This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (195)  • Contact me when this article is cited  Related Content  • Related letters  • Related articles  • Similar articles in JAMA  Topic Collections  • Aging/ Geriatrics  • Alert me on articles by topic  Social Bookmarking   What's this?

The HALE Project

Kim T. B. Knoops, MSc; Lisette C. P. G. M. de Groot, PhD; Daan Kromhout, PhD; Anne-Elisabeth Perrin, MD, MSc; Olga Moreiras-Varela, PhD; Alessandro Menotti, MD, PhD; Wija A. van Staveren, PhD

JAMA. 2004;292:1433-1439.

Context  Dietary patterns and lifestyle factors are associated with mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer, but few studies have investigated these factors in combination.

Objective  To investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and nonsmoking on all-cause and cause-specific mortality in European elderly individuals.

Design, Setting, and Participants  The Healthy Ageing: a Longitudinal study in Europe (HALE) population, comprising individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women, aged 70 to 90 years in 11 European countries. This cohort study was conducted between 1988 and 2000.

Main Outcome Measures  Ten-year mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer.

Results  During follow-up, 935 participants died: 371 from cardiovascular diseases, 233 from cancer, and 145 from other causes; for 186, the cause of death was unknown. Adhering to a Mediterranean diet (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.68-0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67-0.91), physical activity (HR, 0.63; 95% CI, 0.55-0.72), and nonsmoking (HR, 0.65; 95% CI, 0.57-0.75) were associated with a lower risk of all-cause mortality (HRs controlled for age, sex, years of education, body mass index, study, and other factors). Similar results were observed for mortality from coronary heart disease, cardiovascular diseases, and cancer. The combination of 4 low risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44). In total, lack of adherence to this low-risk pattern was associated with a population attributable risk of 60% of all deaths, 64% of deaths from coronary heart disease, 61% from cardiovascular diseases, and 60% from cancer.

Conclusion  Among individuals aged 70 to 90 years, adherence to a Mediterranean diet and healthful lifestyle is associated with a more than 50% lower rate of all-causes and cause-specific mortality.

Author Affiliations: Division of Human Nutrition, Wageningen University, the Netherlands (Drs de Groot, Kromhout, and van Staveren, and Ms Knoops); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (Dr Kromhout); Université Louis Pasteur, France (Dr Perrin); Universidad Complutense de Madrid, Spain (Dr Moreiras-Varela); Associazione per la Ricerca Cardiologica, Roma, Italy (Dr Menotti).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTERS

Mediterranean Diet, Lifestyle Factors, and Mortality
John E. Craighead
JAMA. 2005;293(6):674.
EXTRACT | FULL TEXT  

Mediterranean Diet, Lifestyle Factors, and Mortality
Alvaro Alonso and Miguel A. Martínez-González
JAMA. 2005;293(6):674.
EXTRACT | FULL TEXT  

Mediterranean Diet, Lifestyle Factors, and Mortality—Reply
Kim T. B. Knoops, Lisette C. P. G. M. de Groot, Daan Kromhout, and Wija A. van Staveren
JAMA. 2005;293(6):674-675.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome: A Randomized Trial
Katherine Esposito, Raffaele Marfella, Miryam Ciotola, Carmen Di Palo, Francesco Giugliano, Giovanni Giugliano, Massimo D'Armiento, Francesco D'Andrea, and Dario Giugliano
JAMA. 2004;292(12):1440-1446.
ABSTRACT | FULL TEXT  

Diet, Lifestyle, and Longevity—The Next Steps?
Eric B. Rimm and Meir J. Stampfer
JAMA. 2004;292(12):1490-1492.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Health Behaviors From Early to Late Midlife as Predictors of Cognitive Function: The Whitehall II Study
Sabia et al.
Am J Epidemiol 2009;0:kwp161v1-kwp161.
ABSTRACT | FULL TEXT  

A Combined Healthy Lifestyle Score and Risk of Pancreatic Cancer in a Large Cohort Study
Jiao et al.
Arch Intern Med 2009;169:764-770.
ABSTRACT | FULL TEXT  

A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease
Mente et al.
Arch Intern Med 2009;169:659-669.
ABSTRACT | FULL TEXT  

