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Athens, Greece - One of the largest studies to date looking at the link between mortality and the "Mediterranean diet" has found that people who adhered closely to a diet of vegetables, fruit, whole grains, nuts, and monounsaturated fats had lower rates of total, cardiovascular, and cancer deaths. Strikingly, no one component of the diet was associated with a reduction in mortality risk, hinting that it is the combination of foods that is beneficial.
Dr Antonia Trichopoulou (University of Athens, Greece) and colleagues report their findings in the June 26, 2003 issue of the New England Journal of Medicine.1
"We found that a higher score on a scale that reflects the level of adherence to the traditional Mediterranean diet and integrates current views about the attributes of a healthy diet is associated with a significant and substantial reduction in overall mortality," the authors write.
The higher the score, the lower the deaths
Trichopoulou et al used a 10-point scale to assess adherence to the Mediterranean diet among Greek participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) trial. In total, 22043 Greek adults completed the food-frequency questionnaire at study outset and then were followed for almost four years.
Over this time period, 275 people died, but deaths were lower in people who adhered more closely to the Mediterranean diet. Overall, a two-point increase in the Mediterranean diet score was associated with a 25% reduction in total mortality. The association between score and mortality reduction was stronger for deaths due to coronary disease than for cancer deaths, but even deaths due to cancer were significantly reduced in participants with higher scores.
Hazard ratios associated with a two-point increment in Mediterranean diet score|
Outcome |
Hazard ratio |
95% CI |
|
All-cause death | 0.75 | 0.64-0.87 |
|
Coronary death | 0.67 | 0.47-0.94 |
|
Cancer death | 0.76 | 0.59-0.98 |
A synergistic effect
Of note, when individual components of the diet were analyzed in association with mortality, only fruits and nuts as well as ratio of monounsaturated lipids to saturated lipids were statistically significant.
In an editorial accompanying the study, Dr Frank Hu (Harvard Medical School, Boston, MA) called this particular finding "intriguing."2
"One possible explanation is that the effects of single nutrients or foods may be too small to detect, whereas the cumulative effects of multiple dietary components may be substantial," he notes. "In addition, there may be synergistic or interactive effects among nutrients or foods, which the score automatically takes into account."
Hu makes the point that the Mediterranean diet has for years "been surrounded by as much myth as scientific evidence" and that its definition is complicated by the fact that 15 countries actually border the Mediterranean. In reality, he notes, the Mediterranean-type diet is similar to the traditional diets of many other parts of the globe, including Asian countries. All are to varying degrees threatened.
"The dietary patterns in Greece and other Mediterranean countries are changing rapidly, with increased consumption of saturated fat and refined carbohydrates," Hu observes. "The study by Trichopoulou et al provides another reminder that the preservation of certain dietary and lifestyle traditions may have substantial health dividends for generations to come."
