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Multiple approaches to associations of physical activity and adherence to the Mediterranean diet with all-cause mortality in older adults: the PREvención con DIeta MEDiterránea study

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Abstract

Purpose

Although evidence indicates that both physical activity and adherence to the Mediterranean diet (MedDiet) reduce the risk of all-cause mortality, a little is known about optimal intensities of physical activity and their combined effect with MedDiet in older adults. We assessed the separate and combined associations of leisure-time physical activity (LTPA) and MedDiet adherence with all-cause mortality.

Methods

We prospectively studied 7356 older adults (67 ± 6.2 years) at high vascular risk from the PREvención con DIeta MEDiterránea study. At baseline and yearly thereafter, adherence to the MedDiet and LTPA were measured using validated questionnaires.

Results

After 6.8 years of follow-up, we documented 498 deaths. Adherence to the MedDiet and total, light, and moderate-to-vigorous LTPA were inversely associated with all-cause mortality (p < 0.01 for all) in multiple adjusted Cox regression models. The adjusted hazard of all-cause mortality was 73% lower (hazard ratio 0.27, 95% confidence interval 0.19–0.38, p < 0.001) for the combined category of highest adherence to the MedDiet (3rd tertile) and highest total LTPA (3rd tertile) compared to lowest adherence to the MedDiet (1st tertile) and lowest total LTPA (1st tertile). Reductions in mortality risk did not meaningfully differ between total, light intensity, and moderate-to-vigorous LTPA.

Conclusions

We found that higher levels of LTPA, regardless of intensity (total, light and moderate-to-vigorous), and greater adherence to the MedDiet were associated separately and jointly with lower all-cause mortality. The finding that light LTPA was inversely associated with mortality is relevant because this level of intensity is a feasible option for older adults.

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Acknowledgements

CIBERESP and CIBEROBN are initiatives of the Instituto de Salud Carlos III (ISCIII) of Spain, which are supported by FEDER funds (CB06/03). Also supported by ISCIII, the official funding agency for biomedical research of the Spanish government, through grants provided to research networks specifically developed for the trial (RTIC G03/140 and RD 06/0045) through CIBEROBN, and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria-Fondo Europeo de Desarrollo Regional (PI04-2239, PI05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, and PI11/02505; PI13/00462), Ministerio de Ciencia e Innovación (AGL-2009-13906-C02 and AGL2010-22319-C03), Fundación Mapfre 2010, Consejería de Salud de la Junta de Andalucía (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (ACOMP06109, GVA-COMP2010-181, GVACOMP2011-151, CS2010-AP-111, and CS2011-AP-042), and the Navarra Regional Government (27/2011). MF was supported by a joint contract of the ISCIII and Health Department of the Catalan Government (Generalitat de Catalunya) (CP 06/00100). The Fundación Patrimonio Comunal Olivarero and Hojiblanca SA (Málaga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain), and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study. We appreciate the English revision by Elaine M. Lilly, Ph.D.

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Authors and Affiliations

  1. Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

    Gabriela Cárdenas-Fuentes, Isaac Subirana, Montserrat Fíto & Helmut Schröder

  2. PhD Programme in Biomedicine, Department of Experimental and Health Sciences, Universidad Pompeu Fabra, Barcelona, Spain

    Gabriela Cárdenas-Fuentes

  3. CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

    Isaac Subirana & Helmut Schröder

  4. Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain

    Miguel A. Martinez-Gonzalez & Miguel Ruiz-Canela

  5. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Miguel A. Martinez-Gonzalez, Jordi Salas-Salvadó, Dolores Corella, Ramon Estruch, Montserrat Fíto, Miguel Fiol, José Lapetra, Fernando Aros, Luis Serra-Majem, Josep A. Tur, Xavier Pinto, Emilio Ros, Oscar Coltell, Andres Díaz-López & Miguel Ruiz-Canela

  6. Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA

    Miguel A. Martinez-Gonzalez

  7. Human Nutrition Unit, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, University Hospital of Sant Joan de Reus, Rovira i Virgili University, Reus, Spain

    Jordi Salas-Salvadó & Andres Díaz-López

  8. Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain

    Dolores Corella

  9. Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

    Ramon Estruch

  10. Department of Public Health and Psychiatry, University of Málaga, Málaga, Spain

    Carlos Muñoz-Bravo

  11. Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain

    Miguel Fiol

  12. Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Research Unit, Seville, Spain

    José Lapetra

  13. Department of Cardiology, University Hospital Araba, Vitoria, Spain

    Fernando Aros

  14. Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

    Luis Serra-Majem

  15. Research Group on Community Nutrition and Oxidative Stress, Universitat de les Illes Balears, Palma de Mallorca, Spain

    Josep A. Tur

  16. Lipids and Vascular Risk Units, Internal Medicine, University Hospital of Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

    Xavier Pinto

  17. Lipid Clinic, Endocrinology and Nutrition Service, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    Emilio Ros

  18. Department of Computer Languages and Systems, Universitat Jaume I, Castellon, Spain

    Oscar Coltell

Authors
  1. Gabriela Cárdenas-Fuentes
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  2. Isaac Subirana
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  3. Miguel A. Martinez-Gonzalez
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  4. Jordi Salas-Salvadó
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  5. Dolores Corella
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  6. Ramon Estruch
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  7. Montserrat Fíto
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  8. Carlos Muñoz-Bravo
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  9. Miguel Fiol
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  10. José Lapetra
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  11. Fernando Aros
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  12. Luis Serra-Majem
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  13. Josep A. Tur
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  14. Xavier Pinto
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  15. Emilio Ros
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  16. Oscar Coltell
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  17. Andres Díaz-López
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  18. Miguel Ruiz-Canela
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  19. Helmut Schröder
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Contributions

GMC and HS conceived the project; MAM, JS-S, DC, RE, MF, EGG, MF, JL, FA, LS-M, JAT, XP, ER, OC, AD-L, and MR-C conducted the research; CMG, IS, and HS analysed the data; CMG wrote the manuscript: CMG and HS had primary responsibility for the final content of the manuscript; all authors read and approved the final manuscript.

Corresponding author

Correspondence to Helmut Schröder.

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The authors declare that they have no competing interests related to the study.

Ethics and consent

The Institutional Review Board of all participating centres approved the study protocol and the trial was conducted following the guidelines of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

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Cárdenas-Fuentes, G., Subirana, I., Martinez-Gonzalez, M.A. et al. Multiple approaches to associations of physical activity and adherence to the Mediterranean diet with all-cause mortality in older adults: the PREvención con DIeta MEDiterránea study. Eur J Nutr 58, 1569–1578 (2019). https://doi.org/10.1007/s00394-018-1689-y

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