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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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InfluentialBeyond One Hundred: A Cohort Analysis of Italian Centenarians and Semisupercentenarians
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Caselli, G., Lipsi, R. M., Lapucci, E., & Vaupel, J. W. (2014) · Vienna Yearbook of Population Research · doi:10.1553/populationyearbook2013s247 · Cited by 12
“It was characterised by the patriarchal structure of the family, by the historical characteristics of high and late fertility and the persisting tendency to postpone marriage and childbearing (Livi Bacci 1977; Zei et al. 1990; Astolfi et al. 2002, 2009) and, last but not least, by an internal area, dubbed ‘Blue Zone’…”
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“Dans un souci de comparaison, il convient par conséquent de retenir un autre indicateur, l’indice de longévité, qui rapporte le nombre de personnes ayant atteint l’âge de 100 ans au sein d’une cohorte de nouveau-nés à l’effectif initial de la cohorte (Poulain et al., 2004).”
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“The population of Villagrande is being intensively studied since it was identified as a hotspot of exceptional male longevity, more specifically a place where men live as long as women do (Poulain et al., 2004, 2011).”
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“The Sardinian LBZ is in the central-eastern mountainous region of Sardinia where there is a cluster of villages in which there is a carefully documented high frequency of individuals exhibiting exceptional longevity (Poulain et al., 2004).”
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“This finding is consistent with prior investigation on the role of familial transmission among Sardinian centenarians, which examined a limited number of family trees and suggested that clustering of exceptional survival was mainly on the maternal side (Caselli et al. 2006).”
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Roli, G., Samoggia, A., Miglio, R., & Rettaroli, R. (2012) · Geospatial health · doi:10.4081/gh.2012.141 · Cited by 8
“Keywords: centenarian rate, hierarchical Bayesian models, longevity, small areas, spatial and spatio-temporal models, Italy.”
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Simões, E. J., & Ramos, L. R. (2023) · Nutrients · doi:10.3390/nu15194293 · Cited by 8
Revealing the secrets of Blue Zones
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“For instance, the diet of the generations born in the first half of twentieth century, reportedly one of the determinants of delayed aging and increased longevity recorded for these generations at the end of last century (Poulain et al. 2004) has been replaced with an unhealthier, “Western-like” diet (Pes et al.”
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Self-citationFertility History, Children’s Gender, and Post-Reproductive Survival in a Longevous Population
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“In the present study, we selected the village of Villagrande Strisaili (hereinafter referred to as Villagrande), which exhibits the highest level of longevity of the villages in the Sardinian Longevity Blue Zone (Poulain et al. 2004).”
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Individual Longevity Versus Population Longevity
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The validity of Blue Zones demography: a response to critiques
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“Since the first identification of limited areas with verified, exceptional longevity by Poulain et al. (2004), who baptized these areas “Blue Zones,” the “Blue Zone” concept is enjoying increasing attention in the scientific literature and frequently emerges in the popular press.”
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Behavioral Factors of Longevity
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“Furthermore, the institutionalized participants in our research were residents of Sassari, a small town in Sardinia, a Mediterranean island of Italy that is known for its higher prevalence of centenarians compared to Italy overall and elsewhere in the world (e.g., Poulain et al., 2004).”
BackgroundSPATIAL ANALYSIS OF THE APTITUDE TO LATE MATERNITY ON THE ISLAND OF SARDINIA
Tentoni, S., Lisa, A., Fiorani, O., Lipsi, R. M., Caselli, G., & ASTOLFI, P. (2011) · Journal of Biosocial Science · doi:10.1017/s0021932011000575 · Cited by 6
“It is interesting to note that this area matches well the ‘blue zone’ characterized by high prevalence of centenarians (Poulain et al., 2004).”
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“Among them, CH is the most direct and common index to identify extreme longevity (Magnolfi et al. 2007; Poulain et al. 2004), whereas UOI represents the general level of longevous people can either reach or achieve.”
BackgroundMaternal longevity is associated with lower infant mortality
Caselli, G., Lapucci, E., Lipsi, R. M., Pozzi, L., Baggio, G., Carru, C., Deiana, L., Franceschi, C., & Vaupel, J. W. (2014) · Demographic Research · doi:10.4054/demres.2014.31.42 · Cited by 6
“Both estimates presented higher values in internal/mountainous areas, where the Caselli et al.: Maternal longevity is associated with lower infant mortality 1286 http://www.demographic-research.org presence of centenarians was higher (Poulain et al. 2004).”
