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Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women: The HALE Project
Abstract
ContextDietary patterns and lifestyle factors are associated with mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer, but few studies have investigated these factors in combination.ObjectiveTo investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and nonsmoking on all-cause and cause-specific mortality in European elderly individuals.Design, Setting, and ParticipantsThe Healthy Ageing: a Longitudinal study in Europe (HALE) population, comprising individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women, aged 70 to 90 years in 11 European countries. This cohort study was conducted between 1988 and 2000.Main Outcome MeasuresTen-year mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer.ResultsDuring follow-up, 935 participants died: 371 from cardiovascular diseases, 233 from cancer, and 145 from other causes; for 186, the cause of death was unknown. 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) were associated with a lower risk of all-cause mortality (HRs controlled for age, sex, years of education, body mass index, study, and other factors). Similar results were observed for mortality from coronary heart disease, cardiovascular diseases, and cancer. The combination of 4 low risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44). In total, lack of adherence to this low-risk pattern was associated with a population attributable risk of 60% of all deaths, 64% of deaths from coronary heart disease, 61% from cardiovascular diseases, and 60% from cancer.ConclusionAmong 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.
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“These data have documented that healthy dietary patterns are associated with a substantially reduced risk of CVD, 4 CVD risk factors, 5,6 and noncardiovascular diseases.7”
From Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee (2006) · cites this paper as [6]
In the citing paper
“Regardless, diets rich in vegetables and fruits have been shown to lower BP and improve other CVD risk factors in short-term randomized trials.5,6,31”
From Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee (2006) · cites this paper as [6]
In the citing paper
“Replacement of some carbohydrates with either protein from plant sources or with monounsaturated fat can further lower BP.6”
From Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee (2006) · cites this paper as [6]
In the citing paper
“For example, blacks are especially sensitive to the BP-lowering effects of a reduced salt intake, increased potassium intake, and the DASH diet.6”
From Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee (2006) · cites this paper as [6]
In the citing paper
“In another study of 2,339 European men and women aged 70 to 90 years, adherence to a Mediterranean diet was associated with a 23% lower rate of all-causes mortality (20).”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [20]
In the citing paper
“A healthy lifestyle has been associated with lower risk of incident coronary events among middle-aged women 13 and lower risk of CHD mortality in a population of elderly men and women.14”
In the citing paper
“In an older Mediterranean population (70 to 90 years), risk of CHD mortality was 65% lower among participants who committed to 4 healthy lifestyle choices.14”
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Metadata
- Authors
- Knoops, K. T. B., de Groot, L. C. P. G. M., Kromhout, D., Perrin, A.-E., Moreiras-Varela, O., Menotti, A., & van Staveren, W. A.
- Affiliations
- Wageningen University & Research (NL)
- ORCID
- Menotti, Alessandro
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2004-09-22
- Volume
- 292
- Issue
- 12
- Pages
- 1433
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W84376058
- Cited by
- 146
- References
- 31
- Citations by year
- 2021: 3 · 2019: 1 · 2018: 4 · 2017: 1 · 2016: 7 · 2015: 7 · 2014: 6 · 2013: 15 · 2012: 14
- FWCI
- 12.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- Mediterranean diet, physical activity, moderate drinking, lifestyle factors, all-cause mortality, coronary artery disease, cardiovascular mortality, cancer mortality, older adults, healthy aging, population attributable risk, dietary habits, Seneca, European older adults, sex differences, educational attainment, body mass index, cardiovascular risk factors, cancer risk factors
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