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Knoops KTB, de Groot LCPGM, Kromhout D, et al. Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women: The HALE Project. JAMA. 2004;292(12):1433–1439. doi:10.1001/jama.292.12.1433
Author Affiliations: Division of Human Nutrition, Wageningen University, the Netherlands (Drs de Groot, Kromhout, and van Staveren, and Ms Knoops); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (Dr Kromhout); Université Louis Pasteur, France (Dr Perrin); Universidad Complutense de Madrid, Spain (Dr Moreiras-Varela); Associazione per la Ricerca Cardiologica, Roma, Italy (Dr Menotti).
Context Dietary patterns and lifestyle factors are associated with mortality
from all causes, coronary heart disease, cardiovascular diseases, and cancer,
but few studies have investigated these factors in combination.
Objective To investigate the single and combined effect of Mediterranean diet,
being physically active, moderate alcohol use, and nonsmoking on all-cause
and cause-specific mortality in European elderly individuals.
Design, Setting, and Participants The Healthy Ageing: a Longitudinal study in Europe (HALE) population,
comprising individuals enrolled in the Survey in Europe on Nutrition and the
Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands,
Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women,
aged 70 to 90 years in 11 European countries. This cohort study was conducted
between 1988 and 2000.
Main Outcome Measures Ten-year mortality from all causes, coronary heart disease, cardiovascular
diseases, and cancer.
Results During follow-up, 935 participants died: 371 from cardiovascular diseases,
233 from cancer, and 145 from other causes; for 186, the cause of death was
unknown. Adhering to a Mediterranean diet (hazard ratio [HR], 0.77; 95% confidence
interval [CI], 0.68-0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67-0.91),
physical activity (HR, 0.63; 95% CI, 0.55-0.72), and nonsmoking (HR, 0.65;
95% CI, 0.57-0.75) were associated with a lower risk of all-cause mortality
(HRs controlled for age, sex, years of education, body mass index, study,
and other factors). Similar results were observed for mortality from coronary
heart disease, cardiovascular diseases, and cancer. The combination of 4 low
risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44).
In total, lack of adherence to this low-risk pattern was associated with a
population attributable risk of 60% of all deaths, 64% of deaths from coronary
heart disease, 61% from cardiovascular diseases, and 60% from cancer.
Conclusion Among individuals aged 70 to 90 years, adherence to a Mediterranean
diet and healthful lifestyle is associated with a more than 50% lower rate
of all-causes and cause-specific mortality.
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