Mittelmeerkost plus Bewegung: zwei belegte Hebel, aber kein belegter Bonus

<h4>Background</h4>Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. The Mediterranean diet (MD) and regular physical activity are established components of cardiovascular prevention, but evidence regarding their combined cardiometabolic effects remains heterogeneous.<h4>Objective</h4>This narrative review critically summarizes current evidence on the joint role of the MD and physical exercise in cardiometabolic health.<h4>Methods</h4>A structured literature search was conducted in PubMed, Web of Science, and Scopus using terms related to the MD, CVD, cardiometabolic health, physical activity, and exercise. Experimental and observational human studies published between 2016 and 2026 were considered, together with relevant systematic reviews and meta-analyses. Particular attention was given to 10 key human studies, including randomized intervention studies and observational cohorts. Owing to substantial heterogeneity in populations, interventions, comparators, follow-up periods, and outcomes, the evidence was synthesized narratively.<h4>Results</h4>The key studies generally reported favorable changes in body weight and composition, blood pressure, glucose regulation, and lipid profiles. One observational study also found a lower likelihood of cardiovascular medication initiation among participants with sustained adherence to both lifestyle components. However, most outcomes were surrogate cardiometabolic markers, and the independent eff

Since the 1950s, when Ancel Keys popularized the traditional Mediterranean diet, an immense accrual of large and valid studies, including prospective cohort studies, randomized controlled trials (RCT), and systematic reviews, have been conducted to investigate the potential health benefits related to this dietary pattern. The available evidence shows that the traditional Mediterranean diet represents a sustainable, healthy, and highly palatable pattern with a wide array of associated health benefits. In particular, its protective effects on cardiovascular disease have been supported by several consistent large RCTs, namely, the Lyon Diet-Heart Study, PREDIMED, PREDIMED-Plus and CORDIOPREV. The traditional Mediterranean diet is not a vegetarian diet, but it emphasizes the preferential consumption of minimally processed plant-based foods: fruits, vegetables, whole-grain cereals, legumes, and tree nuts. Its unique components-different from other healthy, plant-based, food patterns-are extra-virgin olive oil as the main source of fat (keeping a high monounsaturated-to-saturated fat ratio), a high consumption of tree nuts, and low-to-moderate consumption of red wine with meals. However, the inclusion of an alcoholic beverage in a healthy diet is becoming increasingly controversial. An ongoing RCT, the University of Navarra Alumni Trialist Initiative (UNATI), aims to answer this question in 10 000 drinkers. In addition to conventional epidemiologic studies, metabolomics techniques