Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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

European Journal of Clinical Nutrition volume 60, pages 746–755 (2006)Cite this article

Abstract

Objective:

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.

Results:

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.

Conclusions:

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

Sponsorship:

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.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  • Agudo A, Slimani N, Ocke MC, Naska A, Miller AB, Kroke A et al. (2002). Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries. Public Health Nutr 5, 1179–1196.

    Article  CAS  Google Scholar 

  • Alberti-Fidanza A, Fidanza F (2004). Mediterranean Adequacy Index of Italian diets. Public Health Nutr 7, 937–941.

    Article  Google Scholar 

  • Alberti-Fidanza A, Fidanza F, Chiuchiu MP, Verducci G, Fruttini D (1999). Dietary studies on two rural Italian population groups of the Seven Countries Study. 3. Trend of food and nutrient intake from 1960 to 1991. Eur J Clin Nutr 53, 854–860.

    Article  CAS  Google Scholar 

  • Andersen PK, Klein JP, Zhang MJ (1999). Testing for centre effects in multi-centre survival studies: a Monte Carlo comparison of fixed and random effects tests. Stat Med 18, 1489–1500.

    Article  CAS  Google Scholar 

  • Arab JS, Wittler M, Schetter G (1987). European Food Composition Tables in Translation. Springer-Verslag: Berlin.

    Book  Google Scholar 

  • Caspersen CJ, Bloemberg BPM, Saris WHM, Merritt RK, Kromhout D (1991). The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen Study, 1985. Am J Epidemiol 133, 1078–1092.

    Article  CAS  Google Scholar 

  • Craighead JE (2005). Mediterranean diet, lifestyle factors, and mortality. JAMA 293 author reply: 674–675.

    CAS  PubMed  Google Scholar 

  • Doll R, Peto R, Boreham J, Sutherland I (2004). Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 328, 1519–1533.

    Article  Google Scholar 

  • Fernandez-Jarne E, Martinez-Losa E, Prado-Santamaria M, Brugarolas-Brufau C, Serrano-Martinez M, Martinez-Gonzalez MA (2002). Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: a case–control study in Spain. Int J Epidemiol 31, 474–480.

    Article  CAS  Google Scholar 

  • Fidanza F, Alberti-Fidanza A, Lanti M, Menotti A (2004). Mediterranean Adequacy Index: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study. Nutr Metab Cardiovasc Dis 14, 254–258.

    Article  CAS  Google Scholar 

  • Gnardellis C, Trichopoulou A, Katsouyanni K, Polychronopoulos E, Rimm EB, Trichopoulos D (1995). Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers. Epidemiology 6, 74–77.

    Article  CAS  Google Scholar 

  • Groot de CPGM, Staveren van WA, Dirren H, Hautvast JGAJ (1996). Summary and conclusions of the report on the second data collection period and longitudinal analyses of the SENECA Study. Eur J Clin Nutr 50, S123–S124.

    Google Scholar 

  • Groot de LC, Sette S, Zajkas G, Carbajal A, Amorim JA (1991). Nutritional status: anthropometry. Euronut SENECA investigators. Eur J Clin Nutr 45, 31–42.

    Google Scholar 

  • Harnack L, Nicodemus K, Jacobs Jr DR, Folsom AR (2002). An evaluation of the Dietary Guidelines for Americans in relation to cancer occurrence. Am J Clin Nutr 76, 889–896.

    Article  CAS  Google Scholar 

  • Haveman-Nies A, Groot de LP, Burema J, Cruz JA, Osler M, Staveren van WA, SENECA Investigators (2002). Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study. Am J Epidemiol 156, 962–968.

    Article  Google Scholar 

  • Haveman-Nies A, Tucker KL, de Groot LC, Wilson PW, van Staveren WA (2001). Evaluation of dietary quality in relationship to nutritional and lifestyle factors in elderly people of the US Framingham Heart Study and the European SENECA study. Eur J Clin Nutr 55, 870–880.

