Mediterranean Diet Improves Survival in Elderly

Laurie Barclay, MD

September 21, 2004

Sept. 21, 2004 — Among 70- to 90-year-olds, adherence to a Mediterranean diet and healthful lifestyle is associated with a more than 50% lower rate of all-cause and cause-specific mortality, according to the results of a cohort study published in the Sept. 22 issue of JAMA.

"Dietary patterns and lifestyle factors are associated with mortality from all causes, coronary heart disease [CHD], cardiovascular diseases [CVD], and cancer, but few studies have investigated these factors in combination," write Kim T. B. Knoops, MSc, from Wageningen University in the Netherlands, and colleagues from the Healthy Ageing: a Longitudinal study in Europe (HALE) Project. "Because of the cumulative effect of adverse factors throughout life, it is particularly important for older persons to adopt diet and lifestyle practices that minimize their risk of death from morbidity and maximize their prospects for healthful aging."

The HALE population cohort study was conducted in 11 European countries between 1988 and 2000 and followed 1,507 apparently healthy men and 832 women, aged 70 to 90 years, enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies. In this cohort, the investigators studied the association of individual and combined dietary patterns and lifestyle factors, including alcohol use, smoking status, and physical activity, with 10-year mortality from all causes, CHD, CVD, and cancer.


Of 935 participants who died during follow-up, 371 deaths were from CVD, 233 from cancer, 145 from other causes, and 186 from unknown causes. Factors associated with a lower risk of all-cause mortality, after controlling for age, sex, years of education, body mass index, study, and other pertinent factors, were adhering to a Mediterranean diet (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.68 - 0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67 - 0.91), physical activity (HR, 0.63; 95% CI, 0.55 - 0.72), and nonsmoking (HR, 0.65; 95% CI, 0.57 - 0.75).

Results were similar for mortality from CHD, CVD, and cancer. In patients with all four low-risk factors, the all-cause mortality rate was reduced to 0.35 (95% CI, 0.28 - 0.44). Lack of adherence to this low-risk pattern was associated with a population-attributable risk of 60% of all deaths, 64% of deaths from CHD, 61% from CVD, and 60% from cancer.

Study limitations include few cases with no healthful diet or lifestyle factors, and low number of deaths due to cause-specific mortality.

"Among individuals aged 70 to 90 years, adherence to a Mediterranean diet and healthful lifestyle is associated with a more than 50% lower rate of all-causes and cause-specific mortality," the authors write. "Establishing a causal relationship would require an intervention study, and the number of years an individual needs to maintain such a lifestyle to realize a benefit is unknown. However, a Mediterranean diet, rich in plant foods in combination with nonsmoking, moderate alcohol consumption, and at least 30 minutes of physical activity per day is associated with a significantly lower mortality rate, even in old age."

The European Union supported this study, based on the HALE project.

In an accompanying editorial, Eric B. Rimm, ScD, and Meir J. Stampfer, MD, DrPH, from the Harvard School of Public Health in Boston, Massachusetts, note that to be protective, healthful behaviors need not be extreme. For example, the physical activity criterion could be met by half an hour of walking daily. They also discuss a research article in the same issue showing that the Mediterranean diet is superior to a reduced-fat diet in patients with metabolic syndrome.

"Although understanding of the relation of lifestyle and health outcomes will continue to be refined, information available now is sufficient to take action," the editorialists write. "As a society, the United States spends billions on chronic disease treatments and interventions for risk factors. Although these are useful and important, a fraction of that investment to promote healthful lifestyles for primary prevention among individuals at all ages would yield greater benefit."

JAMA. 2004;292:1433-1439, 1490-1492

Reviewed by Michael W. Smith, MD


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