Mediterranean Diet and Healthy Lifestyle Extend Life
Chronic conditions, such as cancer and cardiovascular disease, account for most deaths of older people around the world. Currently, 75% of all deaths in persons over age 65 in industrialized nations are due to these two conditions. Numerous studies have shown that a Mediterranean diet, physical fitness, moderate alcohol consumption, and not smoking can independently reduce the risk of mortality from a variety of causes. Few studies, however, have considered the health effect of all these factors combined. A new study, Healthy Aeging: A Longitudinal study in Europe, or HALE, published in the September 22, 2004 issue of the Journal of the American Medical Association , confirms the individual and combined protective benefit of all four of these lifestyle factors. Individually, they reduced the chance of death by a quarter to a third; together, by close to two-thirds.
About the Study
HALE was conducted from 1988 to 2000, and was comprised of individuals previously enrolled in two other European studies: 1) the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and 2) Finland, Italy, the Netherlands, Elderly (FINE). Together these studies supplied 1,507 men and 832 women, aged 70-90, from 11 European countries, whose daily habits were followed for an average of ten years. Any participants diagnosed with chronic disease at the onset of the study (including coronary heart disease (CHD), stroke, diabetes, and cancer) were excluded from the study.
For each of the four variables being measured– diet, physical activity, alcohol, and smoking– high and low-risk groups were identified and compared. For the Mediterranean diet variable, low-risk was associated with a diet rich in monounsaturated versus saturated fat; legumes, nuts, and seeds; fruit; vegetables and potatoes; grains; and fish. High risk was associated with diets rich in meat and meat products, and dairy products.
For the physical activity variable, high and low-risk groups were determined by amount of daily leisure-time activities such as walking, cycling, gardening, and household work; low-risk persons engaged in at least 30 minutes of activity per day.
For alcohol consumption, the low-risk group was defined as anyone who consumed more than zero grams of alcohol per day. And for smoking, anyone who had never smoked, or had quit more than fifteen years ago, was considered low-risk.
For each variable, participants scored one point if they were at low-risk. A “lifestyle” score was then calculated by adding the scores for each variable (maximum score of 4 points).
During the study’s ten-year follow-up, 935 participants (40%) died: 371 from cardiovascular diseases (122 from CHD), 233 from cancer, 145 from other causes, and 186 cases from unknown causes.
Nineteen percent of participants were low-risk for all four variables (receiving an overall lifestyle score of 4), 40% were low risk for three, 30% were low-risk for two, and 11% were low-risk for one or none of the variables. Individuals who were low-risk for two to four of the variables were less likely to die than those who were low-risk for none or only one of them.
Participants who were low-risk for all four variables were 65% less likely to die of all causes. In addition to their combined benefit, each of the four lifestyle variables was found to individually reduce risk of all-cause mortality: adhering to a Mediterranean diet reduced risk by 23%, adequate physical activity by 37%, moderate alcohol use by 22%, and not smoking by 35%. These percentages were similar when calculated separately for coronary heart disease, cardiovascular diseases, and cancer.
Population attributable risk , which refers to the percentage of deaths in the study that would not have occurred if all participants were in the low-risk groups for all four variables, was estimated to be 60%. This means that not eating a Mediterranean diet, not exercising, not drinking moderately, and smoking, all together, accounted for a total of 60% of all mortality in this study.
These findings held even after adjusting for other risk factors that could contribute to mortality in this population: age, sex, years of education, body-mass index, waist circumference, use of antihypertensive medication, region of origin (northern or southern Europe), marital status, occupation, and exposure to industrialized environments.
How Does This Affect You?
The HALE study confirms the advantage of maintaining a sensible diet and lifestyle as we age. While 75% of the deaths of men and women over 65 are due to cardiovascular diseases and cancer, HALE suggests that at least 60% of these deaths can be prevented through changes in lifestyle.
Researchers could not assume that the diet and lifestyle habits displayed during the ten years of this study existed throughout the participants’ lifetimes. However, it is not unreasonable to assume that most of these men and women adopted similar health habits throughout their adult lives.
To examine the issue from a different perspective, another study– reported in the same issue of the Journal of the American Medical Association – evaluated the mechanisms by which the Mediterranean diet may protect against cardiovascular disease. Researchers in Italy measured the effect of the diet on patients with metabolic syndrome, a common condition characterized by high blood pressure, high cholesterol, overweight and pre-diabetes – all risk factors for cardiovascular disease. They found that, compared to subjects who followed a sensible diet (50% to 60% carbohydrate, 15% to 20% protein, and less than 30% fat), those who were on a Mediterranean diet lost more weight and were more likely to reverse their metabolic syndrome over a two year period.
Both of these studies illustrate the importance of controllable lifestyle factors in the prevention of chronic disease. One important finding from the HALE study was that 59% of the participants adhered to at least 3 out of 4 low-risk lifestyles. While this is encouraging, other US studies suggest that most Americans have a long way to go before they can consider themselves at low risk for chronic disease. So, while these lifestyle factors may be controllable, are they really that achievable?
The American Heart Association
Prevention and Early Detection
The American Cancer Society
The Mediterranean Diet Pyramid
Oldways, the Food Issues Think Tank
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome. Journal of the American Medical Association . 2004; 292(12): 1440-1446.
Knoops KTB, de Groot LCPGM, Kromhout D, Perrin A-E, Moreiras-Varela O, Menotti A, et al. Mediterranean Diet, Lifestyle Factors and 10-Year Mortality in Elderly European Men and Women. Journal of the American Medical Association . 2004; 292(12): 1433-1439.
Last reviewed September 2004 by ]]>Richard Glickman-Simon, MD]]>
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