Urinary Potassium Is a Clinically Useful Test to Detect a Poor Quality Diet
Mente et al.
J. Nutr. 2009;139:743-749.
ABSTRACT | FULL TEXT  

Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women
Fung et al.
Circulation 2009;119:1093-1100.
ABSTRACT | FULL TEXT  

Alcohol use and cardiovascular health outcomes: a comparison across age and gender in the Winnipeg Health and Drinking Survey Cohort
Snow et al.
Age Ageing 2009;38:206-212.
ABSTRACT | FULL TEXT  

Mediterranean Diet and Mild Cognitive Impairment
Scarmeas et al.
Arch Neurol 2009;66:216-225.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT  

The Mediterranean Diet and Your Health
Brill
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2009;3:44-56.
ABSTRACT  

Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction: Results of the GOSPEL Study, a Multicenter, Randomized Controlled Trial From the Italian Cardiac Rehabilitation Network
Giannuzzi et al.
Arch Intern Med 2008;168:2194-2204.
ABSTRACT | FULL TEXT  

Dietary patterns, food groups, and telomere length in the Multi-Ethnic Study of Atherosclerosis (MESA)
Nettleton et al.
Am. J. Clin. Nutr. 2008;88:1405-1412.
ABSTRACT | FULL TEXT  

Reply to K Esposito and D Giugliano
Brunner et al.
Am. J. Clin. Nutr. 2008;88:1180-1181.
FULL TEXT  

Combined impact of lifestyle factors on mortality: prospective cohort study in US women
Dam et al.
BMJ 2008;337:a1440-a1440.
ABSTRACT | FULL TEXT  

An unsuitable and degraded diet? Part three: Victorian consumption patterns and their health benefits
Rowbotham and Clayton
JRSM 2008;101:454-462.
FULL TEXT  

Physical activity in the elderly--it is never too late!
Song
QJM 2008;101:743-744.
FULL TEXT  

Primary Prevention of Stroke by Healthy Lifestyle
Chiuve et al.
Circulation 2008;118:947-954.
ABSTRACT | FULL TEXT  

Dietary Patterns and Longevity: Expanding the Blue Zones
Appel
Circulation 2008;118:214-215.
FULL TEXT  

Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study
Martinez-Gonzalez et al.
BMJ 2008;336:1348-1351.
ABSTRACT | FULL TEXT  

Socioeconomic Inequalities in Health in 22 European Countries
Mackenbach et al.
NEJM 2008;358:2468-2481.
ABSTRACT | FULL TEXT  

Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence
Bassuk and Manson
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:191-213.
ABSTRACT  

Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality
Brunner et al.
Am. J. Clin. Nutr. 2008;87:1414-1421.
ABSTRACT | FULL TEXT  

Medical Challenges of Improving the Quality of a Longer Life
Michel et al.
JAMA 2008;299:688-690.
FULL TEXT  

Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members et al.
Circulation 2008;117:e25-e146.
FULL TEXT  

Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population: Results From the NIH-AARP Diet and Health Study
Mitrou et al.
Arch Intern Med 2007;167:2461-2468.
ABSTRACT | FULL TEXT  

Lifestyle Management of Obesity: NHANES and Erectile Dysfunction How to Motivate Change
Miner
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:454-456.
ABSTRACT  

Combined Effect of Low-Risk Dietary and Lifestyle Behaviors in Primary Prevention of Myocardial Infarction in Women
Akesson et al.
Arch Intern Med 2007;167:2122-2127.
ABSTRACT | FULL TEXT  

One-year follow-up of a therapeutic lifestyle intervention targeting cardiovascular disease risk
Wister et al.
CMAJ 2007;177:859-865.
ABSTRACT | FULL TEXT  

Pass the grain; spare the brain
Galvin
Neurology 2007;69:1072-1073.
FULL TEXT  

Mediterranean diet and Alzheimer disease mortality
Scarmeas et al.
Neurology 2007;69:1084-1093.
ABSTRACT | FULL TEXT  

Evolution of medical treatment for endometriosis: back to the roots?
Wieser et al.
Hum Reprod Update 2007;13:487-499.
ABSTRACT | FULL TEXT  

