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Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study
Open accessAbstract
High prevalence and low female/male ratio for validated centenarians are observed in Sardinia and these findings appear to be thus far unique to this island. Moreover a specific region on the island is characterized by exceptional male longevity. We calculated the extreme longevity index (ELI), defined as the percentage of persons born in Sardinia between 1880 and 1900, who became centenarians. A gaussian smoothing method was used in order to identify the so-called 'Blue Zone', where longevity is concentrated in the central-eastern part of the island and covers all the mountainous areas of central Sardinia. The estimated life expectancy in the 'Blue Zone' is longer than in the remaining territory of the island especially for men and the male to female ratio among centenarians born in this area is 1.35 compared to 2.43 in the rest of Sardinia. The specific mechanism by which persons living in this territory were more likely to reach extreme longevity remains unknown but it is interesting to note that most of the 'longevity hot spots' identified in various regions of the world over the years have been located in mountainous geographical areas even if none of these longevity regions have been fully validated. An alternative and interesting hypothesis is that the high rate of inbreeding determined by frequent marriages between consanguineous individuals and low immigration rates have progressively decreased the variability of the genetic pool and facilitated the emergence of genetic characteristics that protect individuals from diseases that are major causes of mortality particularly in older individuals. Given the exceptionally high prevalence of male centenarians in the 'Blue Zone', it is reasonable to assume that either the environmental characteristics or the genetic factors, or both, exert their favorable effect more strongly in men than in women. Thus, the mechanism involved may be modulated by the hormonal milieu, or may be associated with genes located in the sex chromosomes.
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Citations
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BackgroundCognitive and neuroscientific perspectives of healthy ageing
Prince, J. B., Davis, H. L., Tan, J., Muller-Townsend, K. L., Markovic, S. J., Lewis, D. M. G., Hastie, B., Thompson, M. B., Drummond, P. D., Fujiyama, H., et al. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105649 · Cited by 77
“For example, those living in regions characterised by a high frequency of centenarians, known as Blue Zones (Fastame et al., 2021; Poulain et al., 2004), demonstrate more favourable outcomes on a variety of health indicators, such as life expectancy and cognitive decline, compared to other…”
On the age validation of supercentenarians
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“, the inhabitants of the Nuoro Province, have a higher longevity than the Italian average, stimulating numerous studies on the genetic factors (Deiana et al., 1999; Franceschi et al., 2000; Passarino et al., 2002; Poulain et al., 2004).”
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Melis, M., Errigo, A., Crnjar, R., Pes, G. M., & Barbarossa, I. T. (2019) · Scientific Reports · doi:10.1038/s41598-019-54604-1 · Cited by 58
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“This study is very interesting because it analyzed the lifestyle of very old adults living in the Ikaria LBZ.”
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“Despite the challenges associated with evaluating these community-based interventions, when one considers the extant data (Buettner, 2009; Poulain et al., 2004) on longevity and well-being, those societies that produce the most centenarians feature some combination of the following attributes: strong families and comm…”
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“Yet, in Sardinia, one of the blue zones with an exceptional high centenarian prevalence, the gender ratio in age-validated cases is also balanced [6].”
BackgroundCentenarians as a model to discover genetic and epigenetic signatures of healthy ageing
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Biomarkers of aging: from molecules and surrogates to physiology and function
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The unusual genetics of human longevity
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Self-citationSpecific features of the oldest old from the Longevity Blue Zones in Ikaria and Sardinia
Poulain, M., Herm, A., Errigo, A., Chrysohoou, C., Legrand, R., Passarino, G., Stazi, M. A., Voutekatis, K. G., Gonos, E. S., Franceschi, C., et al. (2021) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2021.111543 · Cited by 54
Self-citationA Population Where Men Live As Long As Women: Villagrande Strisaili, Sardinia
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“Based on these validation results, an area with significantly higher levels of longevity and lower F/M ratio among centenarians has been identified in the central-eastern part of the island and was called the Blue Zone [16].”
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“The central-eastern part of Sardinia, Italy, corresponding to the historical subregions of Ogliastra and Barbagia, at latitude North of 39◦55′ and longitude East 9◦31′, was among the first high-longevity areas to be identified worldwide [23] during a comprehensive validation process of the age of Sardinian centenarian…”
BackgroundSelf-citationA user-centred virtual city information model for inclusive community design: State-of-art
Najafi, P., Mohammadi, M., van Wesemael, P. J. V., & Blanc, P. M. L. (2023) · Cities · doi:10.1016/j.cities.2023.104203 · Cited by 52
Height and Survival at Older Ages among Men Born in an Inland Village in Sardinia (Italy), 1866–2006
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“From a demographic point of view, this population belongs to the Blue Zone—an area with higher longevity compared to the rest of the island and mainland Italy (Poulain et al. 2004).”
