Dietary Patterns and Total Mortality in a Mediterranean Cohort: The SUN Project

Abstract

Background: Different dietary patterns have been associated with several health outcomes, including morbidity and mortality. There is little evidence on the association between empirically-derived dietary patterns and all cause mortality in Southern European populations.Objective: the aim of this study was to prospectively evaluate the association between an empirically-derived dietary pattern and all-cause mortality.Design: The SUN Project is an ongoing, multipurpose, prospective and dynamic Spanish cohort.Participants/setting: a prospective cohort of 16,008 middle-aged Spanish adults. All of them were former university graduates (alumni) (59.6 percent women, mean age: 38 years). Usual diet was assessed at baseline with a validated semiquantitative foodfrequency questionnaire.Main outcome measures: Deaths were confirmed by review of medical records and of the National Death Index.Statistical analyses performed: Dietary patterns were ascertained through a factor (principal component) analysis based on 30 predefined food groups. Participants were classified according to tertiles of adherence to the three main dietary patterns identified with factor analysis. Cox regression models were fitted to estimate multivariableadjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality.Results: Three major dietary patterns were identified: they were labelled Western dietary pattern (WDP) (rich in red and processed meat, potatoes and fast food), Mediterranean dietary pattern (MDP) (rich in vegetables, fish and seafood, fruits, and olive oil) and Alcoholic beverages dietary pattern (ABDP). During follow-up, 148 deaths were reported (mean age at death: 54.5 years). After adjustment for potential confounders, the lowest risk of all-cause mortality was found in the tertile of highest adherence to the MDP (adjusted HR for third vs. first tertile: 0.53; 95% CI: 0.34-0.84) (p for trend <0.01). The WDP and ABDP showed no significant association with mortality.Conclusions: Greater adherence to an empirically-derived dietary pattern approaching the traditional Mediterranean diet was associated with a reduction in the risk of allcause mortality among middle-aged Mediterranean adults.

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

“…In agreement with our results, a Mediterranean dietary pattern was inversely associated with all‐cause mortality in the US Multiethnic Cohort,37 the US National Institutes of Health–AARP Diet and Health Study,38 Spanish cohorts,32, 39 an Italian cohort,40 the UK‐based EPIC (European Prospective Investigation of Cancer)–Norfolk study,41 a Danish cohort,42 and a cohort of elderly European men and women 43. However, there was no association of a Mediterranean‐type diet with all‐cause mortality in the UK‐based Whitehall II study 33.…”

“…Western‐type diets (high‐fat, meat‐rich, low‐fiber), which have similarities to our Southern dietary pattern, have shown adverse associations with all‐cause mortality in several cohorts, including the US Nurse's Health study,29 older British men,30 and Chinese men and women (but only in ever smokers) 31. However, a Western dietary pattern showed no association with all‐cause mortality in a Spanish cohort,32 in English civil service employees in the Whitehall II study,33 or in a cohort of Danish men and women 34. There was a surprising inverse association of a Western dietary pattern and all‐cause mortality in a cohort of Japanese men and women 35.…”

Empirically-derived food patterns and the risk of total mortality and cardiovascular events in the PREDIMED study

“…Regarding the Spanish context, a recent study in a large cohort found that higher adherence to 268 an empirically derived MDP in adults was associated with a reduction in the risk of all-cause 269 mortality [6].Several explanations can account for the inverse association observed between 270 better baseline adherence to a MDP and mortality. First, the MDP has been shown to have a 271 beneficial effect on the incidence and prevalence of several diseases [25].…”

Adherence to a Mediterranean-like dietary pattern in children from eight European countries. The IDEFICS study

“…1,2 In adults, a Mediterranean-like dietary pattern is known to be inversely associated with mortality, 3 as well as with a number of chronic diseases including cardiovascular diseases, 4 cancer, 5,6 obesity, 7 metabolic syndrome 8,9 and also diabetes type 2, 10 probably due to the relatively low glycaemic load in spite of the potentially high carbohydrate content. 11 This dietary pattern has also been suggested to improve cognition 12 and to increase longevity 13 and appears to be associated with a better health status overall. 14 Such benefits have been observed both in Mediterranean 15 as well as in non-Mediterranean countries.…”