Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain)

Abstract

Epidemiological studies show that adherence to a Mediterranean diet (MD) increases longevity; however, few studies are restricted to Mediterranean populations or explore the effect of a MD pattern that directly incorporates olive oil. Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The EPIC-Spain analysis included 40 622 participants (37·7 % males) aged 29-69 years who were recruited from five Spanish regions in 1992 -1996. During a mean follow-up of 13·4 years, 1855 deaths were documented: 913 from cancer, 399 from CVD, 425 from other causes and 118 from unknown causes of death. Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD (rMED) score, measured using an 18-unit scale incorporating nine selected dietary components. A high compared with a low rMED score was associated with a significant reduction in mortality from all causes (hazard ratio (HR) 0·79; 95 % CI 0·69, 0·91), from CVD (HR 0·66; 95 % CI 0·49, 0·89), but not from overall cancer (HR 0·92; 95 % CI 0·75, 1·12). A 2-unit increase in rMED score was associated with a 6 % (P, 0·001) decreased risk of all-cause mortality. A high olive oil intake and moderate alcohol consumption contributed most to this association. In this Spanish cohort, following an olive oil-rich MD was related to a significant reduction in all-cause mortality, and reduced the risk of mortality from CVD. These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries.

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

“…In agreement with our results, a Mediterranean dietary pattern was inversely associated with all‐cause mortality in the US Multiethnic Cohort,37 the US National Institutes of Health–AARP Diet and Health Study,38 Spanish cohorts,32, 39 an Italian cohort,40 the UK‐based EPIC (European Prospective Investigation of Cancer)–Norfolk study,41 a Danish cohort,42 and a cohort of elderly European men and women 43. However, there was no association of a Mediterranean‐type diet with all‐cause mortality in the UK‐based Whitehall II study 33.…”

Dietary Patterns and Total Mortality in a Mediterranean Cohort: The SUN Project

“…In contrast to the empirically-derived (or post hoc) approach, several previous studies have ascertained the association between a priori defined dietary patterns and survival among middle-aged and elderly subjects in different European countries (10)(11)(16)(17)43) and in the USA (18). Most of them (10)(11)(16)(17)(18)43) have reported inverse associations between an a priori defined Mediterranean-type diet or dietary patterns similar to the traditional Mediterranean diet and overall mortality.…”

“…Most of them (10)(11)(16)(17)(18)43) have reported inverse associations between an a priori defined Mediterranean-type diet or dietary patterns similar to the traditional Mediterranean diet and overall mortality. However, different country-specific dietary patterns have been described in Mediterranean populations and these results should be interpreted with caution.…”

“…Several studies (8)(9)(10)(11)(12)(13)(14)(15), have evaluated the effect of different dietary patterns as defined by healthy a priori scores and certain health outcomes, including total mortality (12)(13)(14)(15). Most of them have reported an inverse association between adherence to healthy dietary patterns defined a priori and overall mortality.…”

Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score

“…The updated search from recent years resulted in the identification of eighteen additional prospective studies published up to June 2013 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) . Characteristics of these recent studies are displayed in Table 3.…”