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Olive oil consumption is associated with lower cancer, cardiovascular and all-cause mortality among Italian adults: prospective results from the Moli-sani Study and analysis of potential biological mechanisms

European Journal of Clinical Nutrition (2024)Cite this article

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Abstract

Background

Olive oil consumption has been reportedly associated with lower mortality rates, mostly from cardiovascular diseases, but its potential impact on cancer death remains controversial. Moreover, biological mechanisms possibly linking olive oil consumption to mortality outcomes remain unexplored.

Methods

We longitudinally analysed data on 22,892 men and women from the Moli-sani Study in Italy (follow-up 13.1 y), to examine the association of olive oil consumption with mortality. Dietary data were collected at baseline (2005–2010) through a 188-item FFQ, and olive oil consumption was standardised to a 10 g tablespoon (tbsp) size. Diet quality was assessed through a Mediterranean diet score. Multivariable-adjusted Cox proportional hazard models, also including diet quality, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The potential mediating role of inflammatory, metabolic, cardiovascular and renal biomarkers on the association between olive oil intake and mortality was evaluated on the basis of change-in-estimate and associated p values.

Results

Multivariable HRs for all-cause, cancer, cardiovascular and other cause mortality associated with high (>3 tbsp/d) versus low (≤1.5 tbsp/d) olive oil consumption were 0.80 (0.69–0.94), 0.77 (0.59–0.99), 0.75 (0.58–0.97) and 0.97 (0.73–1.29), respectively. Taken together, the investigated biomarkers attenuated the association of olive oil consumption with all-cause and cancer mortality by 21.2% and 13.7%, respectively.

Conclusions

Higher olive oil consumption was associated with lower cancer, cardiovascular and all-cause mortality rates, independent of overall diet quality. Known risk factors for chronic diseases only in part mediated such associations suggesting that other biological pathways are potentially involved in this relationship.

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Fig. 1: Adjusted survival curves for all-cause and cause-specific mortality across categories of olive oil consumption in the Moli-sani Study Cohort, Italy, 2005–2010.
Fig. 2: Hazard ratios for all-cause and cause-specific mortality in association with olive oil intake, modelled by spline curves in the Moli-sani Study Cohort, Italy, 2005–2010.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author. The data are stored in an institutional repository (https://repository.neuromed.it), and access is restricted by the ethical approvals and the legislation of the European Union.

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Acknowledgements

The present study has been performed in the context of the Fondazione Umberto Veronesi – IRCCS Neuromed framework agreement. We are grateful to the population of the Molise region who enthusiastically joined the study and wish to thank the Associazione Cuore Sano ETS (Campobasso, Italy) for its cultural support, and the Moli-sani Study Investigators (full list available in the Supplementary Information file). ER was supported by the Fondazione Umberto Veronesi, which is gratefully acknowledged. The enrolment phase of the Moli-sani Study was supported by research grants from Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (MIUR, Rome, Italy) – Programma Triennale di Ricerca, Decreto no. 1588 and Instrumentation Laboratory, Milan, Italy.

Funding

The analyses reported here were supported by the Italian Ministry of Health (Ricerca Corrente 2022–2024). Funders had no role in the study design, collection, analysis, and interpretation of data, nor in the writing of the manuscript or in the decision to submit the article for publication. All authors were and are independent from funders.

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Authors and Affiliations

  1. Department of Epidemiology and Prevention, IRCCS NEUROMED, via dell’Elettronica, 86077, Pozzilli, IS, Italy

    Emilia Ruggiero, Augusto Di Castelnuovo, Simona Costanzo, Simona Esposito, Amalia De Curtis, Mariarosaria Persichillo, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello & Marialaura Bonaccio

  2. Department of Medicine and Surgery, LUM University “Giuseppe Degennaro”, Casamassima, BA, Italy

    Licia Iacoviello

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Contributions

MB and ER conceived the present study, analysed the data and drafted the manuscript; LI, MB, ER and ADiC contributed to its design and to interpretation of data; SC, SE and MP managed data collection; ADeC organised and performed laboratory tests; MBD, CC, GdG and LI originally inspired the Moli-sani Study and critically reviewed this manuscript. All authors have read and approved the manuscript.

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Correspondence to Licia Iacoviello.

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Ruggiero, E., Di Castelnuovo, A., Costanzo, S. et al. Olive oil consumption is associated with lower cancer, cardiovascular and all-cause mortality among Italian adults: prospective results from the Moli-sani Study and analysis of potential biological mechanisms. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01442-8

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