Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study

doi:10.1136/bmj.38415.644155.8F

BMJ 2005;330:991 (30 April), doi:10.1136/bmj.38415.644155.8F (published 8 April 2005)

Paper

Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study

Antonia Trichopoulou, associate professor¹, Philippos Orfanos, senior biostatistician¹, Teresa Norat, epidemiologist², Bas Bueno-de-Mesquita, project director diet and chronic diseases³, Marga C Ocké, project director food consumption surveys³, Petra HM Peeters, associate professor⁴, Yvonne T van der Schouw, associate professor⁴, Heiner Boeing, chair⁵, Kurt Hoffmann, senior scientist⁵, Paolo Boffetta, chief⁶, Gabriele Nagel, physician⁶, Giovanna Masala, medical epidemiologist⁷, Vittorio Krogh, medical epidemiologist⁸, Salvatore Panico, senior researcher⁹, Rosario Tumino, director¹⁰, Paolo Vineis, chair¹¹, Christina Bamia, chief biostatistician¹, Androniki Naska, lecturer¹, Vassiliki Benetou, medical epidemiologist¹, Pietro Ferrari, statistician², Nadia Slimani, nutritionist², Guillem Pera, biostatistician¹², Carmen Martinez-Garcia, researcher¹³, Carmen Navarro, head¹⁴, Miguel Rodriguez-Barranco, statistician¹⁴, Miren Dorronsoro, vice director¹⁵, Elizabeth A Spencer, nutritionist¹⁶, Timothy J Key, professor¹⁶, Sheila Bingham, deputy director¹⁷, Kay-Tee Khaw, professor¹⁸, Emmanuelle Kesse, researcher¹⁹, Francoise Clavel-Chapelon, research director¹⁹, Marie-Christine Boutron-Ruault, research director¹⁹, Goran Berglund, professor²⁰, Elisabet Wirfalt, associate professor²⁰, Goran Hallmans, head of unit of nutritional research²¹, Ingegerd Johansson, head of dental school²², Anne Tjonneland, head²³, Anja Olsen, research assistant²³, Kim Overvad, research director²⁴, Heidi H Hundborg, senior biostatistician²⁴, Elio Riboli, head², Dimitrios Trichopoulos, professor²⁵

¹ Department of Hygiene and Epidemiology, University of Athens Medical School, Athens 11527, Greece, ² Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France, ³ Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, Netherlands, ⁴ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands, ⁵ Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany, ⁶ Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany, ⁷ Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy, ⁸ Epidemiology Unit, National Cancer Institute, Milan, Italy, ⁹ Dipartimento di Medicina Clinica e Sperimentale Università Federico II, Naples, Italy, ¹⁰ Cancer Registry Azienda Ospedaliera "Civile M P Arezzo," Ragusa, Italy, ¹¹ Environmental Epidemiology, Imperial College London, ¹² Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain, ¹³ Andalusian School of Public Health, Granada, Spain, ¹⁴ Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain, ¹⁵ Department of Public Health of Guipuzcoa, San Sebastian, Spain, ¹⁶ Cancer Research UK Epidemiology Unit, University of Oxford, ¹⁷ Medical Research Council Dunn Nutrition Unit, Cambridge, ¹⁸ Clinical Gerontology, University of Cambridge, ¹⁹ Equipe E3N-EPIC, Institut National de la Sante et de la Recherche Medicale, Institut Gustave Roussy, France, ²⁰ Malmo Diet and Cancer Study, Department of Medicine, Lund University, Sweden, ²¹ Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden, ²² Department of Odontology, Umea University, ²³ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark, ²⁴ Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark, ²⁵ Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Correspondence to: A Trichopoulou antonia{at}nut.uoa.gr

Objective To examine whether adherence to the modified Mediterraneandiet, in which unsaturates were substituted for monounsaturates,is associated with longer life expectancy among elderly Europeans.

Design Multicentre, prospective cohort study.

Setting Nine European countries (Denmark, France, Germany, Greece,Italy, the Netherlands, Spain, Sweden, United Kingdom).

Participants 74 607 men and women, aged 60 or more, withoutcoronary heart disease, stroke, or cancer at enrolment and withcomplete information about dietary intake and potentially confoundingvariables.

