Association of adherence to Mediterranean diet and changes over time with all-cause mortality in older adults: the Seniors-ENRICA cohorts.

BACKGROUND

Despite the well-recognized nutritional quality and health benefits of the Mediterranean diet (MD), its adherence appears to be declining. However, the extent of this decline and its relationship with mortality in the older population remains unclear.

OBJECTIVES

This study aims to analyze the associations between adherence to MD and its changes over time with all-cause mortality in older adults.

METHODS

We used data from 3518 and 3273 older adults, aged 60-96 y at baseline, participating in the Seniors-ENRICA-1 and 2 cohorts, respectively. Adherence to MD was assessed by the 14-item Mediterranean Diet Adherence Screener (MEDAS) and classified as low (<7 points), moderate (7-8 points), and high (≥9 points). All-cause mortality was ascertained up to 31 January, 2024. Analyses were performed using Cox regression models adjusted by main confounders.

RESULTS

Baseline [n = 6083; follow-up of 7.9 y; per 1-point: hazard ratio (HR) = 0.92; 95% confidence interval (CI): 0.89, 0.95] and changes (n = 2070; follow-up of 11.2 y; per 1-point increase: HR = 0.91; 95% CI: 0.86, 0.97) in MEDAS were associated with a lower mortality. At baseline, moderate (HR = 0.87; 95% CI: 0.77, 0.99) and high (HR = 0.70; 95% CI: 0.59, 0.82) adherence to MD were associated with lower mortality, compared with low adherence. In addition, participants who maintained high adherence to MD in both examinations had the lowest mortality compared with consistently low adherence (HR = 0.54; 95% CI: 0.38, 0.76). Baseline and maintained adherence in items of carbonated sweetened beverages (<1 serving/d), fish/seafood (≥3 servings/wk), commercial pastry (<2 servings/wk), and nuts (≥3 servings/wk) was associated with lower mortality.

CONCLUSIONS

Initial adherence to MD, as well as subsequent maintained or increased adherence, is associated with lower all-cause mortality in older adults, with some foods as the main drivers.