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Caruso, C., Accardi, G., Aiello, A., Calabrò, A., Zarcone, R., & Candore, G. (2025) · Journal of Gerontology and Geriatrics · doi:10.36150/2499-6564-n865 · Cited by 5
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“4 The term “blue zone” was coined by Poulain et al. 5 who arbitrarily defined it as a geographical area with a higher proportion of male centenarians compared to female centenarians (which is commonly the opposite case) in Sardinia.”
BackgroundStay social, stay young: a bioanthropological outlook on the processes linking sociality and ageing
Iannuzzi, V., Narboux‐Nême, N., Lehoczki, A., Levi, G., & Giuliani, C. (2024) · GeroScience · doi:10.1007/s11357-024-01416-5 · Cited by 6
“Similarly, Sardinians maintain robust familial bonds and social cohesion, which fosters a sense of belonging and security [118].”
Mereu, V., Costa-Saura, J. M., Antonio, T., & Spano, D. (2024) · Journal of Rural Studies · doi:10.1016/j.jrurstud.2024.103360 · Cited by 5
Adaptive Hyperactivity and Biomarker Exploration: Insights from Elders in the Blue Zone of Sardinia
Scano, A., Orrù, G., Kalcev, G., Cossu, G., Tusconi, M., Spada, M., Atzori, M., Ferreli, C., Cabitza, F., Primavera, D., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216451 · Cited by 6
“In addition to Sardinia, the “blue zones” identified were the following: the island of Okinawa, Japan; Loma Linda, California, U.S.A.; the Nicoya Peninsula in Costa Rica; and, finally, the island of Icaria, Greece [25].”
BackgroundInfluentialRegional hot spots of exceptional longevity in Germany
Klüsener, S., & Scholz, R. D. (2014) · Vienna Yearbook of Population Research · doi:10.1553/populationyearbook2013s137 · Cited by 5
“In their contributions to the debate on exceptional longevity, several scholars have noted the existence of ‘hot spots’ or ‘blue zones’ of longevity (Poulain et al. 2004), which are geographical areas with a high concentration of individuals who have survived to very high ages.”
BackgroundEnvironment and gender influences on the nutritional and health status of Korean centenarians
Park, S., Lee, Is, K., Kwak, C., & Yeo, E. (2008) · Cited by 5
Searching for longevity hotspots in Denmark
Hansen, A. V., Mortensen, L. H., & Westendorp, R. G. J. (2018) · Aging · doi:10.18632/aging.101579 · Cited by 5
Late reproduction at lower risk in Sardinia island: a case of reproductive longevity?
Astolfi, P., Pasquale, A. D., & Zonta, L. A. (2008) · PubMed · Cited by 5
Soriano, J. B., Vázquez, S. F., Carretero, S., González, M. D. P., Soriano, C., Romaguera, D., Alonso‐Fernández, A., Busquets, X., Balcells, S., Grinberg, D., et al. (2013) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.12148 · Cited by 5
Self-citationDIFFERENTIAL MORTALITY IN A LONG-LIVING COMMUNITY IN SARDINIA (ITALY): A COHORT ANALYSIS
Salaris, L. (2014) · Journal of Biosocial Science · doi:10.1017/s0021932014000224 · Cited by 5
“Important differences have been observed in Sardinia in the proportion of recorded centenarians and the possible role of specific causes of death (Caselli & Lipsi, 2006), in their geographical distribution (Poulain et al., 2004; Gatti & Salaris, 2004; Orrù, 2011) and in the sex ratio (Passarino et al.”
BackgroundFloris, P., Dore, M. P., & Pes, G. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245006 · Cited by 5
Self-citationHealth-Promoting Nature-Based Paradigms in Urban Planning
Grahn, P., Stoltz, J., Skärbäck, E., & Bengtsson, A. R. (2023) · Encyclopedia · doi:10.3390/encyclopedia3040102 · Cited by 8
Pes, G. M., Errigo, A., & Dore, M. P. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175322 · Cited by 6
Self-citationLipsi, R. M., Caselli, G., Pozzi, L., Baggio, G., Carru, C., Franceschi, C., Vaupel, J. W., & Deiana, L. (2015) · Demographic Research · doi:10.4054/demres.2015.32.37 · Cited by 4
“This latter area comprises municipalities in Oristano as well as Nuoro where the standardized death rate across old ages for men is less than 10% higher than for women, whereas elsewhere in the two provinces the standardized male death rate is more than 30% higher (Caselli and Lipsi 2006).”
