Abstract
Purpose
Reports on the protective effect of a Mediterranean diet on mortality usually refer to populations from Mediterranean countries, leaving uncertain whether really diet is the fundamental cause. Our aim was to examine the effect of a Mediterranean diet on mortality in Switzerland, a country combining cultural influences from Mediterranean and Central European countries within a common national health and statistical registry.
Methods
In this prospective investigation, we included 17,861 men and women aged ≥16 years who participated 1977–1993 in health studies and were followed up for survival until 2008 by anonymous record linkage with the Swiss National Cohort. A 9-point score Mediterranean Diet Score (MDS) was used to assess adherence to a Mediterranean diet. Mortality hazard ratios (HR) and 95 % confidence intervals (CIs) were calculated by using Cox regression models adjusted for age, sex, survey wave, marital status, smoking, body mass index, language region and nationality.
Results
In all language regions, MDS was inversely associated with mortality. Consumption of dairy products was also consistently associated with lower mortality. When categorizing dairy food consumption as beneficial instead of harmful, this association between MDS and mortality increased in strength and was partly statistically significant. For all causes of death combined (HR for a one-point increase in MDS 0.96, 95 % CI 0.94–0.98), in men (0.94, 0.92–0.97), in women (0.98, 0.95–1.02) for cardiovascular diseases (CVD, 0.96, 0.92–0.99; 0.95, 0.90–1.00; 0.98, 0.92–1.04) and for cancer (0.95, 0.92–0.99; 0.92, 0.88–0.97; 0.98, 0.93–1.04).
Conclusions
Stronger adherence to a Mediterranean diet was associated with lower all-cause, CVD and cancer mortality, largely independently of cultural background. These associations were primary due to the effect in men. Our finding of a beneficial rather than a deleterious impact of dairy products consumption prompts at considering culturally adapted Mediterranean diet recommendations. However, results should be interpreted with caution since only a crude 1-day dietary estimate was available to assess individuals’ habitual dietary intake.
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Abbreviations
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- CVD:
-
Cardiovascular disease
- HR:
-
Hazard ratio
- ICD:
-
International Classification of Diseases
- MDS:
-
Mediterranean Diet Score
- MONICA:
-
MONItoring of trends and determinants in CArdiovscular disease
- NRP 1A:
-
National Research Programm 1A
- SNC:
-
Swiss National Cohort
- WHO:
-
World Health Organization
References
Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D (1995) Diet and overall survival in elderly people. BMJ 311:1457–1460
Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, van Staveren WA (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292:1433–1439. doi:10.1001/jama.292.12.1433
Mitrou PN, Kipnis V, Thiébaut AC, Reedy J, Subar AF, Wirfält E, Flood A, Mouw T, Hollenbeck AR, Leitzmann MF, Schatzkin A (2007) Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 167:2461–2468. doi:10.1001/archinte.167.22.2461
Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB (2009) Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 119:1093–1100. doi:10.1161/CIRCULATIONAHA.108.816736
Buckland G, González CA, Agudo A, Vilardell M, Berenguer A, Amiano P, Ardanaz E, Arriola L, Barricarte A, Basterretxea M, Chirlaque MD, Cirera L, Dorronsoro M, Egües N, Huerta JM, Larrañaga N, Marin P, Martínez C, Molina E, Navarro C, Quirós JR, Rodriguez L, Sanchez MJ, Tormo MJ, Moreno-Iribas C (2009) Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am J Epidemiol 170:1518–1529. doi:10.1093/aje/kwp282
Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocké MC, Peeters PH, van der Schouw YT, Boeing H, Hoffmann K, Boffetta P, Nagel G, Masala G, Krogh V, Panico S, Tumino R, Vineis P, Bamia C, Naska A, Benetou V, Ferrari P, Slimani N, Pera G, Martinez-Garcia C, Navarro C, Rodriguez-Barranco M, Dorronsoro M, Spencer EA, Key TJ, Bingham S, Khaw KT, Kesse E, Clavel-Chapelon F, Boutron-Ruault MC, Berglund G, Wirfalt E, Hallmans G, Johansson I, Tjonneland A, Olsen A, Overvad K, Hundborg HH, Riboli E, Trichopoulos D (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330:991. doi:10.1136/bmj.38415.644155.8F
Trichopoulou A, Bamia C, Trichopoulos D (2009) Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 338:b2337
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA, Investigators PS (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368:1279–1290. doi:10.1056/NEJMoa1200303
