Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study
1 Department of Hygiene and Epidemiology, University of Athens Medical School, Athens 11527, Greece
2 Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
3 Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, Netherlands
4 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands
5 Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany
6 Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany
7 Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy
8 Epidemiology Unit, National Cancer Institute, Milan, Italy
9 Dipartimento di Medicina Clinica e Sperimentale Università Federico II, Naples, Italy
10 Cancer Registry Azienda Ospedaliera “Civile M P Arezzo,” Ragusa, Italy
11 Environmental Epidemiology, Imperial College London
12 Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
13 Andalusian School of Public Health, Granada, Spain
14 Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
15 Department of Public Health of Guipuzcoa, San Sebastian, Spain
16 Cancer Research UK Epidemiology Unit, University of Oxford
17 Medical Research Council Dunn Nutrition Unit, Cambridge
18 Clinical Gerontology, University of Cambridge
19 Equipe E3N-EPIC, Institut National de la Sante et de la Recherche Medicale, Institut Gustave Roussy, France
20 Malmo Diet and Cancer Study, Department of Medicine, Lund University, Sweden
21 Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
22 Department of Odontology, Umea University
23 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
24 Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
25 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
Accepted March 3, 2005.
Objective To examine whether adherence to the modified Mediterranean diet, in which unsaturates were substituted for monounsaturates, is associated with longer life expectancy among elderly Europeans.
Design Multicentre, prospective cohort study.
Setting Nine European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, United Kingdom).
Participants 74 607 men and women, aged 60 or more, without coronary heart disease, stroke, or cancer at enrolment and with complete information about dietary intake and potentially confounding variables.
Main outcome measures Extent of adherence to a modified Mediterranean diet using a scoring system on a 10 point scale, and death from any cause by time of occurrence, modelled through Cox regression.
Results An increase in the modified Mediterranean diet score was associated with lower overall mortality, a two unit increment corresponding to a statistically significant reduction of 8% (95% confidence interval 3% to 12%). No statistically significant evidence of heterogeneity was found among countries in the association of the score with overall mortality even though the association was stronger in Greece and Spain. When dietary exposures were calibrated across countries, the reduction in mortality was 7% (1% to 12%).
Conclusion The Mediterranean diet, modified so as to apply across Europe, was associated with increased survival among older people.