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.

Interventions and public health nutrition

Adherence to the Mediterranean diet and quality of life in the SUN Project

Abstract

Background/Objectives:

Mediterranean diet has been related with reduced morbidity and better well-being. The aim of this study was to assess whether the adherence to the Mediterranean diet were associated with mental and physical health related to quality of life.

Subjects/Methods:

This analysis included 11 015 participants with 4 years of follow-up in the SUN Project (a multipurpose cohort study based on university graduates from Spain). A validated 136-item food frequency questionnaire was used to assess the adherence to the Mediterranean diet at baseline, according to a nine-point score, presented in four categories (low, low-moderate, moderate-high and high). Health-related quality of life (HRQL) was measured after 4 years of follow-up with the Spanish version of the SF-36 Health Survey. Generalized Linear Models were fitted to assess adjusted mean scores, the regression coefficients (β) and their 95% confidence intervals (95% CIs) for the SF-36 domains according to categories of adherence to Mediterranean diet.

Results:

Multivariate-adjusted models revealed a significant direct association between adherence to Mediterranean diet and all the physical and most mental health domains (vitality, social functioning and role emotional). Vitality (β=0.50, 95% CI=0.32–0.68) and general health (β=0.45, 95% CI=0.26–0.62) showed the highest coefficients. Mean values for physical functioning, role physical, bodily pain, general health and vitality domains were significantly better with increasing adherence to the Mediterranean diet. Those having improved their initial high diet scores have better scores in physical functioning, general health and vitality.

Conclusions:

Adherence to the Mediterranean diet seems to be a factor importantly associated with a better HRQL.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  • Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al. (2000). Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32 (Suppl 9), S498–S504.

    CAS  Article  Google Scholar 

  • Akbaraly TN, Brunner E, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A (2009). Dietary pattern and depressive symptoms in middle age. Br J Psychiatry 195, 408–413.

    Article  Google Scholar 

  • Alonso J, Prieto L, Antó JM (1995). The Spanish version of the SF-36 Health Survey (the SF-36 heath questionnaire): an instrument for measuring clinical results. Med Clin 104, 771–776.

    CAS  Google Scholar 

  • Alonso J, Regidor E, Barrio G, Prieto L, Rodríguez C, De la Fuente L (1998). Population referente values of the Spanish version of the Health Questionnaire SF-36. Med Clin 11, 410–416.

    Google Scholar 

  • Babio N, Bulló M, Salas-Salvado J (2009). Mediterranean diet and metabolic syndrome: the evidence. Pub Health Nutr 12, 1607–1617.

    Article  Google Scholar 

  • Bes-Rastrollo M, Pérez JR, Sánchez-Villegas A, Alonso A, Martínez-González MA (2005). Validación del peso e índice de masa corporal auto-declarados de los participantes de una cohorte de graduados universitarios. Rev Esp Obes 3, 352–358.

    Google Scholar 

  • Bottiglieri T (1996). Folate, vitamina B12 and neuropsychiatric disorders. Nutr Rev 54, 382–390.

    CAS  Article  Google Scholar 

  • Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C (2004). Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA Study. J Am Coll Cardiol 44, 152–158.

    Article  Google Scholar 

  • Crowe FL, Skeaff CM, Green TJ, Gray AR (2007). Serum phospholipid n 3 long-chain polyunsaturated fatty acids and physical and mental health in a population-based survey of New Zealand adolescents and adults. Am J Clin Nutr 86, 1278–1285.

    CAS  Article  Google Scholar 

  • de la Fuente-Arrillaga C, Vázquez Z, Bes-Rastrollo M, Sampson L, Martínez-González MA (2010). Reproducibility of a Food Frequency Questionnaire (FFQ) validated in Spain. Public Health Nutr 13, 1364–1372.

    Article  Google Scholar 

  • Engelhart MJ, Geerlings MI, Ruitenberg A, van Swieten JC, Hofman A, Witteman JC et al. (2002). Dietary intake of antioxidants and risk of Alzheimer disease. JAMA 287, 3223–3229.

    CAS  Article  Google Scholar 

  • Fernández-Ballart JD, Piñol JL, Zazpe I, Corella D, Carrasco P, Toledo E et al. (2010). Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Br J Nutr 103, 1808–1816.

    Article  Google Scholar 

  • Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB (2009). Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 119, 1093–1100.

    Article  Google Scholar 

  • Gómez-Pinilla F (2008). Brain foods; the effects of nutrients on brain function. Nature Rev Neurosci 9, 568–578.

    Article  Google Scholar 

  • Guallar-Castillón P, Redondo A, Banegas JR, López- García E, Rodríguez-Artalejo F (2005). Differences in quality of life between women and men in the older population of Spain. Soc Sci Med 60, 1229–1240.

    Article  Google Scholar 

  • Hislop TG, Bajdik CD, Balneaves LG, Holmes A, Chan S, Wu E et al. (2006). Physical and emotional health effects and social consequences after participation in a low-fat, high-carbohydrate dietary trial for more than 5 years. J Clin Oncol 24, 2311–2317.

