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Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US PopulationResults From the NIH-AARP Diet and Health Study
Panagiota N. Mitrou, PhD;
Victor Kipnis, PhD;
Anne C. M. Thiébaut, PhD;
Jill Reedy, PhD;
Amy F. Subar, PhD;
Elisabet Wirfält, PhD;
Andrew Flood, PhD;
Traci Mouw, MPH;
Albert R. Hollenbeck, PhD;
Michael F. Leitzmann, MD, DrPH;
Arthur Schatzkin, MD, DrPH
Arch Intern Med. 2007;167(22):2461-2468.
Background The Mediterranean diet has been suggested to play a beneficial role for health and longevity. However, to our knowledge, no prospective US study has investigated the Mediterranean dietary pattern in relation to mortality.
Methods Study participants included 214 284 men and 166 012 women in the National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study. During follow-up for all-cause mortality (1995-2005), 27 799 deaths were documented. In the first 5 years of follow-up, 5985 cancer deaths and 3451 cardiovascular disease (CVD) deaths were reported. We used a 9-point score to assess conformity with the Mediterranean dietary pattern (components included vegetables, legumes, fruits, nuts, whole grains, fish, monounsaturated fat–saturated fat ratio, alcohol, and meat). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using age- and multivariate-adjusted Cox models.
Results The Mediterranean diet was associated with reduced all-cause and cause-specific mortality. In men, the multivariate HRs comparing high to low conformity for all-cause, CVD, and cancer mortality were 0.79 (95% CI, 0.76-0.83), 0.78 (95% CI, 0.69-0.87), and 0.83 (95% CI, 0.76-0.91), respectively. In women, an inverse association was seen with high conformity with this pattern: decreased risks that ranged from 12% for cancer mortality to 20% for all-cause mortality (P = .04 and P < .001, respectively, for the trend). When we restricted our analyses to never smokers, associations were virtually unchanged.
Conclusion These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes, including deaths due to CVD and cancer, in a US population.
Author Affiliations: Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics (Drs Mitrou, Thiébaut, Leitzmann, and Schatzkin and Ms Mouw), Biometry Research Group, Division of Cancer Prevention (Dr Kipnis), and Applied Research Branch, Division of Cancer Control and Population Sciences (Drs Reedy and Subar), National Cancer Institute, Bethesda, Maryland; Department of Clinical Sciences, Lund University, Malmö, Sweden (Dr Wirfält); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (Dr Flood); and AARP, Washington, DC (Dr Hollenbeck). Dr Mitrou is now with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England.
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