title: Adherence to the traditional Mediterranean diet and mortality in subjects with diabetes. Prospective results from the MOLI-SANI study.
abstract: BACKGROUND
  Adherence to the Mediterranean diet is associated with lower mortality in a general population but limited evidence exists on the effect of a Mediterranean diet on mortality in subjects with diabetes. We aim to examine the association between the Mediterranean diet and mortality in diabetic individuals.
  
  
  METHODS
  Prospective cohort study on 1995 type 2 diabetic subjects recruited within the MOLI-SANI study.
  
  
  METHODS
  Food intake was recorded by the European Project Investigation into Cancer and Nutrition food frequency questionnaire. Adherence to the Mediterranean diet was appraised by the Greek Mediterranean diet score. Hazard ratios were calculated using multivariable Cox-proportional hazard models.
  
  
  RESULTS
  During follow-up (median 4.0 years), 109 all-cause including 51 cardiovascular deaths occurred. A 2-unit increase in Mediterranean diet score was associated with 37% (19%-51%) lower overall mortality. Data remained unchanged when restricted to those being on a hypoglycaemic diet or on antidiabetic drug treatment. A similar reduction was observed when cardiovascular mortality only was considered (hazard ratio = 0.66; 0.46-0.95). A Mediterranean diet-like pattern, originated from principal factor analysis, indicated a reduced risk of overall death (hazard ratio = 0.81; 0.62-1.07). The effect of Mediterranean diet score was mainly contributed by moderate alcohol drinking (14.7% in the reduction of the effect), high intake of cereals (12.2%), vegetables (5.8%) and reduced consumption of dairy and meat products (13.4% and 3.4% respectively).
  
  
  CONCLUSIONS
  The traditional Mediterranean diet was associated with reduced risk of both total and cardiovascular mortality in diabetic subjects, independently of the severity of the disease. Major contributions were offered by moderate alcohol intake, high consumption of cereals, fruits and nuts and reduced intake of dairy and meat products.
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy marialaura.bonaccio@neuromed.it.
authors: Marialaura
authors: M
authors: Bonaccio
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy.
authors: Augusto
authors: A
authors: Di Castelnuovo
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy.
authors: Simona
authors: S
authors: Costanzo
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy.
authors: Mariarosaria
authors: M
authors: Persichillo
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy.
authors: Amalia
authors: A
authors: De Curtis
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy.
authors: Maria Benedetta
authors: MB
authors: Donati
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy.
authors: Giovanni
authors: G
authors: de Gaetano
authors: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Italy.
authors: Licia
authors: L
authors: Iacoviello
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000401:mortality*; D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011795:Surveys and Questionnaires
keywords: Mediterranean diet; cardiovascular mortality; diabetes; overall mortality