Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in Sweden.
BACKGROUND
Comparative studies on dietary patterns and long-term mortality are sparse.


OBJECTIVE
The objective was to examine the relations between 10-y mortality and adherence to the World Health Organization dietary guidelines [Healthy Diet Indicator (HDI)], a Mediterranean-like diet, and a carbohydrate-restricted (CR) diet in elderly Swedish men.


METHODS
Dietary habits were determined by 7-d dietary records in a population-based longitudinal study of 924 Swedish men (age: 71 ± 1 y). The HDI score (-1 to 8 points), the Mediterranean Diet Score (MDS; 0-8 points), and the CR score (2-20 points) were calculated for each participant. Nonadequate reporters of energy intake were identified (n = 413). Mortality was registered during a median follow-up of 10.2 y. Cox proportional hazards regression, with multivariable adjustments, was used to determine the effects of adherence to each dietary pattern.


RESULTS
Two hundred fifteen and 88 subjects died of all-cause and cardiovascular disease, respectively. In all individuals, risk relations to mortality for each SD increment in the scores were observed for only MDS, with an adjusted hazard ratio (HR) of 0.83 (95% CI: 0.70, 0.99). Among adequate dietary reporters (n = 511), adjusted HRs for each SD increment in scores were enhanced for MDS (ie, 0.71; 95% CI: 0.55, 0.92) for all-cause mortality and 0.63 (95% CI: 0.42, 0.96) for cardiovascular mortality. Corresponding HRs for CR diet score were 1.19 (95% CI: 0.97, 1.45) for all-cause mortality and 1.44 (95% CI: 1.03, 2.02) for cardiovascular mortality.


CONCLUSIONS
Adherence to a Mediterranean-like dietary pattern reduced mortality, whereas adherence to a CR dietary pattern appeared to increase mortality in elderly Swedish men, especially when only adequate dietary reporters were considered.
Sjögren
Per
P
Department of Public Health and Caring Sciences, Section of Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden. per.sjogren@pubcare.uu.se
Becker
Wulf
W
Warensjö
Eva
E
Olsson
Erika
E
Byberg
Liisa
L
Gustafsson
Inga-Britt
IB
Karlström
Brita
B
Cederholm
Tommy
T
D000368:Aged; D000818:Animals; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D004032:Diet / Q000592:standards; D050528:Diet, Carbohydrate-Restricted / Q000401:mortality*; D038441:Diet, Mediterranean; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D004044:Dietary Proteins; D002149:Energy Intake; D005399:Fishes; D005638:Fruit; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D018579:Patient Selection; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D014675:Vegetables
D004040:Dietary Carbohydrates; D004044:Dietary Proteins