after 6.5 years of nutritional intervention. Researchers who assessed the outcome were blinded to group assignment. We used general linear models to control for potential confounding. Results After adjustment for sex, age, education, Apolipoprotein E genotype, family history of cognitive impairment/dementia, smoking, physical activity, body mass index, hypertension, dyslipidaemia, diabetes, alcohol and total energy intake, participants allocated to the MedDiet+EVOO showed higher mean MMSE and CDT scores with significant differences versus control (adjusted differences: +0.62 95% CI +0.18 to +1.05, p=0.005 for MMSE, and +0.51 95% CI +0.20 to +0.82, p=0.001 for CDT). The adjusted means of MMSE and CDT scores were also higher for participants allocated to the MedDiet+Nuts versus control (adjusted differences: +0.57 (95% CI +0.11 to +1.03), p=0.015 for MMSE and +0.33 (95% CI +0.003 to +0.67), p=0.048 for CDT). These results did not differ after controlling for incident depression. Conclusions An intervention with MedDiets enhanced with either EVOO or nuts appears to improve cognition compared with a low-fat diet. ISRCTN:35739639.
Key findings
- Objective Previous observational studies reported beneficial effects of the Mediterranean diet (MedDiet) on cognitive function, but results were inconsistent.
- Methods We assessed 522 participants at high vascular risk (44.6% men, age 74.6 ± 5.7 years at cognitive evaluation) enrolled in a multicentre, randomised, primary prevention trial (PREDIMED), after a nutritional intervention comparing two MedDiets (supplemented with either extra-virgin olive oil (EVOO) or mixed nuts) versus a low-fat control diet.
- Results After adjustment for sex, age, education, Apolipoprotein E genotype, family history of cognitive impairment/dementia, smoking, physical activity, body mass index, hypertension, dyslipidaemia, diabetes, alcohol and total energy intake, participants allocated to the MedDiet+EVOO showed higher mean MMSE and CDT scores with significant differences versus control (adjusted differences: +0.62 95% CI +0.18 to +1.05, p=0.005 for MMSE, and +0.51 95% CI +0.20 to +0.82, p=0.001 for CDT).
- The adjusted means of MMSE and CDT scores were also higher for participants allocated to the MedDiet+Nuts versus control (adjusted differences: +0.57 (95% CI +0.11 to +1.03), p=0.015 for MMSE and +0.33 (95% CI +0.003 to +0.67), p=0.048 for CDT).
- These results did not differ after controlling for incident depression.
Why it matters
In this randomised trial of 522 participants at high vascular risk, those allocated to a Mediterranean diet supplemented with extra-virgin olive oil showed higher mean Mini-Mental State Examination and Clock Drawing Test scores after 6.5 years compared with a low-fat control diet. It reports an effect on cognitive test scores, not a treatment or cure for Alzheimer's disease.
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Study details
- Participants522
- Effect size44.6%
- Evidence strengthHigh
How this study scored 78/100
Published in a peer-reviewed journal, and it is a randomised controlled trial.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of neurology, neurosurgery, and psychiatry) |
| Journal's citation record | 3 / 4 | Journal of Neurology Neurosurgery & Psychiatry: journal h-index 336 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A randomised controlled trial (from PubMed type “Randomized Controlled Trial”) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 522 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 2 / 2 | Randomised and blinded or placebo-controlled (as stated in the record) |
| Times cited | 6 / 7 | Cited 749 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 49.9 citations a year over 15 year(s) since 2013 |
| Impact for its field and year | 5 / 6 | Cited 32.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 32 other studies in this library |
| Still being cited | 3 / 4 | Cited 178 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Miguel Ángel Martínez‐González: h-index 145 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Universitat de Barcelona: institution h-index 1,049 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 10 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 23670794) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 78 / 100 | — |
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APA 7th
Martínez-Lapiscina, E. H., Clavero, P., Toledo, E., Estruch, R., Salas-Salvadó, J., San Julián, B., et al. (2013). Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of neurology, neurosurgery, and psychiatry. https://doi.org/10.1136/jnnp-2012-304792
Vancouver
Martínez-Lapiscina EH, Clavero P, Toledo E, Estruch R, Salas-Salvadó J, San Julián B, et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of neurology, neurosurgery, and psychiatry. 2013. doi:10.1136/jnnp-2012-304792. PMID: 23670794.
BibTeX
@article{martinezlapiscina2013-23670794,
author = {Martínez-Lapiscina, E. H. and Clavero, P. and Toledo, E. and Estruch, R. and Salas-Salvadó, J. and San Julián, B. and Sanchez-Tainta, A. and Ros, E. and others},
title = {{Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial}},
journal = {Journal of neurology, neurosurgery, and psychiatry},
year = {2013},
doi = {10.1136/jnnp-2012-304792},
pmid = {23670794},
url = {https://doi.org/10.1136/jnnp-2012-304792}
}
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