Mediterranean Diet Reduces Mortality in Elderly

The Mediterranean diet, modified so as to apply across Europe, was associated with increased survival among older people. "The Mediterranean diet has been used in many studies because several of its components have been related to common chronic diseases, ecological evidence suggests that such a diet may be beneficial to health, and variants of this diet have improved the prognosis of patients with coronary heart disease," write Antonia Trichopoulou, MD, and colleagues from the European Prospective Investigation into Cancer and nutrition study (EPIC). "The Mediterranean diet is characterized by a high intake of vegetables, legumes, fruits, and cereals (in the past largely unrefined); a moderate to high intake of fish; a low intake of saturated lipids but high intake of unsaturated lipids, particularly olive oil; a low to moderate intake of dairy products, mostly cheese and yogurt; a low intake of meat; and a modest intake of ethanol, mostly as wine."

Because intake of monounsaturates from olive oil is minimal in non-Mediterranean populations, the investigators determined adherence to a modified Mediterranean diet by substituting monounsaturated lipids with the sum of monounsaturated and polyunsaturated lipids in the numerator of the lipid ratio used to calculate the adherence score.

This multicenter study enrolled 74,607 men and women from Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, and the U.K. Subjects were aged 60 years or older, without coronary heart disease, stroke, or cancer at enrollment and with complete information about dietary intake and potentially confounding variables.

Primary outcomes were the extent of adherence to the modified Mediterranean diet based on a 10-point scoring system and death from any cause by time of occurrence analyzed with Cox regression.

Increased modified Mediterranean diet score was associated with lower overall mortality, with a two-unit increment corresponding to a statistically significant reduction of 8% (95% confidence interval, 3% – 12%). Although the association was stronger in Greece and Spain, there was no significant heterogeneity among countries in the association of the score with overall mortality. When dietary exposures were calibrated across countries, mortality was reduced by 7% (1% – 12%).

"The Mediterranean diet, modified so as to apply across Europe, was associated with increased survival among older people," the authors write. "Because the study is observational, it is possible for residual confounding from suboptimally measured factors."

From the results it was concluded that: The Mediterranean diet is characterized by a high intake of vegetables, legumes, fruits and cereals; a moderate to high intake of fish; a low intake of saturated fats, with a high intake of unsaturated fats such as olive oil; a low intake of dairy products (mainly cheese and yogurt) and meat; and a modest intake of alcohol, mostly as wine. Adherence to a diet relying on plant foods and unsaturated fats that resembles the Mediterranean diet is associated with reduction in overall mortality in elderly Europeans.
BMJ. Posted online April 8, 2005.

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