    Article  Google Scholar 

  • Kunst A, Bos V, Lahelma E, Bartley M, Lissau I, Regidor E et al. (2005). Trends in socio-economic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 34, 316–326.

    Article  Google Scholar 

  • Kyrozis A, Psaltopoulou T, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A (2009). Dietary lipids and geriatric depression scale score among elders: the EPIC-Greece cohort. J Psychiatr Res 43, 763–769.

    CAS  Article  Google Scholar 

  • La Vecchia C (2009). Association between Mediterranean dietary patterns and cancer risk. Nutr Rev 67 (Suppl 1), S126–S299.

    Article  Google Scholar 

  • Laaksonen E, Martikainen P, Lahelma E, Lallukka T, Rahkonen O, Head J et al. (2007). Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study. Int J Epidemiol 36, 776–786.

    Article  Google Scholar 

  • Liu C, Xie B, Chou CP, Koprowski C, Zhou D, Palmer P et al. (2007). Perceived stress, depression and food consumption frequency in the college students of China Seven Cities. Physiol Behav 92, 748–754.

    CAS  Article  Google Scholar 

  • López-Garcia E, Schulze MB, Fung TT, Meigs JB, Rifai N, Manson JE et al. (2004). Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 80, 1029–1035.

    Article  Google Scholar 

  • López-Miranda J, Pérez-Jiménez F, Ros E, De Caterina R, Badimón L, Covas MI et al. (2010). Olive oil and health: summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008. Nutr Metab Cardiovasc Dis 20, 284–294.

    Article  Google Scholar 

  • MacKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF (2004). Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring cohort. Diabetes Care 27, 538–546.

    Article  Google Scholar 

  • Martínez-González MA, Bes-Rastrollo M, Serra-Majem L, Lairon D, Estruch R, Trichopoulou A (2009). Mediterranean food pattern and the primary prevention of chronic disease: recent developments. Nutr Rev 67 (Suppl 1), S111–S116.

    Article  Google Scholar 

  • Martínez-González MA, Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vázquez Z et al. (2008). Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 336, 1348–1351.

    Article  Google Scholar 

  • Martínez-González MA, García-López M, Bes-Rastrollo M, Toledo E, Martínez-Lapiscina EH, Delgado-Rodriguez M et al. (2011). Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort. Nutr Metab Cardiovasc Dis 21, 237–244.

    Article  Google Scholar 

  • Martínez-González MA, López-Fontana C, Varo JJ, Sánchez-Villegas A, Martinez JA (2005). Validation of the Spanish version of the physical activity questionnaire used in the Nurses’ Health Study and the Health Professionals’ Follow-up Study. Public Health Nutr 8, 920–927.

    Article  Google Scholar 

  • Mataix J (2003). Tabla de Composición de Alimentos Españoles, 4th edn. Universidad de Granada: Granada.

    Google Scholar 

  • Mikolajczyk RT, Ansari W, Maxwell AE (2009). Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutr J 8, 31.

    Article  Google Scholar 

  • Moreiras O, Carbajal A, Cabrera L, Cuadrado C (2005). Tablas de Composición de Alimentos, 9th edn. Pirámide: Madrid.

    Google Scholar 

  • Muñóz MA, Fíto M, Marrugat J, Covas MI, Schröeder H (2009). Adherence to the Mediterranean diet is associated with better mental and physical health. B J Nutr 101, 1821–1827.

    Article  Google Scholar 

  • Murakami K, Mizoue T, Sasaki S, Ohta M, Sato M, Matsushita Y et al. (2008). Dietary intake of folate, other B vitamins, and omega-3 polyunsaturated fatty acids in relation to depressive symptoms in Japanese adults. Nutrition 24, 140–147.

    CAS  Article  Google Scholar 

  • Myint PK, Welch AA, Bingham SA, Surtees PG, Wainwright WJ, Luben RN et al. (2007). Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk): a population based cross-sectional study. Public Health Nutr 10, 34–41.

    Article  Google Scholar 

  • Núñez-Córdoba JM, Valencia-Serrano F, Toledo E, Alonso A, Martínez-González MA (2009). Mediterranean diet and incidence of hypertension: the SUN cohort. Am J Epidemiol 169, 339–346.

    Article  Google Scholar 

  • Panagiotakos DB, Pitsavos Ch, Chrysohoou Ch, Vlismas K, Skoumas Y, Palliou K et al. (2007). Dietary habits mediate the relationship between socio-economic status and CVD factors among healthy adults: the ATTICA study. Pub Health Nutr 11, 1342–1349.

    Article  Google Scholar 

  • Plaisted CS, Lin PH, Ard JD, McClure ML, Svetkey LP (1999). The effects of dietary patterns on quality of life: a substudy of the Dietary Approaches to Stop Hypertension trial. J Am Diet Assoc 99 (Suppl 8), S84–S89.