BackgroundInfluentialSelf-citationExploring the impact of climate on human longevity
Robine, J., Herrmann, F. R., Arai, Y., Willcox, D. C., Gondo, Y., Hirose, N., Suzuki, M., & Saito, Y. (2012) · Experimental Gerontology · doi:10.1016/j.exger.2012.05.009 · Cited by 50
Activity of mannose‐binding lectin in centenarians
Tomaiuolo, R., Ruocco, A., Salapete, C., Carru, C., Baggio, G., Franceschi, C., Zinellu, A., Vaupel, J. W., Bellia, C., Sasso, B. L., et al. (2012) · Aging Cell · doi:10.1111/j.1474-9726.2012.00793.x · Cited by 47
“We have a complete computerized clinical record for each subject, within the frame of the AKea study (Deiana et al., 1999; Poulain et al., 2004) chaired by Prof.”
Self-citationWang, S., Luo, K., Liu, Y., Zhang, S., Lin, X.-X., Ni, R., Tian, X., & Gao, X. (2015) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2015.03.004 · Cited by 47
“The proportion of centenarians was an important indicator of longevity (Poulain et al., 2004; Rosero-Bixby, 2008; Stefanadis, 2010; Willcox, Willcox, Hsueh, & Suzuki, 2006).”
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Zábó, V., Csiszár, A., Ungvari, Z. I., & Purebl, G. (2023) · GeroScience · doi:10.1007/s11357-023-00856-9 · Cited by 54
Centenarians and diet: what they eat in the Western part of Sicily
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“Buettner D: The Blue Zone: Lessons for living longer from the people who’ve lived the longest.”
BackgroundResultSurvival differences among the oldest old in Sardinia: who, what, where, and why?
Caselli, G., & Lipsi, R. M. (2006) · Demographic Research · doi:10.4054/demres.2006.14.13 · Cited by 44
“At municipal level, a 2001 analysis on Sardinians born between 1880 and 1900 as part of the AKEA1 11 project (Poulain et al. 2004) showed that the area with the highest 11 AKEA1 is the first project of the study on Sardinian centenarian, directed by Luca Deiana, Sassari University.”
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“This hypothesis may be strengthened by the fact that pastoralism was often an important male activity in the areas where extreme longevity was found [61], yet, other factors should be preponderant, as other pastoral societies do not share this exceptional male longevity.”
BackgroundMadrigal-Leer, F., Martìnez-Montandòn, A., Solìs-Umaña, M., Helo-Guzmàn, F., Salas, K. I. A., Barrientos-Calvo, I., Camacho-Mora, Z., Jimènez-Porras, V., Estrada-Montero, S., & Morales‐Martínez, F. (2019) · Aging Clinical and Experimental Research · doi:10.1007/s40520-019-01176-9 · Cited by 42
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“If we consider [16,17], one may wonder if this difference could be related to specific genetic factors, whose variability have progressively decreased due to low immigration rates and facilitated the emergence of specific genetic characteristics that either do not predispose towards or might actually protect from dise…”
BackgroundFigueroa, C., Echeverría, G., Villarreal, G. A., Martínez, X., Catterina Ferreccio, R., & Rigotti, A. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.680452 · Cited by 39
Exceptional Longevity in Okinawa:
Poulain, M. (2011) · Demographic Research · doi:10.4054/demres.2011.25.7 · Cited by 38
“, the Caucasus, Ecuador, and Pakistan, have been found to be invalid (Jeune and Kannisto 1997), except for Sardinia, where males have been proven to live significantly longer in the mountainous populations (Poulain et al. 2004).”
