a1 Department of Hygiene and Epidemiology, University of Athens, Medical School, 75 Mikras Asias Street, 115 27 Athens, Greece
a2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
a3 Nutrition and Hormones Group, International Agency for Research on Cancer (IARC)–World Health Organization, Lyon, France
a4 Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aarhus, Denmark
a5 Cardiovascular Research Center, Department of Preventive Cardiology, Aalborg Hospital, Aarhus University Hospital, Aarhus, Denmark
a6 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
a7 Equipe E3N-EPIC, INSERM, Institut Gustave Roussy, Paris, France
a8 Institut Scientifique et Technique de la Nutrition et de l'Alimentation, Paris, France
a9 Genetics and Epidemiology Cluster, IARC, Lyon, France
a10 Department of Epidemiology, University of Ulm, Ulm, Germany
a11 Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany
a12 Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
a13 Infections and Cancer Epidemiology Group, IARC, Lyon, France
a14 Molecular and Nutritional Epidemiology Unit, CSPO–Scientific Institute of Tuscany, Florence, Italy
a15 Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
a16 Dipartimento di Medicina Clinica e Sperimentale, Federico II University, Naples, Italy
a17 Cancer Registry, Azienda Ospedaliera ‘Civile MP Arezzo’, Ragusa, Italy
a18 Unit of Cancer Epidemiology, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy
a19 Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
a20 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
a21 Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain
a22 Andalusian School of Public Health, Granada Cancer Registry, Granada, Spain
a23 Epidemiology Department, Murcia Health Council, Murcia, Spain
a24 Public Health Institute, Navarra, Spain
a25 Department of Public Health of Gipuzkoa, Health Department of Basque Country, San Sebastian, Spain
a26 Department of Medicine, Surgery and Orthopaedics, Lund University, Malmö, Sweden
a27 Nutritional Research, Department of Public Health and Clinical Medicine & Department of Odontology, Umeå University, Umeå, Sweden
a28 Nutritional Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
a29 MRC Dunn Human Nutrition Unit, Cambridge, UK
a30 Institute of Public Health, University of Cambridge, Cambridge, UK
a31 Cancer Research UK Epidemiology Unit, Oxford University, Oxford, UK
Objective To investigate the association of a posteriori dietary patterns with overall survival of older Europeans.
Design and setting This is a multi-centre cohort study. Cox regression analysis was used to investigate the association of the prevailing, a posteriori-derived, plant-based dietary pattern with all-cause mortality in a population of subjects who were 60 years or older at recruitment to the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort). Analyses controlled for all known potential risk factors.
Subjects In total, 74 607 men and women, 60 years or older at enrolment and without previous coronary heart disease, stroke or cancer, with complete information about dietary intakes and potentially confounding variables, and with known survival status as of December 2003, were included in the analysis.
Results An increase in the score which measures the adherence to the plant-based diet was associated with a lower overall mortality, a one standard deviation increment corresponding to a statistically significant reduction of 14% (95% confidence interval 5–23%). In country-specific analyses the apparent association was stronger in Greece, Spain, Denmark and The Netherlands, and absent in the UK and Germany.
Conclusions Greater adherence to the plant-based diet that was defined a posteriori in this population of European elders is associated with lower all-cause mortality. This dietary score is moderately positively correlated with the Modified Mediterranean Diet Score that has been constructed a priori and was also shown to be beneficial for the survival of the same EPIC-Elderly cohort.
(Received February 17 2006)
(Accepted July 04 2006)
(Online publication March 05 2007)