Adherence to Three Mediterranean Dietary Indexes and All-Cause, Cardiovascular, and Cancer Mortality in an Older Mediterranean Population

Abstract

Background/Objectives: A higher adherence to the Mediterranean diet (MedDiet) has been associated with a lower risk of death in different populations, but this association has been insufficiently investigated in the elderly Spanish population. In this study, we assess the association between adherence to three MedDiet indexes and all-cause, cardiovascular disease (CVD), and cancer mortality in a population aged 65 years and older in Spain. Methods: The population included 903 participants from two population-based surveys. Diet was assessed at baseline by using validated food-frequency questionnaires (FFQ). We calculated scores of adherence to the MedDiet for three indexes: alternate Mediterranean Diet Score (aMED), relative Mediterranean Diet Score (rMED) and 17-item energy-restricted Mediterranean Diet Adherence Screener (erMEDAS). Deaths were ascertained through the National Death Index of Spain and the Mortality Registry in the Valencian Region during a 12 year follow-up period. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI), adjusting for relevant confounders. Results: During the 12 years of follow-up, 403 deaths occurred: 160 due to CVD and 90 to cancer. Compared to participants in the lowest tertile of adherence to aMED, those in the highest tertile showed a 30% lower risk of all-cause mortality, HR = 0.70 (95% CI 0.51–0.96). In addition, per two-point increase in aMED, we observed a 17% lower risk of all-cause mortality, HR = 0.83 (95% CI 0.73–0.95), and a 21% lower risk of CVD mortality, HR = 0.79 (95% CI 0.64–0.99). A 9% lower risk of all-cause mortality was also observed per two-point increase in the rMED score, HR = 0.91 (95% CI 0.84–0.99). Compared to participants in the lowest tertile of adherence to rMED, those in the highest tertile showed evidence of a marginally significant, lower risk of cancer mortality, HR = 0.55 (95% CI 0.29–1.04). No association was observed between the erMEDAS index and mortality for any cause. Conclusions: High adherence to the MedDiet, as measured by aMED and rMED indexes, was associated with lower all-cause, CVD, and cancer mortality in an older Mediterranean population after 12 years of follow-up.