Main outcome measures Extent of adherence to a modified Mediterraneandiet using a scoring system on a 10 point scale, and death fromany cause by time of occurrence, modelled through Cox regression.

Results An increase in the modified Mediterranean diet scorewas associated with lower overall mortality, a two unit incrementcorresponding to a statistically significant reduction of 8%(95% confidence interval 3% to 12%). No statistically significantevidence of heterogeneity was found among countries in the associationof the score with overall mortality even though the associationwas stronger in Greece and Spain. When dietary exposures werecalibrated across countries, the reduction in mortality was7% (1% to 12%).

Conclusion The Mediterranean diet, modified so as to apply acrossEurope, was associated with increased survival among older people.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Relevant Articles

Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study: M Á Martínez-González, C de la Fuente-Arrillaga, J M Nunez-Cordoba, F J Basterra-Gortari, J J Beunza, Z Vazquez, S Benito, A Tortosa, and M Bes-Rastrollo
BMJ 2008 336: 1348-1351. [Abstract] [Full Text] [PDF]

Cardiovascular risk factors in Croatia: struggling to provide the evidence for developing policy recommendations: Josipa Kern, Marija Strnad, Tanja Coric, and Silvije Vuletic
BMJ 2005 331: 208-210. [Extract] [Full Text] [PDF]

Modified Mediterranean diet and survival: Evidence for diet linked longevity is substantial: Emanuele Cereda, Alexis E Malavazos, Carla Favaro, and Anna M Pagani
BMJ 2005 330: 1329. [Extract] [Full Text] [PDF]

Mediterranean diet does prolong life
BMJ 2005 330: 0. [Full Text]

Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study: Patricia Huijbregts, Edith Feskens, Leena Räsänen, Flaminio Fidanza, Aulikki Nissinen, Alessandro Menotti, and Daan Kromhout
BMJ 1997 315: 13-17. [Abstract] [Full Text]

Diet and overall survival in elderly people: Antonia Trichopoulou, Antigone Kouris-Blazos, Mark L Wahlqvist, Charalambos Gnardellis, Pagona Lagiou, Evangelos Polychronopoulos, Tonia Vassilakou, Loren Lipworth, and Dimitrios Trichopoulos
BMJ 1995 311: 1457-1460. [Abstract] [Full Text]

This article has been cited by other articles:

