• Antonia Trichopoulou, Tina Costacou, Christina Bamia, and Dimitrios Trichopoulos.
• Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece. antonia@nut.uoa.gr
• N. Engl. J. Med. 2003 Jun 26; 348 (26): 259926082599-608.

BackgroundAdherence to a Mediterranean diet may improve longevity, but relevant data are limited.MethodsWe conducted a population-based, prospective investigation involving 22,043 adults in Greece who completed an extensive, validated, food-frequency questionnaire at base line. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet (range of scores, 0 to 9, with higher scores indicating greater adherence). We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality, as well as mortality due to coronary heart disease and mortality due to cancer, with adjustment for age, sex, body-mass index, physical-activity level, and other potential confounders.ResultsDuring a median of 44 months of follow-up, there were 275 deaths. A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality (adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score, 0.75 [95 percent confidence interval, 0.64 to 0.87]). An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease (adjusted hazard ratio, 0.67 [95 percent confidence interval, 0.47 to 0.94]) and death due to cancer (adjusted hazard ratio, 0.76 [95 percent confidence interval, 0.59 to 0.98]). Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant.ConclusionsGreater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality.Copyright 2003 Massachusetts Medical Society

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