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Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project



To investigate and compare the associations between dietary patterns and mortality using different European indexes of overall dietary quality.

Design, Setting and Participants:

The HALE (Healthy Ageing: a Longitudinal study in Europe) population includes 2068 men and 1049 women, aged between 70 and 90 years of 10 European countries. Subjects were followed for 10 years. This cohort study was conducted between 1988 and 2000.


During the follow-up period, 1382 people died. The Mediterranean Diet Score (MDS) (HR: 0.82 with 95% CI: 0.75–0.91), the Mediterranean Adequacy Index (MDI) (HR: 0.83 with 95% CI: 0.75–0.92) and the Healthy Diet Indicator (HDI)(HR: 0.89 with 95% CI: 0.81–0.98) were inversely associated with all-causes mortality. Adjustments were made for age, gender, alcohol consumption, physical activity, smoking, number of years of education, body mass index, chronic diseases at baseline and study centre.


The MDS, the MDI and the HDI were significantly inversely related with mortality.


This study is based on data of the HALE project and supported by a grant from the European Union (QLK6-CT-2000–00211) to D Kromhout.

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This study is based on data of the HALE project and supported by a grant from the European Union (QLK6-CT-2000–00211) to D Kromhout. The following principal investigators contributed to the HALE project:


Professor G de Backer, University of Ghent, Ghent.


Professor M Schroll, Bispebjerk Hospital, Copenhagen.


Professor A Nissinen, National Public Health Institute, Helsinki.


Dr M Ferry, Centre Hospitalier de Valence, Valence.

Professor JL Schlienger, Université Louis Pasteur, Strasbourg.


Professor A Kafatos, University of Crete, Iraklion-Crete.


Dr G Zajkas, József Fodor National Center For Public Health, National Institute of Food-Hygiene and Nutrition, Budapest.


Professor G Enzi, Università degli Study di Padova, Padova.

Professor F Fidanza, University of Rome.

Dr S Giampaoli, Istituto Superiore di Sanità, Roma.

Dr G Maiani, Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione, Roma.

Professor A Menotti, Associazione per la Ricerca Cardiologica, Roma.

The Netherlands

Dr L de Groot, Wageningen University, Wageningen.

Professor D Kromhout, National Institute for Public Health and the Environment, Bilthoven.

Professor W van Staveren, Wageningen University, Wageningen.

Dr M Tijhuis, National Institute for Public Health and the Environment, Bilthoven.


Professor A Brzozowska, Warsaw Agricultural University, Warsaw.


Professor JA Amorim Cruz, Instituto Nacional de Saude, Lisbon.


Professor O Moreiras-Varela, Universidad Complutense de Madrid, Madrid.


Dr D Schlettwein-Gsell, Basel.

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Correspondence to K T B Knoops.

Additional information

Guarantor: WA van Staveren.

Contributors: The principal investigator was DK for the FINE study, WAS, LCG for the SENECA study, and KTB Knoops had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. The study concept and design was by LCG, FF, AA-F, DK, WAS. The analysis and interpretation of data was by KTBK, LCG, DK, WAS, FF, AA-F. The drafting of the manuscript was done by KTBK, LCG, WAS, DK. Critical revision of the manuscript for important intellectual content was by FF, AA-F. The statistical analysis was carried out by KTBK, DK, FF. DK, WAS obtained the funding.

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Knoops, K., Groot de, L., Fidanza, F. et al. Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project. Eur J Clin Nutr 60, 746–755 (2006).

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