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Cardiovascular Benefits of a Mediterranean Diet (and Other Lifestyle Factors)

Results from diet studies suggest that, even among elders, benefit accrues from modifying lifestyle factors.

The cardiovascular (CV) benefits of a Mediterranean-style diet (high intake of monounsaturated fats, legumes, nuts, fruits, vegetables, and fish) and other lifestyle factors (not smoking, alcohol consumption, physical activity) were assessed in a large longitudinal observational European study of 2339 elders (age range, 70-90) without known CV disease, cancer, or diabetes at enrollment. Diet was assessed through structured dietary recall. After 10 years, 935 participants had died, most from CV diseases or cancer. Hazard ratios (HRs) for all-cause mortality were: Mediterranean-style diet, 0.77; any alcohol intake, 0.78; moderate physical activity, 0.63; and no smoking, 0.65. HR associated with having all these factors was 0.35. All HRs were statistically significant.

In an unrelated controlled trial, 180 Italian subjects with metabolic syndrome were randomized to either a Mediterranean-style diet with diet counseling or a "prudent" diet without counseling. After 2 years of follow-up, intervention subjects had significantly lower levels of C-reactive protein and interleukins, and lower insulin resistance, which are all markers for a proinflammatory state. Endothelial function, thought to be an underlying mechanism for the development of metabolic syndrome, significantly improved from baseline in the intervention group and remained stable in the control group. Although mean weight loss was only modestly greater among intervention subjects than among controls (4.0 vs. 1.2 kg), significantly fewer intervention subjects still exhibited at least 3 components of metabolic syndrome (40 vs. 78).

Comment: The first study's findings are important because they suggest that older age does not preclude benefits from lifestyle choices, and the second study is important because its subjects achieved benefits despite a lack of substantial weight loss. Editorialists conclude that the results of these studies and others mandate a widespread public health approach, based on lifestyle modification, to prevent chronic disease and premature mortality. At the time of publication, the full text of the first original article was available free of charge.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine October 8, 2004

Citation(s):

Knoops KTB et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: The HALE Project. JAMA 2004 Sep 22/29; 292:1433-9.

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• Medline abstract (Free)

Esposito K et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: A randomized trial. JAMA 2004 Sep 22/29; 292:1440-6.

• Original article (Subscription may be required)
• Medline abstract (Free)

Rimm EB and Stampfer MJ. Diet, lifestyle, and longevity -- The next steps? JAMA 2004 Sep 22/29; 292:1490-2.

• Original article (Subscription may be required)
• Medline abstract (Free)