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Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study

BMJ 2014; 349 doi: (Published 02 December 2014) Cite this as: BMJ 2014;349:g6674
  1. Marta Crous-Bou, postdoctoral research fellow1, research fellow2,
  2. Teresa T Fung, associate professor3, adjunct associate professor4,
  3. Jennifer Prescott, instructor in medicine1,
  4. Bettina Julin, postdoctoral research fellow1, research fellow2,
  5. Mengmeng Du, postdoctoral research fellow1, research fellow561,
  6. Qi Sun, assistant professor14,
  7. Kathryn M Rexrode, associate professor7,
  8. Frank B Hu, professor124,
  9. Immaculata De Vivo, associate professor12
  1. 1Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
  2. 2Department of Epidemiology, Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, MA 02115, USA
  3. 3Department of Nutrition, Simmons College, Boston, MA 02115, USA
  4. 4Department of Nutrition, Harvard School of Public Health, Boston
  5. 5Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
  6. 6School of Public Health, University of Washington, Seattle, WA 98195, USA
  7. 7Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston
  1. Correspondence to: I De Vivo nhidv{at}
  • Accepted 23 October 2014


Objective To examine whether adherence to the Mediterranean diet was associated with longer telomere length, a biomarker of aging.

Design Population based cohort study.

Setting Nurses’ Health Study, an ongoing prospective cohort study of 121 700 nurses enrolled in 1976; in 1989-90 a subset of 32 825 women provided blood samples.

Participants 4676 disease-free women from nested case-control studies within the Nurses’ Health Study with telomere length measured who also completed food frequency questionnaires.

Main outcome measure Association between relative telomere lengths in peripheral blood leukocytes measured by quantitative real time polymerase chain reaction and Alternate Mediterranean Diet score calculated from self reported dietary data.

Results Greater adherence to the Mediterranean diet was associated with longer telomeres after adjustment for potential confounders. Least squares mean telomere length z scores were −0.038 (SE 0.035) for the lowest Mediterranean diet score groups and 0.072 (0.030) for the highest group (P for trend=0.004).

Conclusion In this large study, greater adherence to the Mediterranean diet was associated with longer telomeres. These results further support the benefits of adherence to the Mediterranean diet for promoting health and longevity.


  • We thank the participants and staff of the Nurses’ Health Study for their valuable contributions, as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, and WY. We also thank Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School. Finally, we acknowledge Patrice Soule and Esther Orr for their laboratory assistance, and Meir J Stampfer, Walter Willet, and JoAnn Manson for their insightful comments on the manuscript.

  • Contributors: MC-B was the lead author, and IDV was the senior author; both proposed the hypothesis and planned the analysis. MC-B analyzed the data and wrote the first draft of the manuscript. MC-B and IDV contributed to all aspects of the study design, data collection, data analysis and interpretation, and the writing of the article. IDV was the expert on telomere length. TTF and FBH created and validated the dietary scores and contributed to data collection, data interpretation, and the writing of the article. BJ and QS supervised the dietary analysis and data interpretation and contributed to the writing of the article. JP contributed to telomere data cleaning and collection. JP and MD supervised telomere analysis and contributed to data interpretation and the writing of the article. KMR contributed to data collection, data interpretation, and the writing of the article. All authors read and approved the final version of the manuscript. IDV is the guarantor.

  • Funding: The Nurses’ Health Study is supported by the National Cancer Institute, National Institutes of Health (1R01 CA134958, 2R01 CA082838, P01 CA087969, R01 CA49449, CA065725, CA132190, CA139586, CA140790, CA133914, CA132175, CA163451, HL088521, HL60712, U54 CA155626, R01 AR059073, HL34594). MC-B is also supported by a Sara Borrell postdoctoral fellowship from the Spanish Ministry of Health, Carlos III Health Institute. MD is supported by grant R25 CA94880 from the National Cancer Institute. QS is supported by an NHLBI sponsored career development award (R00HL098459). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work other than those described above; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study protocol was approved by the Human Research Committee at the Brigham and Women’s Hospital (Boston, MA), with written informed consent from all participants.

  • Transparency: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: A detailed plan for common data sharing procedures to be used in the Nurses’ Health Study has been reviewed by Nurses’ Health Study external advisory committee, which endorses the use of a data enclave approach to data sharing. Along with a general description of the cohort, the policies and guidelines for access to biospecimens and questionnaire data are published on the Nurses’ Health Study website ( for outside investigators interested in accessing the resources of the study.

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