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Mediterranean diet and mortality in the elderly: a prospective cohort study and a meta-analysis

  • Marialaura Bonaccio (a1), Augusto Di Castelnuovo (a1), Simona Costanzo (a1), Alessandro Gialluisi (a1), Mariarosaria Persichillo (a1), Chiara Cerletti (a1), Maria Benedetta Donati (a1), Giovanni de Gaetano (a1) and Licia Iacoviello (a1) (a2)...

The Mediterranean diet (MD) has been associated with prolonged survival in the general population, but no meta-analysis has apparently investigated the potential health benefits in relation to mortality in the elderly. We performed a longitudinal analysis on 5200 individuals aged ≥65 years identified within the general population recruited in the Moli-sani study cohort (2005–2010). Adherence to the MD was appraised by the a priori Mediterranean diet score (MDS; range 0–9). Survival estimates were derived using Cox regression and competing risk models. For the meta-analysis, PubMed and Scopus databases were searched from inception until April 2018 to identify prospective studies on the MD and death risk in the elderly. Over a median follow-up of 8·1 years, a total of 900 deaths were ascertained in the elderly sub-sample of the Moli-sani cohort. A one-point increase in the MDS was associated with lower risk of all-cause, coronary artery disease/cerebrovascular and non-cardiovascular/non-cancer mortality (multi-variable hazard ratio (HR)=0·94; 95 % CI 0·90, 0·98; HR=0·91; 95 % CI 0·83, 0·99 and HR=0·89; 95 % CI 0·81, 0·96, respectively). In a meta-analysis of seven prospective studies, including our results, for a total of 11 738 participants and 3874 deaths, one-point increment in MDS was associated with 5 % (4–7 %) lower risk of all-cause death. An inverse linear dose–response relationship was found from a meta-analysis including three studies. In conclusion, a prospective cohort study and a meta-analysis showed that closer adherence to the MD was associated with prolonged survival in elderly individuals, suggesting the appropriateness for older persons to adopt/preserve the MD to maximise their prospects for survival.

Corresponding author
*Corresponding author: M. Bonaccio, fax +39 0865927575, email,
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Moli-sani Study Investigators are listed in Supplementary Appendix S4.

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Supplementary materials

Bonaccio et al. supplementary material
Appendices S1-S4, Tables S1-S2 and Figure S1

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