OBJECTIVE--To assess the influence of a specific dietary pattern on overall survival. DESIGN--Cohort study. SETTING--Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life. SUBJECTS--182 elderly residents of the three villages. MAIN OUTCOME MEASURE--Overall mortality. RESULTS--Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%). CONCLUSION--A diet meeting currently understood health criteria does predict survival among people.