BackgroundSelf-citationKheirbek, R., Fokar, A., Shara, N. M., Bell‐Wilson, L. K., Moore, H. J., Olsen, E. J., Blackman, M. R., & Llorente, M. D. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14900 · Cited by 40
Spatio-temporal distribution of human lifespan in China
Wang, S., Luo, K., & Liu, Y. (2015) · Scientific Reports · doi:10.1038/srep13844 · Cited by 40
Montesanto, A., Rango, F. D., Pirazzini, C., Guidarelli, G., Domma, F., Franceschi, C., & Passarino, G. (2017) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2017.04.008 · Cited by 39
Self-citationPes, G. M., Poulain, M., Errigo, A., & Dore, M. P. (2021) · Nutrients · doi:10.3390/nu13051495 · Cited by 35
“Among these communities, one is located in the innermost area of the Mediterranean island of Sardinia, where the number of age-validated centenarians, especially males, is remarkably high [13].”
BackgroundSelf-citationMore to Blue Zones than long life: positive psychological characteristics
Hitchcott, P. K., Fastame, M. C., & Penna, M. P. (2018) · Health Risk & Society · doi:10.1080/13698575.2018.1496233 · Cited by 33
“With respect to the Sardinian Blue Zone, some researchers have speculated that unusual psychological characteristics, related to exceptional longevity, increased functional status or increased quality of life, may also be present (Poulain et al., 2013; 2004).”
BackgroundCentenarians in Tuscany: The role of the environmental factors
Magnolfi, S. U., Noferi, I., Petruzzi, E., Pinzani, P., Malentacchi, F., Pazzagli, M., Antonini, F. M., & Marchionni, N. (2008) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2008.02.002 · Cited by 32
“Lucca Province has the highest CI% (2.29), and the highest sex ratio (18.20), while in Sardinia, in Nuoro Province, that is the most longevous area, centenarian male have the same frequency than female ones (Poulain et al., 2004).”
BackgroundInfluentialAnalysis of Physical Activity Among Free–Living Nonagenarians From a Sardinian Longevous Population
Pes, G. M., Dore, M. P., Errigo, A., & Poulain, M. (2017) · Journal of Aging and Physical Activity · doi:10.1123/japa.2017-0088 · Cited by 32
“…in an inland area considered a Longevity Blue Zone (LBZ) where an exceptional life expectancy among men was described more than a decade ago (Poulain et al., 2004); (ii) until recently, this population practiced agriculture or animal husbandry, occupations both entailing high levels of…”
BackgroundSelf-citationDietary polyphenols as geroprotective compounds: From Blue Zones to hallmarks of ageing
Davinelli, S., Medoro, A., Hu, F. B., & Scapagnini, G. (2025) · Ageing Research Reviews · doi:10.1016/j.arr.2025.102733 · Cited by 34
Life satisfaction and social desirability across the late life span: What relationship?
Fastame, M. C., Penna, M. P., & Hitchcott, P. K. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0750-4 · Cited by 31
“Overall, in agreement with previous studies [16, 17], it is plausible to hypothesise that Sardinian elderly people are a specific subpopulation showing not only high longevity, but also the highest levels of LS compared with further Italian older groups.”
ResultFastame, M. C., & Penna, M. P. (2013) · Aging & Mental Health · doi:10.1080/13607863.2013.866635 · Cited by 31
“…were recruited at Grontardo, in northern Italy, and in four villages of the Sardinian province of Ogliastra (i.e. Arzana, Ilbono, Lanusei and Villagrande Strisaili), which have been studied in the past because of the extraordinary longevity of their inhabitants (e.g. Poulain et al., 2004).”
BackgroundMontesanto, A., Latorre, V., Giordano, M., Martino, C., Domma, F., & Passarino, G. (2011) · European Journal of Human Genetics · doi:10.1038/ejhg.2011.40 · Cited by 30
Maier, H., Jeune, B., & Vaupel, J. W. (2020) · Demographic research monographs · doi:10.1007/978-3-030-49970-9 · Cited by 33
Religious and Nonreligious Spirituality in Relation to Death Acceptance or Rejection
Cicirelli, V. G. (2011) · Death Studies · doi:10.1080/07481187.2011.535383 · Cited by 29
“…world indicate that many people living to 100 or beyond are very healthy and show little evidence of major illnesses such as cancer, coronary disease, and the like (Hagberg & Samuelsson, 2008; Poulain et al., 2004; Robine & Vaupel, 2002; D. C. Willcox, Wilcox, Shimajiri, Kurechi, & Suzuki, 2007).”
