British Journal of Nutrition

Dietary Surveys and Nutritional Epidemiology

Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain)

Genevieve Bucklanda1 c1, Antonio Agudoa1, Noemie Traviera1, José María Huertaa2a3, Lluís Cireraa2a3, María-José Tormoa2a3a4, Carmen Navarroa2a3a4, María Dolores Chirlaquea2a3, Conchi Moreno-Iribasa3a5a6, Eva Ardanaza3a5, Aurelio Barricartea3a5, Jaione Etxeberriaa3a5a7, Pilar Marina3a5, J. Ramón Quirósa8, María-Luisa Redondoa8, Nerea Larrañagaa3a9, Pilar Amianoa3a9, Miren Dorronsoroa3a9, Larraitz Arriolaa3a9, Mikel Basterretxeaa3a9, María-José Sancheza3a10, Esther Molinaa3a10 and Carlos A. Gonzáleza1

a1 Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain

a2 Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain

a3 CIBER Epidemiología y Salud Pública (CIBERESP), Spain

a4 Department of Public Health and Preventive Medicine, University of Murcia, Spain

a5 Public Health Institute of Navarra, Pamplona, Spain

a6 Departments of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain

a7 Department of Statistics and O. R., Universidad Pública de Navarra, Spain

a8 Public Health and Health Planning Directorate, Asturias, Spain

a9 Public Health Department of Gipuzkoa, Basque Government, San Sebastián, Spain

a10 Andalusian School of Public Health, Granada, Spain


Epidemiological studies show that adherence to a Mediterranean diet (MD) increases longevity; however, few studies are restricted to Mediterranean populations or explore the effect of a MD pattern that directly incorporates olive oil. Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The EPIC-Spain analysis included 40 622 participants (37·7 % males) aged 29–69 years who were recruited from five Spanish regions in 1992–1996. During a mean follow-up of 13·4 years, 1855 deaths were documented: 913 from cancer, 399 from CVD, 425 from other causes and 118 from unknown causes of death. Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD (rMED) score, measured using an 18-unit scale incorporating nine selected dietary components. A high compared with a low rMED score was associated with a significant reduction in mortality from all causes (hazard ratio (HR) 0·79; 95 % CI 0·69, 0·91), from CVD (HR 0·66; 95 % CI 0·49, 0·89), but not from overall cancer (HR 0·92; 95 % CI 0·75, 1·12). A 2-unit increase in rMED score was associated with a 6 % (P < 0·001) decreased risk of all-cause mortality. A high olive oil intake and moderate alcohol consumption contributed most to this association. In this Spanish cohort, following an olive oil-rich MD was related to a significant reduction in all-cause mortality, and reduced the risk of mortality from CVD. These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries.

(Received January 14 2011)

(Revised March 14 2011)

(Accepted March 14 2011)

(Online publication May 17 2011)


c1 Corresponding author: Dr Genevieve Buckland, email


Abbreviations: EPIC, European Prospective Investigation into Cancer and Nutrition; EPIC-Spain, Spanish cohort of EPIC; HR, hazard ratio; MD, Mediterranean diet; rMED, relative Mediterranean diet