Mediterranean diet and mortality in Switzerland: an alpine paradox?
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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.
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.
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).
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.
KeywordsMediterranean diet Alpine paradox Dairy food Mortality Switzerland
Body mass index
International Classification of Diseases
Mediterranean Diet Score
MONItoring of trends and determinants in CArdiovscular disease
- NRP 1A
National Research Programm 1A
Swiss National Cohort
World Health Organization
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).
Conflict of interest
The authors declare that they have no conflict of interest.
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