Public Health Nutrition

Research Paper

Dietary patterns and survival of older Europeans: The EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition)

Christina Bamiaa1, Dimitrios Trichopoulosa2, Pietro Ferraria3, Kim Overvada4, Lone Bjerregaarda5, Anne Tjønnelanda6, Jytte Halkjæra6, Françoise Clavel-Chapelona7, Emmanuelle Kessea8, Marie-Christine Boutron-Ruaulta7, Paolo Boffettaa9, Gabriele Nagela10, Jacob Linseisena11, Heiner Boeinga12, Kurt Hoffmanna12, Christina Kasapaa1, Anastasia Orfanoua1, Chrysoula Travezeaa1, Nadia Slimania3, Teresa Norata13, Domenico Pallia14, Valeria Palaa15, Salvatore Panicoa16, Rosario Tuminoa17, Carlotta Sacerdotea18, H Bas Bueno-de-Mesquitaa19, Patricia MCM Waijersa19, Petra HM Peetersa20, Yvonne T van der Schouwa20, Antonio Berenguera21, Carmen Martinez-Garciaa22, Carmen Navarroa23, Aurelio Barricartea24, Miren Dorronsoroa25, Göran Berglunda26, Elisabet Wirfälta26, Ingegerd Johanssona27, Gerd Johanssona28, Sheila Binghama29, Kay-Tee Khawa30, Elizabeth A Spencera31, Tim Keya31, Elio Ribolia3 and Antonia Trichopouloua1 c1

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)


c1 *Corresponding author: Email