title: Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Human Nutrition, Wageningen University, The Netherlands. Kim.Knoops@wur.nl
authors.forename: Kim T B
authors.initials: KT
authors.lastname: Knoops
authors.forename: Lisette C P G M
authors.initials: LC
authors.lastname: de Groot
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.forename: Anne-Elisabeth
authors.initials: AE
authors.lastname: Perrin
authors.forename: Olga
authors.initials: O
authors.lastname: Moreiras-Varela
authors.forename: Alessandro
authors.initials: A
authors.lastname: Menotti
authors.forename: Wija A
authors.initials: WA
authors.lastname: van Staveren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D002318:Cardiovascular Diseases / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality; D038441:Diet, Mediterranean; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking