The Mediterranean diet and physical activity: better together than apart for the prevention of premature mortality

Abstract

Diet and physical activity (PA) have been studied extensively in epidemiology as single or combined lifestyle factors; however, their interaction has not been studied thoroughly. Studying potential synergisms between lifestyle components with a comprehensive interaction analysis, including additive measures of interaction, provides key insights into the nature of their joint effect and helps target interventions more effectively. First, a comprehensive review was conducted to assess the potential research gap regarding reported interaction analyses conducted in studies assessing the Mediterranean diet (MedDiet) in combination with PA on all-cause mortality. Thereafter, we prospectively assessed the joint association of the MedDiet with PA on all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort, followed by both multiplicative and additive interaction analyses. The conjoint effect of low adherence to the MedDiet and low PA observed an increased risk greater than the individual risk factors, suggesting a potential additive interaction or synergism between both exposures, with relative risk due to interaction (RERI) and (95 % confidence interval (95 % CI)) = 0·46 (–0·83 to 1·75) and attributable proportion (95 % CI) due to interaction of 36 % (–0·62, 1·34). No multiplicative interacaltion was detected. Studying interactions between lifestyle factors, such as the MedDiet and PA, is particularly relevant given the current research gaps in studying the complexities of combined aspects of lifestyle in comparison with isolated behaviours. Our findings underline the important public health message of adhering to both the MedDiet and PA for the prevention of premature mortality.

A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol

“…This fact is also consistent with the recommendation of meeting with 24-h movement guidelines [ 1 , 2 ], since the current evidence suggests that these guidelines may have essential implications for health and are linked with several desirable health outcomes in young [ 65 ] and adult populations [ 6 , 7 ]. Based on the low levels of the young population meeting the 24-h movement guidelines as well as low adherence to the MedDiet (especially in this region of Spain [ 45 ]), it is clear that knowledge, awareness, and implementation of these healthy behaviors by the general population need to be improved in combination with one another for their potential synergistic effect [ 4 , 10 , 28 , 78 ].…”

Mediterranean diet and structural neuroimaging biomarkers of Alzheimer’s and cerebrovascular disease: a systematic review

“…Participants who adhere to a MedDiet are often more likely to be physically active (Alvarez-Alvarez et al, 2018;Bizzozero-Peroni, 2022). The interaction between MedDiet and physical activity has been highlighted as significant in reducing overall mortality (Alvarez-Alvarez et al, 2018;Hershey et al, 2022), suggesting it is important to look at interaction effects in outcomes such as AD and cerebrovascular disease. Poor sleep quality has been associated with higher risk for AD (Minakawa et al, 2019), with adherence to the MedDiet associated with better sleep quality (Zuraikat et al, 2020), suggesting a possible intervention opportunity to reduce AD risk.…”

Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a “Planeterranean” diet

“…However, comprehensive evidence of literature underlined how a combination of dietary and physical activity interventions would have a higher impact on health and body weight [ 239 ]. Furthermore, some studies suggested a joint synergistic effect on mortality risk of higher adherence to specifically Mediterranean diet and high physical activity addressing the current research gap regarding interaction analyses regarding these two variables [ 240 ].…”