    Article  CAS  Google Scholar 

  • Heiat A, Vaccarino V, Krumholz HM (2001). An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 161, 1194–1203.

    Article  CAS  Google Scholar 

  • Hoffmann K, Schulze MB, Schienkiewitz A, Nothlings U, Boeing H (2004). Application of a new statistical method to derive dietary patterns in nutritional epidemiology. Am J Epidemiol 159, 935–944.

    Article  Google Scholar 

  • Huijbregts P, Feskens E, Rasanen L, Fidanza F, Nissinen A, Menotti A et al. (1997). Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ 315, 13–17.

    Article  CAS  Google Scholar 

  • Huijbregts PP, Feskens EJ, Rasanen L, Alberti-Fidanza A, Mutanen M, Fidanza F et al. (1995). Dietary intake in five ageing cohorts of men in Finland, Italy and The Netherlands. Eur J Clin Nutr 49, 852–860.

    CAS  PubMed  Google Scholar 

  • Jacques PF, Tucker K (2001). Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr 73, 1–2.

    Article  CAS  Google Scholar 

  • Kant AK (2004). Dietary patterns and health outcomes. J Am Diet Assoc 104, 615–635.

    Article  Google Scholar 

  • Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Rosner B et al. (1993). Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med 119, 992–1000.

    Article  CAS  Google Scholar 

  • Kennedy ET, Ohls J, Carlson S, Fleming K (1995). The healthy eating index: design and applications. J Am Diet Assoc 95, 1103–1108.

    Article  CAS  Google Scholar 

  • Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A et al. (2004). Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292, 1433–1439.

    Article  Google Scholar 

  • Knoops KT, de Groot LC, Kromhout D, Staveren WA (2005). JAMA 293, 674–675; author reply.

  • Kromhout D, Menotti A, Blackburn H (2002). Prevention of Coronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven Countries Study. Kluwer Academic Press: Boston, Mass.

    Book  Google Scholar 

  • Liao Y, McGee DL, Cao G, Cooper RS (2000). Alcohol intake and mortality: findings from the National Health Interview Surveys (1988 and 1990). Am J Epidemiol 151, 651–659.

    Article  CAS  Google Scholar 

  • Lowik MR, Hulshof KF, Brussaard JH (1999). Patterns of food and nutrient intakes of Dutch adults according to intakes of total fat, saturated fatty acids, dietary fibre, and of fruit and vegetables. Br J Nutr 81, S91–S98.

    Article  Google Scholar 

  • Marmot MG (2001). Alcohol and coronary heart disease. Int J Epidemiol 30, 724–729.

    Article  CAS  Google Scholar 

  • Martinez-Gonzalez MA, Sanchez-Villegas A (2004). The emerging role of Mediterranean diets in cardiovascular epidemiology: monounsaturated fats, olive oil, red wine or the whole pattern? Eur J Epidemiol 19, 9–13.

    Article  Google Scholar 

  • McCullough ML, Feskanich D, Rimm EB, Giovannucci EL, Ascherio A, Variyam JN et al. (2000). Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. Am J Clin Nutr 72, 1223–1231.

    Article  CAS  Google Scholar 

  • Menotti A, Kromhout D, Blackburn H, Fidanza F, Buzina R, Nissinen A (1999). Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group. Eur J Epidemiol 15, 507–515.

    Article  CAS  Google Scholar 

  • Menotti A, Mulder I, Nissinen A, Feskens E, Giampaoli S, Tervahauta M et al. (2001). Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations; the FINE study. Finland, Italy, Netherlands, Elderly. Eur Heart J 22, 573–579.

    Article  CAS  Google Scholar 

  • Mukamal KJ, Conigrave KM, Mittleman MA, Camargo Jr CA, Stampfer MJ, Willett WC et al. (2003). Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med 348, 108–109.

