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Mediterranean diet, alcohol-drinking pattern and their combined effect on all-cause mortality: the Seguimiento Universidad de Navarra (SUN) cohort

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Abstract

Purpose

The health benefits of the Mediterranean diet (MedDiet) have been widely studied. However, controversy remains for one of its components: alcohol intake. We aimed to assess the joint effect of adherence to the MedDiet and alcohol-drinking pattern on all-cause mortality.

Methods

We used data from 20,506 subjects from a prospective cohort of Spanish university graduates, the Seguimiento Universidad de Navarra (SUN) cohort. Adherence to the MedDiet was operationalized using four different dietary indexes and then categorized in low or high adherence, according to the median score. Alcohol-drinking pattern was evaluated with the previously defined the Mediterranean alcohol-drinking pattern (MADP), grouped into three categories of adherence (low, moderate and high adherence) and a fourth category for abstainers. The outcome was all-cause mortality.

Results

During a median follow-up of 12.1 years, we observed 460 deaths. No statistically significant supra-multiplicative interaction between the two exposures was found. Low adherence to both the MedDiet and MADP was associated with higher all-cause mortality compared to high adherence to both exposures [multivariable-adjusted hazard ratio (HR) = 2.02, 95% confidence interval (CI): 1.33–3.07]. Similar results were found for cancer mortality and cardiovascular mortality.

Conclusions

Although the combined effect of the MedDiet and MADP was not significantly higher than the product of their individual effects, a low adherence to both the MedDiet and MADP was associated with higher rates of all-cause mortality. This report also shows the usefulness of the dietary pattern approach applied to alcohol intake and of including the drinking pattern as another component of the MedDiet.

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Acknowledgements

We thank very specially all participants in the SUN cohort for their long-standing and enthusiastic collaboration as well as our advisors from Harvard TH Chan School of Public Health, Walter Willett, Alberto Ascherio, Frank B. Hu and Meir J. Stampfer who helped us design the SUN Project. We also thank the other members of the SUN Group.

Funding

The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045, CIBER-OBN, Grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, PI17/01795 and G03/140), the Navarra Regional Government (27/2011, 45/2011, 122/2014). G.M was supported by the Office of Research at the Universidad de La Frontera for her postdoctoral internship at the University of Navarra.

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Authors and Affiliations

  1. Departamento de Salud Pública, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile

    Gladys Morales

  2. Centro de Investigación en Epidemiología Cardiovascular y Nutricional (EPICYN), Universidad de La Frontera, Temuco, Chile

    Gladys Morales

  3. Department of Preventive Medicine and Public Health, IdisNA, University of Navarra, Pamplona, Spain

    Miguel A. Martínez-González, María Barbería-Latasa, Maira Bes-Rastrollo & Alfredo Gea

  4. Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain

    Miguel A. Martínez-González, