BACKGROUND: The proportion of elderly worldwide is increasing. This increase in life expectancy, is staggering posing tremendous challenges in disease burden, especially, in chronic diseases such as obesity, diabetes, hypertension, hypercholesterolemia, cancer and cardiovascular disease (CVD). Limited studies investigate the effect of Mediterranean diet on cardiovascular risk and cancer in older populations. In this review, findings from observational studies are summarized to evaluate the effect of Mediterranean diet on cancer and cardiovascular disease risk in elderly people. METHODS: Published results from observational studies that assessed food habits on cancer and cardiovascular disease risk in elderly were retrieved and summarized. RESULTS: In all studies diet had an effect on cardiovascular disease risk. The Mediterranean diet, a high-quality diet and increased fruit and vegetable consumption were all found to be cardioprotective. CONCLUSION: The systematically reviewed studies reveal that a high adherence to a Mediterranean type of diet or "prudent diet" is associated with reduced risk of CVD and some types of cancer, even in the elderly. Also dietary intervention strategies can prevent morbidity, premature mortality and improve quality of life in older persons worldwide.