BackgroundInfluentialSelf-citationEchocardiographic evaluation of centenarians in Trieste
Cannata, A. N., Gentile, P., Paldino, A., Nuzzi, V., Camparini, L., Ciucci, G., Manca, P., Artico, J., Ferro, M. D., Marcon, G., et al. (2020) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000000984 · Cited by 4
Geospatial clustering of suicide mortality in Sardinia
Lorettu, L., Nivoli, A., Bellizzi, S., Piu, D., Meloni, R., Dore, M. P., & Pes, G. M. (2021) · Current Psychology · doi:10.1007/s12144-021-02448-2 · Cited by 4
“Furthermore, the population examined appeared to have a higher average age and a proportion of elderly individuals higher than the national standard (Poulain et al. 2004).”
BackgroundSelf-citationGenetics, Lifestyles, Environment and Longevity: A Look in a Complex Phenomenon
Roberto, P., & Rita, P. D. (2017) · Open Access Journal of Gerontology & Geriatric Medicine · doi:10.19080/oajggm.2017.02.555576 · Cited by 4
Długowieczność i zmiany maksymalnego trwania życia – wyzwania dla statystyki
Wróblewska, W. (2012) · Wiadomości Statystyczne The Polish Statistician · doi:10.59139/ws.2012.11.1 · Cited by 4
Consanguinity and Late Fertility: Spatial Analysis Reveals Positive Association Patterns
Lisa, A., Astolfi, P., Zei, G., & Tentoni, S. (2014) · Annals of Human Genetics · doi:10.1111/ahg.12092 · Cited by 4
“…an area of refuge for Sardinian people from past invasions (Contini et al., 1989; Cappello et al., 1996; Zei et al., 2003); (iii) it mostly overlaps zones already known for a high frequency of centenarians (Poulain et al., 2004), and reproductive/ postreproductive longevity (Tentoni et al., 2012).”
BackgroundAre 20th-century recommendations for growth and height correct? A review
Samaras, T. (2009) · South African Journal of Clinical Nutrition · doi:10.1080/16070658.2009.11734245 · Cited by 4
Pes, G. M., & Poulain, M. (2016) · Springer eBooks · doi:10.1007/978-981-287-080-3_144-1 · Cited by 4
Self-citationPreventing Functional Decline with Age: Biomarkers and Best PracticesPreprint
Halma, M. T. J., & Marik, P. E. (2024) · Preprints.org · doi:10.20944/preprints202403.0667.v1 · Cited by 3
Ortiz, M., Wischnewsky, M. B., Jeitler, M., Brinkhaus, B., Michalsen, A., Hoffmann, R., & Keßler, C. S. (2025) · BMC Public Health · doi:10.1186/s12889-025-23908-5 · Cited by 4
“Diets including fish, such as the Mediterranean Diet, are prevalent in “Blue Zones” such as Japan (Okinawa), Greece (Ikaria island), Italy (Sardinia), and Costa Rica (Nicoya), and are often associated with increased longevity [38].”
Abbondio, M., Palomba, A., Serra, M., Fraumene, C., Meo, C. D., Marongiu, F., Sau, R., Pagnozzi, D., Laconi, E., Tanca, A., et al. (2025) · BMC Microbiology · doi:10.1186/s12866-025-04333-5 · Cited by 4
“Notably, the Ogliastra and Bar-bagia territories are included within the Blue Zones [16], i.e., the regions with the highest life expectancy values in the world.”
A Critical Analysis of Klaus Schwab’s Concept of the Fourth Industrial Revolution
Kushnir, A. M., & KUSHNIR, A. A. (2023) · Sociopolitical sciences · doi:10.33693/2223-0092-2023-13-4-105-124 · Cited by 3
Goldsby, T. L., Goldsby, M. E., Haines, M., Marrapodi, C., Galdós, J. S., Chopra, D., & Mills, P. J. (2021) · Journal of Public Health Issues and Practices · doi:10.33790/jphip1100180 · Cited by 3
“Certain cultures and communities, such as those in Sardinia, Italy, have been found to have exceptionally long-lived citizens and comparatively lower levels of chronic disease [91], as well as lower levels of depressive symptomology and higher levels of perceived wellbeing [92].”
Background
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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