Benetou V, Trichopoulou A, Orfanos P, Naska A, Lagiou P, Boffetta P, Trichopoulos D, Greek EPIC cohort (2008) Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. Br J Cancer 99:191–195. doi:10.1038/sj.bjc.6604418
Buckland G, Agudo A, Luján L, Jakszyn P, Bueno-de-Mesquita HB, Palli D, Boeing H, Carneiro F, Krogh V, Sacerdote C, Tumino R, Panico S, Nesi G, Manjer J, Regnér S, Johansson I, Stenling R, Sanchez MJ, Dorronsoro M, Barricarte A, Navarro C, Quirós JR, Allen NE, Key TJ, Bingham S, Kaaks R, Overvad K, Jensen M, Olsen A, Tjønneland A, Peeters PH, Numans ME, Ocké MC, Clavel-Chapelon F, Morois S, Boutron-Ruault MC, Trichopoulou A, Lagiou P, Trichopoulos D, Lund E, Couto E, Boffeta P, Jenab M, Riboli E, Romaguera D, Mouw T, González CA (2010) Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Am J Clin Nutr 91:381–390. doi:10.3945/ajcn.2009.28209
Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA (2009) Mediterranean diet and mild cognitive impairment. Arch Neurol 66:216–225. doi:10.1001/archneurol.2008.536
Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA (2006) Mediterranean diet and risk for Alzheimer’s disease. Ann Neurol 59:912–921. doi:10.1002/ana.20854
Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92:1189–1196. doi:10.3945/ajcn.2010.29673
Sofi F, Macchi C, Abbate R, Gensini GF, Casini A (2013) Mediterranean diet and health. BioFactors. doi:10.1002/biof.1096
Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC, Llewellyn DJ (2013) Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology 24:479–489. doi:10.1097/EDE.0b013e3182944410
Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N (2013) Mediterranean diet and stroke, cognitive impairment, depression: a meta-analysis. Ann Neurol. doi:10.1002/ana.23944
Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D (1995) Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 61:1402S–1406S
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337:a1344
Hauswirth CB, Scheeder MR, Beer JH (2004) High omega-3 fatty acid content in alpine cheese: the basis for an alpine paradox. Circulation 109:103–107. doi:10.1161/01.CIR.0000105989.74749.DD
Keller U, Battaglia Richi E, Beer M, Darioli R, Meyer K, Renggli A, Römer-Lüthi C, Stoffel-Kurt N (2012) Sechster Schweizerischer Ernährungsbericht. Bundesamt für Gesundheit, Bern
Gutzwiller F, Nater B, Martin J (1985) Community-based primary prevention of cardiovascular disease in Switzerland: methods and results of the National Research Program (NRP 1A). Prev Med 14:482–491
Wietlisbach V, Paccaud F, Rickenbach M, Gutzwiller F (1997) Trends in cardiovascular risk factors (1984–1993) in a Swiss region: results of three population surveys. Prev Med 26:523–533. doi:10.1006/pmed.1997.0167
Bopp M, Braun J, Faeh D, Gutzwiller F, Group SNCS (2010) Establishing a follow-up of the Swiss MONICA participants (1984–1993): record linkage with census and mortality data. BMC Public Health 10:562. doi:10.1186/1471-2458-10-562
Bopp M, Braun J, Gutzwiller F, Faeh D, Group SNCS (2012) Health risk or resource? Gradual and independent association between self-rated health and mortality persists over 30 years. PLoS One 7:e30795. doi:10.1371/journal.pone.0030795
Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrländer C, Rougemont A, Egger M (2009) Cohort profile: the Swiss National Cohort—a longitudinal study of 6.8 million people. Int J Epidemiol 38:379–384. doi:10.1093/ije/dyn042
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608. doi:10.1056/NEJMoa025039
Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Lamuela-Raventós R, Ros E, Salaverría I, Fiol M, Lapetra J, Vinyoles E, Gómez-Gracia E, Lahoz C, Serra-Majem L, Pintó X, Ruiz-Gutierrez V, Covas MI (2011) A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 141:1140–1145. doi:10.3945/jn.110.135566
Day NE (1982) Cumulative rate and cumulative risk. In: Waterhouse JAMAICA, Shanmugaratnam K, Powell J (eds) Cancer incidence in five continents (IARC Scientific Publications No 42). International Agency for Research on Cancer, Lyon, pp 668–670
Misirli G, Benetou V, Lagiou P, Bamia C, Trichopoulos D, Trichopoulou A (2012) Relation of the traditional Mediterranean diet to cerebrovascular disease in a Mediterranean population. Am J Epidemiol 176:1185–1192. doi:10.1093/aje/kws205
van den Brandt PA (2011) The impact of a Mediterranean diet and healthy lifestyle on premature mortality in men and women. Am J Clin Nutr 94:913–920. doi:10.3945/ajcn.110.008250