BackgroundHitchcott, P. K., Fastame, M. C., Ferrai, J., & Penna, M. P. (2017) · Europe’s Journal of Psychology · doi:10.5964/ejop.v13i3.1416 · Cited by 29
“Sixty-three cognitively healthy community dwelling adults were recruited in twenty-one families residing in Arzana, a small village (i.e., approximate population 2500) located in the Sardinian ‘blue zone’ area of Ogliastra (Poulain et al., 2004), which is known for the longevity of its inhabitants and their successful…”
BackgroundInfluentialPes, G. M., Errigo, A., Tedde, P., & Dore, M. P. (2019) · Rejuvenation Research · doi:10.1089/rej.2018.2129 · Cited by 29
Self-citationMontesanto, A., Passarino, G., Senatore, A., Carotenuto, L., & BENEDICTIS, G. D. (2007) · Annals of Human Genetics · doi:10.1111/j.1469-1809.2007.00405.x · Cited by 28
“Of note, the F/M ratio in nonagenarians of this area is significantly lower than the regional value (1.19 vs 1.98; p<0.001) and closer to the value (1.35) observed in centenarians of a mountainous area of the central-eastern part of the Sardinia island (Poulain et al. 2004).”
BackgroundResultInfluentialAliberti, S. M., & Capunzo, M. (2025) · Nutrients · doi:10.3390/nu17040722 · Cited by 29
“The concept of Blue Zones [145]—geographically distinct regions where populations exhibit exceptional longevity [146,147]—has a tt racted signi fi cant scienti fi c interest for its potential to uncover pathways to healthy aging. gradual nature of health deterioration allows for targeted…”
Diana, M. G., Mascia, M. L., Tomczyk, Ł., & Penna, M. P. (2025) · Sustainability · doi:10.3390/su17041718 · Cited by 33
Dementia-Free Survival Among Centenarians: An Evidence-Based Review
Calvert, J. F., Hollander-Rodriguez, J. C., Kaye, J. A., & Leahy, M. (2006) · The Journals of Gerontology Series A · doi:10.1093/gerona/61.9.951 · Cited by 27
“All the studies in Table 3 found more female than male centenarians, although in Sardinia (41,48) and among the Uygur people of China (44) the proportion of men is higher.”
BackgroundMental Health in Late Adulthood: What Can Preserve It?
Fastame, M. C., Penna, M. P., & Hitchcott, P. K. (2014) · Applied Research in Quality of Life · doi:10.1007/s11482-014-9323-5 · Cited by 26
Nutritional status in the healthy longeval population from Sardinia (Italy)
Buffa, R., Floris, G., Lodde, M., Cotza, M., & Marini, E. (2010) · The journal of nutrition health & aging · doi:10.1007/s12603-010-0018-9 · Cited by 26
“The high frequency of extremely old people has been attributed to predisposing or protective genetic factors (10-18), although the environment and culture might also play a role (15).”
Fastame, M. C., Mulas, I., & Pau, M. (2020) · International Psychogeriatrics · doi:10.1017/s1041610220001659 · Cited by 29
“There is evidence that one of the five Blue Zones is in the central–eastern region of Sardinia, an Italian island located in theMediterranean Sea, where the number of male centenarians is very similar to that of women (Poulain et al., 2004).”
BackgroundVegan Nutrition: Latest Boom in Health and Exercise
Wirnitzer, K. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-814625-5.00020-0 · Cited by 28
Diet and longevity: The effects of traditional eating habits on human lifespan extension
Caprara, G. (2018) · Mediterranean Journal of Nutrition and Metabolism · doi:10.3233/mnm-180225 · Cited by 24
“Therefore, it is not surprising that one of the world’s longest-living populations is represented by the vegetarians from the Seventh-day Adventist community of Loma Linda in California, a group of about 9000 people living in the core of the United States’ “Blue Zone” region [12, 13].”
BackgroundInfluentialFastame, M. C., Ruiu, M., & Mulas, I. (2021) · Journal of Religion and Health · doi:10.1007/s10943-021-01261-2 · Cited by 32
“In the Sardinian Blue Zone, a high proportion of shepherds preserving their cultural traditions and being more resistant to change live and the highest gender-balanced presence of centenarians in the world has been experimentally validated (Pes et al., 2015; Poulain et al., 2004).”
BackgroundFastame, M. C., Penna, M. P., & Rossetti, E. S. (2014) · Journal of Adult Development · doi:10.1007/s10804-014-9189-7 · Cited by 25
Ribeiro, A. I., Krainski, E. T., Carvalho, M. S., & de Pina, M. D. F. (2016) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2015-206827 · Cited by 25
Aliberti, S. M., Donato, A., Funk, R. H. W., & Capunzo, M. (2024) · Nutrients · doi:10.3390/nu16050729 · Cited by 25
The Less We Eat, the Longer We Live: Can Caloric Restriction Help Us Become Centenarians?