    Article  Google Scholar 

  • Osler M, Heitmann BL, Gerdes LU, Jorgensen LM, Schroll M (2001). Dietary patterns and mortality in Danish men and women: a prospective observational study. Br J Nutr 85, 219–225.

    Article  CAS  Google Scholar 

  • Osler M, Helms Andreasen A, Heitmann B, Hoidrup S, Gerdes U, Morch Jorgensen L et al. (2002). Food intake patterns and risk of coronary heart disease: a prospective cohort study examining the use of traditional scoring techniques. Eur J Clin Nutr 56, 568–574.

    Article  CAS  Google Scholar 

  • Patterson RE, Haines PS, Popkin BM (2004). Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 94, 57–64.

    Article  Google Scholar 

  • Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R (2000). Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case–control studies. BMJ 321, 323–329.

    Article  CAS  Google Scholar 

  • Rose G, Blackburn H (1968). Cardiovascular Survey Methods. WHO: Geneva.

    Google Scholar 

  • Schulze MB, Hoffmann K, Kroke A, Boeing H (2003). Risk of hypertension among women in the EPIC-Potsdam Study: comparison of relative risk estimates for exploratory and hypothesis-oriented dietary patterns. Am J Epidemiol 158, 365–373.

    Article  Google Scholar 

  • Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC (2000). Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 343, 16–22.

    Article  CAS  Google Scholar 

  • Trichopoulos D, Lagiou P (2004). Mediterranean diet and cardiovascular epidemiology. Eur J Epidemiol 19, 7–8.

    CAS  PubMed  Google Scholar 

  • Trichopoulou A, Bamia C, Trichopoulos D (2005a). Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 165, 29–35.

    Article  Google Scholar 

  • Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003). Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 2599–2608.

    Article  Google Scholar 

  • Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E et al. (1995). Diet and overall survival in elderly people. BMJ 311, 1457–1460.

    Article  CAS  Google Scholar 

  • Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocke MC, Peeters PH et al. (2005b). Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330, 991. Epub 2005 April 8.

    Article  Google Scholar 

  • Voorrips LE, Ravelli ACJ, Dongelman PCA, Deurenberg P, Staveren van WA (1990). A physical activity questionnaire for the elderly. Med Sci Sports Exerc 23, 974–979.

    Google Scholar 

  • White IR, Altmann DR, Nanchahal K (2002). Alcohol consumption and mortality: modeling risks for men and women at different ages. BMJ 325, 191–198.

    Article  Google Scholar 

Download references

Acknowledgements

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:

Belgium

Professor G de Backer, University of Ghent, Ghent.

Denmark

Professor M Schroll, Bispebjerk Hospital, Copenhagen.

Finland

Professor A Nissinen, National Public Health Institute, Helsinki.

France

Dr M Ferry, Centre Hospitalier de Valence, Valence.

Professor JL Schlienger, Université Louis Pasteur, Strasbourg.

Greece

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

Hungary

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

Italy

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.

Poland

Professor A Brzozowska, Warsaw Agricultural University, Warsaw.

Portugal

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

Spain

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

Switzerland

Dr D Schlettwein-Gsell, Basel.

Author information

Authors and Affiliations

  1. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands

    K T B Knoops, L C Groot de, D Kromhout & W A van Staveren

  2. Department of Neurosciences, Human Nutrition Section, University of Rome Tor Vergata, Rome, Italy

    F Fidanza & A Alberti-Fidanza

  3. National Institute for Public Health and the Environment, Bilthoven, The Netherlands

    D Kromhout

Authors
  1. K T B Knoops
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L C Groot de
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F Fidanza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Alberti-Fidanza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D Kromhout
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W A van Staveren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

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.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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). https://doi.org/10.1038/sj.ejcn.1602378

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602378

Keywords

  • dietary patterns
  • mediterranean diet
  • mortality
  • elderly

This article is cited by

Search

Advanced search

Quick links