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Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study

BMJ 1997; 315 doi: (Published 05 July 1997) Cite this as: BMJ 1997;315:13
  1. Patricia Huijbregts, research fellowa,
  2. Edith Feskens, senior epidemiologista,
  3. Leena Räsänen, assistant professor of nutritionb,
  4. Flaminio Fidanza, professor of nutritionc,
  5. Aulikki Nissinen, professor of community health and general practiced,
  6. Alessandro Menotti, professor of epidemiologye,
  7. Daan Kromhout, professor of public health researcha
  1. a Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and the Environment, PO Box 1, NL-3720 BA Bilthoven, Netherlands
  2. b Division of Nutrition, Department of Applied Chemistry and Microbiology, University of Helsinki, 00014 Helsinki, Finland
  3. c Institute of Food Sciences and Nutrition, University of Perugia, Perugia, 00610 Italy
  4. d Department of Community Health and General Practice, University of Kuopio, 70211 Kuopio, Finland
  5. e Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN 55454-1015, USA
  1. Correspondence to: Ms Huijbregts
  • Accepted 15 April 1977


Objective: To investigate the association of dietary pattern and mortality in international data.

Design: Cohort study with 20 years' follow up of mortality.

Setting: Five cohorts in Finland, the Netherlands, and Italy.

Subjects: Population based random sample of 3045 men aged 50-70 years in 1970.

Main outcome measures: Food intake was estimated using a cross check dietary history. In this dietary survey method, the usual food consumption pattern in the 6-12 months is estimated. A healthy diet indicator was calculated for the dietary pattern, using the World Health Organisation's guidelines for the prevention of chronic diseases. Vital status was verified after 20 years of follow up, and death rates were calculated.

Results: Dietary intake varied greatly in 1970 between the three countries. In Finland and the Netherlands the intake of saturated fatty acids and cholesterol was high and the intake of alcohol was low; in Italy the opposite was observed. In total 1796 men (59%) died during 20 years of follow up. The healthy diet indicator was inversely associated with mortality (P for trend <0.05). After adjustment for age, smoking, and alcohol consumption, the relative risk in the group with the healthiest diet indicator compared with the group with the least healthy was 0.87 (95% confidence interval 0.77 to 0.98). Estimated relative risks were essentially similar within each country.

Conclusions: Dietary intake of men aged 50-70 is associated with a 20 year, all cause mortality in different cultures. The healthy diet indicator is useful in evaluating the relation of mortality to dietary patterns.

Key messages

  • Studying dietary patterns instead of single nutrients in relation to mortality takes into account the intercorrelation of nutrients in the diet

  • A healthy diet, as measured by an indicator based on WHO recommendations, is associated with a reduction of 13% after 20 years in all cause mortality for men aged 50-70

  • The dietary pattern as a whole is more important than specific dietary components with respect to survival among older people

  • The WHO dietary recommendations for the prevention of chronic diseases seem to be effective

  • The healthy diet indicator is useful for evaluating the relation of dietary patterns and mortality in a cross cultural setting


    • Accepted 15 April 1977
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