title: Adherence to a Mediterranean diet and survival in a Greek population. Adherence to the Mediterranean diet is associated with total antioxidant capacity in healthy adults: the ATTICA study. The Mediterranean score of dietary habits in Chinese populations in four different geographical areas Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study Diet profiles in a population sample from Mediterranean southern France. Determinants of the adherence to an “a priori” defined Mediterranean dietary pattern Mediterranean diet cools down the inflammatory milieu in type 2 diabetes: the MÉDITA randomized controlled trial Identifying reports of controlled trials in the BMJ and the Lancet Dietary patterns and survival of older Europeans: the EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition). Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study
abstract: BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality BACKGROUND Greater adherence to the Mediterranean diet has been associated with a lower incidence of cardiovascular disease and cancer . OBJECTIVE We studied the effect of the Mediterranean diet on total antioxidant capacity ( TAC ) in 3042 participants who had no clinical evidence of cardiovascular disease . DESIGN During 2001 - 2002 , a r and om sample of 1514 men and 1528 women aged 18 - 89 y from the Attica area of Greece was selected .  TAC was measured with an immune-diagnostic assay . Food consumption was evaluated with a vali date d food-frequency question naire , and adherence to the Mediterranean diet was assessed on the basis of a diet score that incorporated the inherent characteristics of this diet . RESULTS TAC was positively correlated with diet score . The participants in the highest tertile of the diet score had , on average , 11 % higher TAC levels than did the participants in the lowest tertile , even after adjustment for relevant confounders ( P < 0.01 ) . On the other h and , the participants in the highest tertile of the diet score had , on average , 19 % lower oxidized LDL-cholesterol concentrations than did the participants in the lowest tertile ( P < 0.01 ) . An additional analysis showed that TAC was positively correlated with the consumption of olive oil ( rho = 0.54 , P = 0.002 ) and of fruit and vegetables ( rho = 0.34 and rho = 0.31 , respectively ; P < 0.001 for both ) , whereas it was inversely associated with the consumption of red meat ( rho = -0.35 , P = 0.02 ) . CONCLUSION Greater adherence to the Mediterranean diet is associated with elevated TAC levels and low oxidized LDL-cholesterol concentrations , which may explain the beneficial role of this diet on the cardiovascular system Objective : To compare the dietary intake of Chinese people living in Pan Yu , Hong Kong , San Francisco and Sydney with respect to cardiovascular health , using the Mediterranean diet score , examining the effects of age , gender , urbanization and acculturation on the diet score . Subjects : A total of 500 men and 510 women in Hong Kong were recruited as a territory-wide stratified r and om sample . Subjects were recruited in response to  local advertisements for the other three sites : Pan Yu , 58 men , 95 women ; San Francisco , 166 men , 192 women ; Sydney , 95 men , 73 women . Method : Food-frequency question naire over a 7 week period . A high/healthy score was taken as ≥4 for men and ≥3 for women , representing a dietary pattern beneficial for cardiovascular health . Results : In Hong Kong , more women in the middle age group ( 35–54 ) had a high score than other age groups , and overall more women had high scores than men . In comparing the four geographical regions , Pan Yu had the highest number of subjects with high score , and Hong Kong had the lowest . With the exception of the younger population and men in Hong Kong , the percentage of the population with a high score in all sites is greater than among elderly Greeks consuming a more traditional heart-healthy Mediterranean diet . Conclusion : Considerable variations in Chinese dietary patterns exist with respect to age , gender and geographic location . Overall , the Chinese diet is comparable to the Mediterranean diet and may be expected to have similar health benefits that have been documented for the traditional Mediterranean diet . European Journal of Clinical Nutrition ( 2001 ) 55 , Epidemiological studies show that adherence to a Mediterranean diet ( MD ) increases longevity ; however , few studies are restricted to Mediterranean population s or explore the effect of a MD pattern that directly incorporates olive oil . Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Spain ) . The EPIC-Spain analysis included 40 622 participants ( 37·7 % males ) aged 29 - 69 years who were recruited from five Spanish regions in 1992 - 1996 . During a mean follow-up of 13·4 years , 1855 deaths were documented : 913 from cancer , 399 from CVD , 425 from other causes and 118 from unknown causes of death . Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD ( rMED ) score , measured using an 18-unit scale incorporating nine selected dietary components . A high compared with a low rMED score was associated with a significant reduction in mortality from all causes ( hazard ratio ( HR ) 0·79 ; 95 % CI 0·69 , 0·91 ) , from CVD ( HR 0·66 ; 95 % CI 0·49 , 0·89 ) , but not from overall cancer ( HR 0·92 ; 95 % CI 0·75 , 1·12 ) . A 2-unit increase in rMED score was associated with a 6 % ( P < 0·001 ) decreased risk of all-cause mortality . A high olive oil intake and moderate alcohol consumption contributed most to this association . In this Spanish cohort , following an olive oil-rich MD was related to a significant reduction in all-cause mortality , and reduced the risk of mortality from CVD . These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries Abstract Objective To examine whether adherence to the modified Mediterranean diet , in which unsaturates were substituted for monounsaturates , is associated with longer life expectancy among elderly Europeans . Design Multicentre , prospect i ve cohort study . Setting Nine European countries ( Denmark , France , Germany , Greece , Italy , the Netherl and s , Spain , Sweden , United Kingdom ) . Participants 74 607 men and women , aged 60 or more , without coronary heart disease , stroke , or cancer at enrolment and with complete information about dietary intake and potentially confounding variables . Main outcome measures Extent of adherence to a modified Mediterranean diet  using a scoring system on a 10 point scale , and death from any cause by time of occurrence , modelled through Cox regression . Results An increase in the modified Mediterranean diet score was associated with lower overall mortality , a two unit increment corresponding to a statistically significant reduction of 8 % ( 95 % confidence interval 3 % to 12 % ) . No statistically significant evidence of heterogeneity was found among countries in the association of the score with overall mortality even though the association was stronger in Greece and Spain . When dietary exposures were calibrated across countries , the reduction in mortality was 7 % ( 1 % to 12 % ) . Conclusion The Mediterranean diet , modified so as to apply across Europe , was associated with increased survival among older people OBJECTIVE A Mediterranean diet quality index ( MDQI ) was devised to give an overall assessment of dietary habits and to identify groups at risk . DESIGN The MDQI was based on scores given for selected levels of consumption of selected nutrients and foods . SETTING Mediterranean southern France . SUBJECTS The sample included 473 men and 491 women in three age classes recruited at r and om . RESULTS Only 9.5 % of men , 9.0 % of women , 4.7 % of 20 - 34 year old subjects , 6.6 % of 35 - 54 year old subjects and 14.0 % of 55 - 76 year old subjects were shown to have a healthy diet . However , 10.1 % of men , 8.6 % of women , 19.4 % of 20 - 34 year old subjects , 10.2 % of 35 - 54 year old subjects and 4.6 % of 55 - 76 year old subjects were shown to have a poor diet . There were significantly fewer smokers among subjects with a good diet but the distribution of moderate wine drinkers was comparable between those with a good diet and those with a poor diet . Correspondence analysis associated a healthy diet with 55 - 76 year old men and women living in rural areas , who had received primary schooling only and who were manual workers . Both men and women with a poor MDQI score tended to be young and smokers . In addition , women with a poor MDQI tended to be heavy drinkers and obese . CONCLUSIONS This study showed that the Mediterranean model , which is generally recognized as a healthy diet , appears restricted to older people and to rural areas , whereas urbanized young people depart from it . A nutritional prevention policy targeted at young adults is required to encourage them to adhere to the Mediterranean model . Smoking and drinking showed different distribution patterns in the sample under study Summary . Background : A prospect i ve cohort study with university level participants was initiated to study the effect of Mediterranean diet on health . Aims : The objective of this study was to identify possible lifestyle and socioeconomic variables associated with the consumption of a Mediterranean dietary pattern ( MDP ) . Method : This analysis includes 1587 males and 2260 females . MDP was defined “ a priori ” by summing the st and ardized residuals of nutrients and foods after adjusting a regression model using total energy intake as the independent variable . Multiple regression and non-parametric locally weighted regression models were adjusted with the relative adherence to the MDP as the dependent variable in males and females . Results : Women were more compliant than men with the MDP ( Coefficient regression ( b ) = 4.1 ; Confidence Interval ( CI ) 95 % = 3.2 to 4.9 ) . The compliance with the MDP was significantly poorer among younger participants both in men and women ( p < 0.001 in men and in women ) . Participants who were more physically active were more likely to fulfill the traditional MDP ( p = 0.01 in men and p < 0.001 in women ) . Conclusions : Our findings provide evidence supporting the progressive departure from the traditional MDP in younger and highly educated subjects of the Mediterranean area . A more active life-style is associated with a better compliance with the MDP Mediterranean-style diets provide cardiovascular benefits and increase insulin sensitivity . There is little evidence that adherence to Mediterranean diet may influence the levels of the inflammatory milieu in type 2 diabetes . The aim of this study was to assess whether Mediterranean diet influences both C-reactive protein ( CRP ) and adiponectin in newly diagnosed