A Food Pattern Predicting Prospective Weight Change Is Associated with Risk of Fatal but Not with Nonfatal Cardiovascular Disease
Drogan et al.
J. Nutr. 2007;137:1961-1967.
ABSTRACT | FULL TEXT  

Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete
Chatzi et al.
Thorax 2007;62:677-683.
ABSTRACT | FULL TEXT  

Effect of a Traditional Mediterranean Diet on Lipoprotein Oxidation: A Randomized Controlled Trial
Fito et al.
Arch Intern Med 2007;167:1195-1203.
ABSTRACT | FULL TEXT  

Is the Whole Larger Than the Sum of the Parts? The Promise of Combining Physical Activity and Diet to Improve Cancer Outcomes
Ballard-Barbash and McTiernan
JCO 2007;25:2335-2337.
FULL TEXT  

Greater Survival After Breast Cancer in Physically Active Women With High Vegetable-Fruit Intake Regardless of Obesity
Pierce et al.
JCO 2007;25:2345-2351.
ABSTRACT | FULL TEXT  

Fruit and vegetable intakes, dietary antioxidant nutrients, and total mortality in Spanish adults: findings from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain)
Agudo et al.
Am. J. Clin. Nutr. 2007;85:1634-1642.
ABSTRACT | FULL TEXT  

Whole-Diet Approach, Mediterranean Diet, and Alzheimer Disease--Reply
Scarmeas et al.
Arch Neurol 2007;64:607-607.
FULL TEXT  

Type of alcohol consumed, changes in intake over time and mortality: the Leisure World Cohort Study
Paganini-Hill et al.
Age Ageing 2007;36:203-209.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Rosamond et al.
Circulation 2007;115:e69-e171.
FULL TEXT  

The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes: Part I: Pathophysiology and Clinical Trial Evidence (Risk Factors Through Stable Coronary Artery Disease)
Dzau et al.
Circulation 2006;114:2850-2870.
FULL TEXT  

Mediterranean Diet, Alzheimer Disease, and Vascular Mediation
Scarmeas et al.
Arch Neurol 2006;63:1709-1717.
ABSTRACT | FULL TEXT  

Summary of American Heart Association Diet and Lifestyle Recommendations Revision 2006
Lichtenstein et al.
Arterioscler. Thromb. Vasc. Bio. 2006;26:2186-2191.
FULL TEXT  

Secondary prevention of coronary artery disease in elderly persons: a treatise on a report by the american heart association.
Keller and Lemberg
Am J Crit Care 2006;15:514-518.
FULL TEXT  

Nutrition and Stroke Prevention
Fisher et al.
Stroke 2006;37:2430-2435.
ABSTRACT | FULL TEXT  

Obesity, physical activity, and mortality in a prospective chinese elderly cohort.
Schooling et al.
Arch Intern Med 2006;166:1498-1504.
ABSTRACT | FULL TEXT  

Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications
Chiuve et al.
Circulation 2006;114:160-167.
ABSTRACT | FULL TEXT  

Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors: A Randomized Trial
Estruch et al.
ANN INTERN MED 2006;145:1-11.
ABSTRACT | FULL TEXT  

Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee
Lichtenstein et al.
Circulation 2006;114:82-96.
ABSTRACT | FULL TEXT  

A Mediterranean Diet Is Cost-Effective in Patients with Previous Myocardial Infarction
Dalziel et al.
J. Nutr. 2006;136:1879-1885.
ABSTRACT | FULL TEXT  

Chapter 5.1: Major public health problems -- cardiovascular diseases
Rosen
Scand J Public Health 2006;34:51-58.
 

Dietary patterns and survival in older Dutch women
Waijers et al.
Am. J. Clin. Nutr. 2006;83:1170-1176.
ABSTRACT | FULL TEXT  

Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s
Avendano et al.
Heart 2006;92:461-467.
ABSTRACT | FULL TEXT  

Commentary: What is the best way to promote healthy eating?
Brunner
Int J Epidemiol 2006;35:415-417.
FULL TEXT  

Serum C-reactive protein as a marker for wellness assessment.
Kao et al.
Annals of Clinical & Laboratory Science 2006;36:163-169.
ABSTRACT | FULL TEXT  

Diet and inflammation: a link to metabolic and cardiovascular diseases
Esposito and Giugliano
Eur Heart J 2006;27:15-20.
ABSTRACT | FULL TEXT  

Low Serum Selenium and Total Carotenoids Predict Mortality among Older Women Living in the Community: The Women's Health and Aging Studies
Ray et al.
J. Nutr. 2006;136:172-176.
ABSTRACT | FULL TEXT  

Alcohol Consumption and Risk of Type 2 Diabetes Among Older Women
Beulens et al.
Diabetes Care 2005;28:2933-2938.
ABSTRACT | FULL TEXT  

What is the relationship between risk factor reduction and degree of weight loss?
Van Gaal et al.
Eur Heart J Suppl 2005;7:L21-L26.
ABSTRACT | FULL TEXT  

Alcohol consumption and cognitive function in late life: A longitudinal community study
Ganguli et al.
Neurology 2005;65:1210-1217.
ABSTRACT | FULL TEXT  

The Year in Epidemiology, Health Services, and Outcomes Research
Krumholz
J Am Coll Cardiol 2005;46:1362-1370.
FULL TEXT  

Effect Size Estimates of Lifestyle and Dietary Changes on All-Cause Mortality in Coronary Artery Disease Patients: A Systematic Review
Iestra et al.
Circulation 2005;112:924-934.
ABSTRACT | FULL TEXT  

The Role of Dietary Factors in Cancer Prevention: Beyond Fruits and Vegetables
Williams and Hord
Nutr Clin Pract 2005;20:451-459.
ABSTRACT | FULL TEXT  

Is It Ever Too Late?
Holman
DOC News 2005;2:10-11.
FULL TEXT  

Sources of immoderation and proportion in marketing thought
Witkowski
Marketing Theory 2005;5:221-231.
 

Relation of diet to cardiovascular disease risk factors in subjects with cardiovascular disease in Australia and New Zealand: analysis of the Long-Term Intervention with Pravastatin in Ischaemic Disease trial
Nestel et al.
Am. J. Clin. Nutr. 2005;81:1322-1329.
ABSTRACT | FULL TEXT  

Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study
Trichopoulou et al.
BMJ 2005;330:991.
ABSTRACT | FULL TEXT  

Alcohol and Cognitive Function in Older Women
Schmidt et al.
NEJM 2005;352:1817-1819.
FULL TEXT  

Mediterranean Diet and Survival Among Patients With Coronary Heart Disease in Greece
Trichopoulou et al.
Arch Intern Med 2005;165:929-935.
ABSTRACT | FULL TEXT  

A Nutritional Intervention Promoting the Mediterranean Food Pattern Is Associated with a Decrease in Circulating Oxidized LDL Particles in Healthy Women from the Quebec City Metropolitan Area
Lapointe et al.
J. Nutr. 2005;135:410-415.
ABSTRACT | FULL TEXT  

Mediterranean Diet, Lifestyle Factors, and Mortality
Craighead
JAMA 2005;293:674-674.
FULL TEXT  

Mediterranean Diet, Lifestyle Factors, and Mortality
Alonso and Martinez-Gonzalez
JAMA 2005;293:674-674.
FULL TEXT  

The "Good Cholesterol": High-Density Lipoprotein
Toth
Circulation 2005;111:e89-e91.
FULL TEXT  

Research Shows Benefits of Mediterranean Diet
Kreimer
DOC News 2005;2:16-16.
FULL TEXT  

Cardiovascular Benefits of a Mediterranean Diet (and Other Lifestyle Factors)
Journal Watch Dermatology 2004;2004:12-12.
FULL TEXT  

Mediterranean Diet: Benefits and Mechanisms
Journal Watch Cardiology 2004;2004:3-3.
FULL TEXT  

Cardiovascular Benefits of a Mediterranean Diet (and Other Lifestyle Factors)
JWatch General 2004;2004:1-1.
FULL TEXT  

Diet, Lifestyle, and Longevity--The Next Steps?
Rimm and Stampfer
JAMA 2004;292:1490-1492.
FULL TEXT