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Evidence from randomized trials and prospective cohort studies suggests that microbiome remodeling may partly mediate or modify the effects of the Mediterranean diet on adiposity, insulin resistance, lipid metabolism, inflammation, and cardiometabolic risk. However, effects are heterogeneous, global diversity metrics are inconsistent, and most studies rely on surrogate outcomes rather than incident cardiovascular events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>The gut microbiome is a plausible mediator and modifier of Mediterranean diet-related cardiovascular protection, but it is not yet a validated clinical target. Future research should prioritize longitudinal multiomic studies with repeated measures, standardized analytical pipelines, externally validated biomarkers, and pragmatic trials testing whether microbiome-informed Mediterranean diet counseling improves adherence, cardiometabolic profiles, and cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11883-026-01463-7","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:51:03Z","timestamp":1789116663000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of the Gut Microbiome in the Relationship Between the Mediterranean Diet and Cardiovascular Disease Risk"],"prefix":"10.1007","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5250-1048","authenticated-orcid":false,"given":"Adri\u00e1n","family":"Hern\u00e1ndez-Cacho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5625-0373","authenticated-orcid":false,"given":"Jiaqi","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3707-5255","authenticated-orcid":false,"given":"Jes\u00fas F.","family":"Garc\u00eda-Gavil\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0044-1263","authenticated-orcid":false,"given":"Josu\u00e9 Alberto","family":"P\u00e9rez-Acosta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0183-6902","authenticated-orcid":false,"given":"H\u00e9ctor","family":"V\u00e1zquez-Lorente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5171-9408","authenticated-orcid":false,"given":"Julio","family":"Plaza-Diaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-7459","authenticated-orcid":false,"given":"Jordi","family":"Salas-Salvad\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"issue":"8","key":"1463_CR1","doi-asserted-by":"publisher","first-page":"e41","DOI":"10.1161\/CIR.0000000000001303","volume":"151","author":"SS Martin","year":"2025","unstructured":"Martin SS, Aday AW, Allen NB, et al. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. 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