type 2 diabetes , and whether adherence to Mediterranean diet affects their circulating levels . In a two-arm , single-center trial , 215 men and women with newly diagnosed type 2 diabetes were r and omized to a Mediterranean diet ( n = 108 , 54 males and 54 females ) or a low-fat diet ( n = 107 , 52 males and 55 females ) , with a total follow-up of 8.1 years . At baseline visit and at 1 year , body weight , HOMA index , CRP , and adiponectin and its fractions were assessed . Adherence to the diets was assessed by calculating the Mediterranean-diet score . At 1 year , CPR fell by 37 % and adiponectin rose by 43 % in the Mediterranean diet group , while remaining unchanged in the low-fat diet group . The pattern of adiponectin fractions ( high and non-high molecular weight ) showed a response similar to that of total adiponectin . Diabetic patients with the highest scores ( 6–9 points ) of adherence to Mediterranean diet had lower circulating CRP level and higher circulating total adiponectin levels than the diabetic patients who scored <3 points on the scale ( P = 0.001 ) . The results of this r and omized controlled trial demonstrate that Mediterranean diet cools down the inflammatory milieu of type 2 diabetes In 1994 the European Union BIOMED programme awarded £ 330 000 to a project , coordinated by the UK Cochrane Centre , to identify reports of r and omised controlled trials in general health care journals in Europe . The rationale is that reports of r and omised controlled trials are difficult to identify through sources such as Medline .1 For example , a study of the first six months of Medline for 1993 identified over 400 reports of r and omised controlled trials which were not coded as such , despite having the word r and om or r and omised in the title or abstract .2 A systematic review in 1993 indicated that , on average , search es of Medline identify only 50 % of trials.3 We present here the results of h and search ing the BMJ and the Lancet from 1948 onwards to identify reports of trials . Twenty h and search ers were trained OBJECTIVE To investigate the association of a posteriori dietary patterns with overall survival of older Europeans . DESIGN AND SETTING This is a multi-centre cohort study . Cox regression analysis was used to investigate the association of the prevailing , a posteriori-derived , plant-based dietary pattern with all-cause mortality in a population of subjects who were 60 years or older at recruitment to the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Elderly cohort ) . Analyses controlled for all known potential risk factors . SUBJECTS In total , 74,607 men and women , 60 years or older at enrolment and without previous coronary heart disease , stroke or cancer , with complete information about dietary intakes and potentially confounding variables , and with known survival status as of December 2003 , were included in the analysis . RESULTS An increase in the score which measures the adherence to the plant-based diet was associated with a lower overall mortality , a one st and ard deviation increment corresponding to a statistically significant reduction of 14 % ( 95 % confidence interval 5 - 23 % ) . In country-specific analyses the apparent association was stronger in Greece , Spain , Denmark and The Netherl and s , and absent in the UK and Germany . CONCLUSIONS Greater adherence to the plant-based diet that was defined a posteriori in this population of European elders is associated with lower all-cause mortality . This dietary score is moderately positively correlated with the Modified Mediterranean Diet Score that has been constructed a priori and was also shown to be beneficial for the survival of the same EPIC-Elderly cohort Objective To examine whether adherence to the Mediterranean diet was associated with longer telomere length , a biomarker of aging . Design Population based cohort study . Setting Nurses ’ Health Study , an ongoing prospect i ve cohort study of 121 700 nurses enrolled in 1976 ; in 1989 - 90 a subset of 32 825 women provided blood sample s. Participants 4676 disease-free women from nested case-control studies within the Nurses ’ Health Study with telomere length measured who also completed food frequency question naires . Main outcome measure Association between relative telomere lengths in peripheral blood leukocytes measured by  quantitative real time polymerase chain reaction and Alternate Mediterranean Diet score  calculated from self reported dietary data . Results Greater adherence to the Mediterranean diet was associated with longer telomeres after adjustment for potential confounders . Least squares mean telomere length z scores were −0.038 ( SE 0.035 ) for the lowest Mediterranean diet score groups and 0.072 ( 0.030 ) for the highest group ( P for trend=0.004 ) . Conclusion In this large study , greater adherence to the Mediterranean diet was associated with longer telomeres . These results further support the benefits of adherence to the Mediterranean diet for promoting health and longevity
target: The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality .
  Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population .
background: OBJECTIVE The aim of this review was to evaluate the conceptual suitability , applicability and psychometric properties of scores used internationally to measure adherence to the Mediterranean diet ( MD ) .