Brunner, E., Witte, D., Shipley, M., Marmot, M., Mosdol, A., Martikainen, P. (2008). Reply to K Esposito and D Giugliano. Am. J. Clin. Nutr. 88: 1180-1181 [Full text]
Fortes, C, Mastroeni, S, Melchi, F, Pilla, M A, Antonelli, G, Camaioni, D, Alotto, M, Pasquini, P (2008). A protective effect of the Mediterranean diet for cutaneous melanoma. Int J Epidemiol 37: 1018-1029 [Abstract] [Full text]
Reedy, J., Mitrou, P. N., Krebs-Smith, S. M., Wirfalt, E., Flood, A., Kipnis, V., Leitzmann, M., Mouw, T., Hollenbeck, A., Schatzkin, A., Subar, A. F. (2008). Index-based Dietary Patterns and Risk of Colorectal Cancer: The NIH-AARP Diet and Health Study. Am J Epidemiol 168: 38-48 [Abstract] [Full text]
Jensen, M. K., Chiuve, S. E., Rimm, E. B., Dethlefsen, C., Tjonneland, A., Joensen, A. M., Overvad, K. (2008). Obesity, Behavioral Lifestyle Factors, and Risk of Acute Coronary Events. Circulation 117: 3062-3069 [Abstract] [Full text]
Martinez-Gonzalez, M A, Fuente-Arrillaga, C d. l., Nunez-Cordoba, J M, Basterra-Gortari, F J, Beunza, J J, Vazquez, Z, Benito, S, Tortosa, A, Bes-Rastrollo, M (2008). Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 336: 1348-1351 [Abstract] [Full text]
Bassuk, S. S., Manson, J. E. (2008). Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2: 191-213 [Abstract]
Brunner, E. J, Mosdol, A., Witte, D. R, Martikainen, P., Stafford, M., Shipley, M. J, Marmot, M. G (2008). Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Am. J. Clin. Nutr. 87: 1414-1421 [Abstract] [Full text]
Hirte, L, Nolte, E, Mossialos, E, McKee, M (2008). The changing regional pattern of ischaemic heart disease mortality in southern Europe: still healthy but uneven progress.. J. Epidemiol. Community Health 62: e4-e4 [Abstract] [Full text]
Goulet, J., Lamarche, B., Lemieux, S. (2008). A Nutritional Intervention Promoting a Mediterranean Food Pattern Does Not Affect Total Daily Dietary Cost in North American Women in Free-Living Conditions. J. Nutr. 138: 54-59 [Abstract] [Full text]
American Diabetes Association, (2008). Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association. Diabetes Care 31: S61-S78 [Full text]
Vercambre, M.-N., Fournier, A., Boutron-Ruault, M.-C., Clavel-Chapelon, F., Ringa, V., Berr, C. (2007). Differential Dietary Nutrient Intake according to Hormone Replacement Therapy Use: An Underestimated Confounding Factor in Epidemiologic Studies?. Am J Epidemiol 166: 1451-1460 [Abstract] [Full text]
Mitrou, P. N., Kipnis, V., Thiebaut, A. C. M., Reedy, J., Subar, A. F., Wirfalt, E., Flood, A., Mouw, T., Hollenbeck, A. R., Leitzmann, M. F., Schatzkin, A. (2007). Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population: Results From the NIH-AARP Diet and Health Study. Arch Intern Med 167: 2461-2468 [Abstract] [Full text]
Scarmeas, N., Luchsinger, J. A., Mayeux, R., Stern, Y. (2007). Mediterranean diet and Alzheimer disease mortality. Neurology 69: 1084-1093 [Abstract] [Full text]
Maillot, M., Darmon, N., Vieux, F., Drewnowski, A. (2007). Low energy density and high nutritional quality are each associated with higher diet costs in French adults. Am. J. Clin. Nutr. 86: 690-696 [Abstract] [Full text]
McKellar, G, Morrison, E, McEntegart, A, Hampson, R, Tierney, A, Mackle, G, Scoular, J, Scott, J A, Capell, H A (2007). A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis 66: 1239-1243 [Abstract] [Full text]
Scarmeas, N., Stern, Y., Mayeux, R., Nieves, J. W., Luchsinger, J. A. (2007). Whole-Diet Approach, Mediterranean Diet, and Alzheimer Disease--Reply. Arch Neurol 64: 607-607 [Full text]
American Diabetes Association, (2007). Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association. Diabetes Care 30: S48-S65 [Full text]
Fiaccavento, R., Carotenuto, F., Minieri, M., Masuelli, L., Vecchini, A., Bei, R., Modesti, A., Binaglia, L., Fusco, A., Bertoli, A., Forte, G., Carosella, L., Di Nardo, P. (2006). {alpha}-Linolenic Acid-Enriched Diet Prevents Myocardial Damage and Expands Longevity in Cardiomyopathic Hamsters. Am. J. Pathol. 169: 1913-1924 [Abstract] [Full text]
Scarmeas, N., Stern, Y., Mayeux, R., Luchsinger, J. A. (2006). Mediterranean Diet, Alzheimer Disease, and Vascular Mediation. Arch Neurol 63: 1709-1717 [Abstract] [Full text]
American Diabetes Association, (2006). Nutrition Recommendations and Interventions for Diabetes-2006: A position statement of the American Diabetes Association.. Diabetes Care 29: 2140-2157 [Full text]
Mantzoros, C. S, Williams, C. J, Manson, J. E, Meigs, J. B, Hu, F. B (2006). Adherence to the Mediterranean dietary pattern is positively associated with plasma adiponectin concentrations in diabetic women.. Am. J. Clin. Nutr. 84: 328-335 [Abstract] [Full text]
Bertoli, S, Magni, P, Krogh, V, Ruscica, M, Dozio, E, Testolin, G, Battezzati, A (2006). Is ghrelin a signal of decreased fat-free mass in elderly subjects?. Eur J Endocrinol 155: 321-330 [Abstract] [Full text]
Waijers, P. M., Ocke, M. C, van Rossum, C. T., Peeters, P. H., Bamia, C., Chloptsios, Y., van der Schouw, Y. T, Slimani, N., Bueno-de-Mesquita, H B. (2006). Dietary patterns and survival in older Dutch women. Am. J. Clin. Nutr. 83: 1170-1176 [Abstract] [Full text]
Brunner, E. (2006). Commentary: What is the best way to promote healthy eating?. Int J Epidemiol 35: 415-417 [Full text]
Choi, B. C K, Hunter, D. J, Tsou, W., Sainsbury, P. (2005). Diseases of comfort: primary cause of death in the 22nd century. J. Epidemiol. Community Health 59: 1030-1034 [Abstract] [Full text]
Trichopoulou, A., Naska, A., Orfanos, P., Trichopoulos, D. (2005). Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study. Am. J. Clin. Nutr. 82: 935-940 [Abstract] [Full text]
Young, I. S. (2005). Lipids for Psychiatrists - an overview. J Psychopharmacol 19: 66-75 [Abstract]
(2005). From the Library. Br. J. Ophthalmol. 89: 1072-1072 [Full text]
Kern, J., Strnad, M., Coric, T., Vuletic, S. (2005). Cardiovascular risk factors in Croatia: struggling to provide the evidence for developing policy recommendations. BMJ 331: 208-210 [Full text]
Holman, J. R. (2005). Is It Ever Too Late?. DOC News 2: 10-11 [Full text]
Malik, I. (2005). JournalScan. Heart 91: 991-992 [Full text]
(2005). Mediterranean Diet Helps Healthy European Elders Live Longer. JWatch General 2005: 5-5 [Full text]
Cereda, E., Malavazos, A. E, Favaro, C., Pagani, A. M (2005). Modified Mediterranean diet and survival: Evidence for diet linked longevity is substantial. BMJ 330: 1329-1329 [Full text]
Vos, E. (2005). Modified Mediterranean diet and survival: Key confounder was missed. BMJ 330: 1329-1329 [Full text]
(2005). Modified Mediterranean Diet and Survival in Elders. Journal Watch Cardiology 2005: 2-2 [Full text]
(2005). Papers of Note. Sci Aging Knowl Environ 2005: nw15-nw15 [Full text]

