Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly 
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Mediterranean Diet, Lifestyle Factors, and 10-Year
Mortality in Elderly European Men and Women

The HALE Project

Kim T. B. Knoops, MSc; Lisette C. P. G. M. de Groot,
PhD; Daan Kromhout, PhD; Anne-Elisabeth Perrin, MD,
MSc; Olga Moreiras-Varela, PhD; Alessandro Menotti,
MD, PhD; Wija A. van Staveren, PhD

JAMA. 2004;292:1433-1439.

ABSTRACT
http://jama.ama-assn.org/cgi/content/full/292/12/1433   

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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