Dakic, T. B., Jevdjovic, T. V., Vujovic, P. Z., & Mladenović, A. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23126546 · Cited by 25
“[34] Sardinian population/AKEA study Identification of Sardinia island as an area characterized by extreme longevity [18] Blue Zones Blue Zones as areas of exceptional longevity [19] Greek Adults/EPIC Study Hypertension in the Greek general population [17] NA Worldwide demography of centenarians”
BackgroundPersonality Traits and Circadian Blood Pressure Patterns
Terracciano, A., Strait, J., Scuteri, A., Meirelles, O., Sutin, A. R., Tarasov, K. V., Ding, J., Marongiu, M., Orrù, M., Pilia, M. G., et al. (2014) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000035 · Cited by 24
“The population in this rural region is characterized by a relatively low level of genetic admixture and a high proportion of long-lived individuals (33).”
BackgroundManaging a tourism destination as a viable complex system. The case of Arbatax Park
Iandolo, F., Fulco, I., Bassano, C., & D’Amore, R. (2019) · Land Use Policy · doi:10.1016/j.landusepol.2019.02.019 · Cited by 22
Ganau, A., Orrù, M., Floris, M., Saba, P. S., Loi, F., Sanna, G. D., Marongiu, M., Balaci, L., Curreli, N., Ferreli, L. A. P., et al. (2023) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwad254 · Cited by 22
Ribeiro, A. I., Krainski, E. T., Carvalho, M. S., & de Pina, M. D. F. (2017) · Geospatial health · doi:10.4081/gh.2017.581 · Cited by 22
“This and similar indicators are straightforward and understandable metrics to estimate survival at advanced ages in small areas, which solely require a time series of population census data (Poulain et al., 2004; Magnolfi et al., 2007; Ribeiro et al., 2016b).”
BackgroundAccardi, G., Aprile, S., Candore, G., Caruso, C., Cusimano, R., Cristaldi, L., Bona, D. D., Duro, G., Galimberti, D., Gambino, C. M., et al. (2019) · Current Pharmaceutical Design · doi:10.2174/1381612825666190313115233 · Cited by 22
SME network relationships and competitive strategies in the agri-food sector
Camanzi, L., & Giua, C. (2020) · European Business Review · doi:10.1108/ebr-08-2019-0150 · Cited by 21
Metadata
- Authors
- Poulain, M., Pes, G. M., Grasland, C., Carru, C., Ferrucci, L., Baggio, G., Franceschi, C., & Deiana, L.
- Affiliations
- UCLouvain (BE)
- University of Sassari (IT)
- UMR Géographie-cités (FR)
- National Institute on Aging (US)
- University of Padua (IT)
- Istituto Nazionale di Riposo e Cura per Anziani (IT)
- Corresponding author
- Poulain, Michel
- ORCID
- Venue
- Experimental Gerontology
- Publisher
- Elsevier BV
- Published
- 2004-09
- Volume
- 39
- Issue
- 9
- Pages
- 1423-1429
- ISSN
- 0531-5565 (ISSN-L)
- OpenAlex
- W2030134966
- Cited by
- 286
- References
- 10
- Citations by year
- 2026: 16 · 2025: 28 · 2024: 21 · 2023: 12 · 2022: 20 · 2021: 19 · 2020: 15 · 2019: 20 · 2018: 12 · 2017: 20 · 2016: 7 · 2015: 11 · 2014: 15 · 2013: 7 · 2012: 10
- FWCI
- 18.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Experimental Gerontology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- DIAL (Catholic University of Leuven) (submittedVersion)
- UnissResearch (Università degli Studi di Sassari) (submittedVersion)
- Funders
- Regione Autonoma della Sardegna
- Max-Planck-Institut für demografische Forschung
- National Institutes of Health
- National Cancer Institute (03-SC-NIH-1027)
- Topics
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Aging › Genetics, Aging, and Longevity in Model Organisms
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- exceptional longevity, centenarians, Blue Zones, Sardinia, male longevity, life expectancy, inbreeding, consanguinity, mountainous terrain, sex differences in aging
- MeSH terms
- Aged, Aged, 80 and over, Consanguinity, Female, Geography, Humans, Italy, Life Expectancy, Longevity, Male, Sex Factors, Sex Ratio
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