Rapid Responses:

Read all Rapid Responses

Greater evidence for diet-linked longevity: Emanuele Cereda, et al.
bmj.com, 23 Apr 2005 [Full text]
The Mediterranean Diet: Dr. Herbert H. Nehrlich
bmj.com, 29 Apr 2005 [Full text]
The Mediterranean Diet - missing the key confounder, omega-3: Eddie Vos
bmj.com, 1 May 2005 [Full text]
The Mediterranean Diet - omega-6 and omega-3: Ellen C G Grant
bmj.com, 2 May 2005 [Full text]
It's the Omega-3 Phenomenon: Dr. Herbert H. Nehrlich
bmj.com, 2 May 2005 [Full text]
It's not just an Omega-3 Phenomenon: Ellen C G Grant
bmj.com, 3 May 2005 [Full text]
It's Not Hunch Medicine: Dr. Herbert H. Nehrlich
bmj.com, 3 May 2005 [Full text]
An explanatory role of depression: Alexander M Ponizovsky
bmj.com, 3 May 2005 [Full text]
Scientific Medicine and the Mediterranean diet: Ellen CG Grant
bmj.com, 4 May 2005 [Full text]
The Art Of Medicine Consists In Amusing The Patient While Nature Cures The Disease: Dr. Herbert H. Nehrlich
bmj.com, 5 May 2005 [Full text]
The art and science of modern Medicine: Ellen C G Grant
bmj.com, 5 May 2005 [Full text]
"The two unit problem": John Roger Andersen
bmj.com, 13 May 2005 [Full text]
The first author replies: Antonia Trichopoulou
bmj.com, 24 May 2005 [Full text]
Measuring Fatty Acids: Edward Siguel
bmj.com, 26 May 2005 [Full text]
Re: Measuring Fatty Acids - Possible increases in omega-3 and omega-6 deficiencies among women: Ellen C G Grant
bmj.com, 28 May 2005 [Full text]
The health benefits of the Mediterranean diet may be due to a synergistic combinations of phytochemicals and fatty-acids.: Fortes Cristina
bmj.com, 16 Jun 2005 [Full text]
The Colombian Crossroad.: Emilio Polo Ledezma, et al.
bmj.com, 21 Jul 2005 [Full text]