    CAS  Article  Google Scholar 

  • Samsa G, Edelman D, Rothman ML, Williams GR, Lipscomb J, Matchar D (1999). Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics 15, 141–155.

    CAS  Article  Google Scholar 

  • Sánchez-Villegas A, Bes-Rastrollo M, Martínez-González MA, Serra-Majem L (2006). Adherence to a Mediterranean dietary pattern and weight gain in a follow-up study: the SUN cohort. Int J Obes 30, 350–358.

    Article  Google Scholar 

  • Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, Schlatter J, Lahortiga F, Serra-Majem L et al. (2009). Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 66, 1090–1098.

    Article  Google Scholar 

  • Sánchez-Villegas A, Verberne L, De Irala J, Ruíz-Canela M, Toledo E, Serra-Majem L et al. (2011). Dietary fat intake and the risk of depression: the SUN Project. PLoS One 6, e16268.

    Article  Google Scholar 

  • Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA (2009). Mediterranean diet and mild cognitive impairment. Arch Neurol 66, 216–225.

    PubMed  PubMed Central  Google Scholar 

  • Schiepers OJ, de Groot RH, Jolles J, van Boxtel MP (2010). Fish consumption, not fatty acid status, is related to quality of life in a healthy population. Prostaglandins, Leukot Essent Fatty Acids 83, 31–35.

    CAS  Article  Google Scholar 

  • Seguí-Gómez M, de la Fuente C, Vázquez Z, de Irala J, Martínez-González MA (2006). Cohort profile: the ‘Seguimiento Universidad de Navarra’ (SUN) study. Int J Epidemiol 35, 1417–1422.

    Article  Google Scholar 

  • Serra-Majem L, Bes-Rastrollo M, Roman-Viñas B, Pfrimer K, Sánchez-Villegas A, Martínez-González MA (2009). Dietary patterns and nutritional adequacy in a Mediterranean country. Br J Nutr 101 (Suppl 2), S21–S28.

    CAS  Article  Google Scholar 

  • Shohaimi S, Welch A, Bingham S, Luben R, Day N, Wareham N et al. (2004). Residential area deprivation predicts fruit and vegetable consumption independently of individual educational level and occupational social class: a cross sectional population study in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). J Epidemiol Community Health 58, 686–691.

    Article  Google Scholar 

  • Silvers KM, Scott KH (2002). Fish consumption and self-reported physical and mental health status. Public Health Nutr 5, 427–431.

    Article  Google Scholar 

  • Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008). Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337, a1344.

    Article  Google Scholar 

  • Steptoe A, Perkin-Porras L, Rink E, Capuccio FP (2004). Quality of life and self-rated in relation to changes in fruit and vegetable intake and in plasma vitamins C and E in a randomised trial of behavioural and nutritional education counselling. Br J Nutr 92, 177–184.

    CAS  Article  Google Scholar 

  • Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Radcliffe JL, Wander RC et al. (2003). Biologic and quality-of-life outcomes from the mediterranean lifestyle program. Diabetes Care 26, 2288–2293.

    Article  Google Scholar 

  • Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Núñez-Córdoba JM, Martinez-Gonzalez MA (2007). Mediterranean diet inversely associated with the incidence of metabolic syndrome. Diabetes Care 30, 2957–2959.

    Article  Google Scholar 

  • Trichopoulou A, Bamia C, Trichopoulos D (2009). Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 338, b2337.

    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 

  • Ware JE, Gandek B (1998). Overview of the SF-36 health surrey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol 51, 903.

    Article  Google Scholar 

  • Willett WC (1998). Issues in analysis and presentation of dietary data. In: Willett W (ed). Nutritional Epidemiology, 2nd edn. Oxford University Press: New York, NY, pp 321–346.

    Chapter  Google Scholar 

Download references

Acknowledgements

We are indebted to the participants of the SUN Study for their continued cooperation and participation. We thank to other members of the SUN Group: A Alonso, I Ara, FJ Basterra-Gortari, S Benito, M Bes-Rastrollo, JJ Beunza, M Delgado-Rodriguez, T Dierssen, J Doreste, F Guillen-Grima, J Krafka, J Llorca, C Lopez del Burgo, A Marti, JA Martinez, JM Nuñez-Cordoba, AM Pimenta, D Sanchez, M Segui-Gomez, M Serrano-Martínez and Z Vazquez. The Spanish Government Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias, projects PI042241, PI040233, PI050976, PI070240, PI0801943, and RD 06/0045 and the Navarra Regional Government project PI41/2005 have supported the SUN Project.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P Henríquez Sánchez.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Henríquez Sánchez, P., Ruano, C., de Irala, J. et al. Adherence to the Mediterranean diet and quality of life in the SUN Project. Eur J Clin Nutr 66, 360–368 (2012). https://doi.org/10.1038/ejcn.2011.146

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2011.146

Keywords

  • Mediterranean diet
  • quality of life
  • mental health
  • physical health

Further reading

Search

Quick links