Associations of evolutionary-concordance diet, Mediterranean diet and evolutionary-concordance lifestyle pattern scores with all-cause and cause-specific mortality

Abstract

Various individual diet and lifestyle factors are associated with mortality. Investigating these factors collectively may help clarify whether dietary and lifestyle patterns contribute to life expectancy. We investigated the association of previously described evolutionary-concordance and Mediterranean diet pattern scores and a novel evolutionary-concordance lifestyle pattern score with all-cause and cause-specific mortality in the prospective Iowa Women’s Health Study (1986–2012). We created the diet pattern scores from Willett FFQ responses, and the lifestyle pattern score from self-reported physical activity, BMI and smoking status, and assessed their associations with mortality, using multivariable Cox proportional hazards regression. Of the 35 221 55- to 69-year-old cancer-free women at baseline, 18 687 died during follow-up. The adjusted hazard ratios (HR) and 95 % CI for all-cause, all CVD, and all-cancer mortality among participants in the highest relative to the lowest quintile of the evolutionary-concordance lifestyle score were, respectively, 0·52 (95 % CI 0·50, 0·55), 0·53 (95 % CI 0·49, 0·57) and 0·51 (95 % CI 0·46, 0·57). The corresponding findings for the Mediterranean diet score were HR 0·85 (95 % CI 0·82, 0·90), 0·83 (95 % CI 0·76, 0·90) and 0·93 (95 % CI 0·84, 1·03), and for the evolutionary-concordance diet score they were close to null and not statistically significant. The lowest estimated risk was among those in the highest joint quintile of the lifestyle score and either diet score (both Pinteraction <0·01). Our findings suggest that (1) a more Mediterranean-like diet pattern and (2) a more evolutionary-concordant lifestyle pattern, alone and in interaction with a more evolutionary-concordant or Mediterranean diet pattern, may be inversely associated with mortality.

The Impact of Plant-Based Dietary Patterns on Cancer-Related Outcomes: A Rapid Review and Meta-Analysis

“…Forty-seven publications were excluded for not fulfilling the inclusion criteria (no cancer related outcomes = 19; not about dietary patterns but single nutrient/food studies = 14; not an original study = 1; a posteriori indexes = 5; a priori but not MD = 8). Thus, 26 studies were included in this review: 5 VD-like studies [ 34 , 35 , 36 , 37 , 38 ], 12 MD-like studies [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], 2 provegetarian diet studies [ 52 , 53 ], and 6 post-diagnosis studies [ 54 , 55 , 56 , 57 , 58 , 59 ]. The study by Key et al was not included because no risk ratios on cancer mortality were reported [ 60 ].…”

“…Our literature search retrieved 13 studies on the association between the MD (either the original MD scores (MDS), or its derivatives including the alternate MD (aMED), the modified MD (mMSD), the MD pattern (MDP), or the relative Mediterranean diet (rMED) scores) and cancer mortality and other related-outcomes [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Thus, the association between adherence to the MD and cancer mortality has been examined through five different a priori derived MD indexes.…”

“…Among the studies analyzing the association between MDS adherence and cancer mortality risk [ 39 , 41 , 43 , 46 , 48 ], two studies showed a statistically significant protective association [ 39 , 41 ], but three studies did not support an association [ 43 , 46 , 59 ]. In this regard, Lassale et al [ 39 ] studied this association in the European Prospective Investigation into Cancer and Nutrition (EPIC) study among 451,256 healthy participants, followed-up for 12.8 years.…”

“…On the other hand, a Spanish study conducted among 12,449 men and women [ 46 ], found that MDS was not significantly associated with cancer mortality risk. As for the MDP score, Cheng et al [ 48 ] studied its association with cancer mortality risk within the prospective Iowa Women’s Health Study from the USA, which included 35,221 cancer-free women at baseline, of which 4665 died due to cancer during follow-up. The adjusted HR and 95% CI for all-cancer mortality among participants in the highest relative to the lowest quintile was 0.93 (95% CI: 0.84–1.03).…”

“…We included eight studies comparing extreme groups (high vs. low) of adherence to the MD [ 39 , 45 , 47 , 48 , 49 , 50 , 51 ]. There were two studies that did not report HR by these groups [ 41 , 43 ].…”