Fung TT, Hu FB, Holmes MD, Rosner BA, Hunter DJ, Colditz GA, Willett WC (2005) Dietary patterns and the risk of postmenopausal breast cancer. Int J Cancer 116:116–121. doi:10.1002/ijc.20999
Issa C, Darmon N, Salameh P, Maillot M, Batal M, Lairon D (2011) A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon. Int J Obes (Lond) 35:251–258. doi:10.1038/ijo.2010.130
Hoffman R, Gerber M (2013) Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: a critical appraisal. Nutr Rev 71:573–584. doi:10.1111/nure.12040
Bonaccio M, Iacoviello L, de Gaetano G, Moli-Sani Investigators (2012) The Mediterranean diet: the reasons for a success. Thromb Res 129:401–404. doi:10.1016/j.thromres.2011.10.018
Tognon G, Rothenberg E, Eiben G, Sundh V, Winkvist A, Lissner L (2011) Does the Mediterranean diet predict longevity in the elderly? A Swedish perspective. Age (Dordr) 33:439–450. doi:10.1007/s11357-010-9193-1
Arranz S, Chiva-Blanch G, Valderas-Martínez P, Medina-Remón A, Lamuela-Raventós RM, Estruch R (2012) Wine, beer, alcohol and polyphenols on cardiovascular disease and cancer. Nutrients 4:759–781. doi:10.3390/nu4070759
Faeh D, Minder C, Gutzwiller F, Bopp M, Group SNCS (2009) Culture, risk factors and mortality: can Switzerland add missing pieces to the European puzzle? J Epidemiol Community Health 63:639–645. doi:10.1136/jech.2008.081042
Waltner-Toews D, Lang T (2000) The new conceptual base for food and agricultural policy: the emerging model of links between agriculture, food, health, environment and society. Glob Change Hum Health 1:116–130
de Lorgeril M, Salen P (2012) New insights into the health effects of dietary saturated and omega-6 and omega-3 polyunsaturated fatty acids. BMC Med 10:50. doi:10.1186/1741-7015-10-50
World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington
Collomb M, Bütikofer U, Sieber R, Bosset O, Jeangros B (2001) Conjugated linoleic acid and trans fatty acid composition of cows’ milk fat produced in lowlands and highlands. J Dairy Res 68:519–523
Hebeisen DF, Hoeflin F, Reusch HP, Junker E, Lauterburg BH (1993) Increased concentrations of omega-3 fatty acids in milk and platelet rich plasma of grass-fed cows. Int J Vitam Nutr Res 63:229–233
Leiber F, Kreuzer M, Nigg D, Wettstein HR, Scheeder MR (2005) A study on the causes for the elevated n-3 fatty acids in cows’ milk of alpine origin. Lipids 40:191–202
de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, Guidollet J, Touboul P, Delaye J (1994) Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 343:1454–1459
Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, Manor O, Pella D, Berry EM (2002) Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 360:1455–1461. doi:10.1016/S0140-6736(02)11472-3
Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, Hu FB, Engberink MF, Willett WC, Geleijnse JM (2011) Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 93:158–171. doi:10.3945/ajcn.2010.29866
Chagas CE, Rogero MM, Martini LA (2012) Evaluating the links between intake of milk/dairy products and cancer. Nutr Rev 70:294–300. doi:10.1111/j.1753-4887.2012.00464.x
Kontou N, Psaltopoulou T, Panagiotakos D, Dimopoulos MA, Linos A (2011) The mediterranean diet in cancer prevention: a review. J Med Food 14:1065–1078. doi:10.1089/jmf.2010.0244
Bere E, Brug J (2010) Is the term ‘Mediterranean diet’ a misnomer? Public Health Nutr 13:2127–2129. doi:10.1017/S1368980010000480
Bere E, Brug J (2009) Towards health-promoting and environmentally friendly regional diets—a Nordic example. Public Health Nutr 12:91–96. doi:10.1017/S1368980008001985
Acknowledgments
The authors thank the Swiss Federal Statistical Office for providing mortality and census data and for the support which made the Swiss National Cohort and this study possible. The members of the Swiss National Cohort Study Group are Milo Puhan (Chairman of Scientific Board), Matthias Bopp (both Zurich), Matthias Egger (Chairman of Executive Board), Adrian Spoerri, Marcel Zwahlen (all Bern), Nino Künzli (Basel), Fred Paccaud (Lausanne) and Michel Oris (Geneva). This work was supported by the Swiss National Science Foundation (Grants 3347CO-108806 and 33CS30-134273).
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The authors declare that they have no conflict of interest.
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Vormund, K., Braun, J., Rohrmann, S. et al. Mediterranean diet and mortality in Switzerland: an alpine paradox?. Eur J Nutr 54, 139–148 (2015). https://doi.org/10.1007/s00394-014-0695-y
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DOI: https://doi.org/10.1007/s00394-014-0695-y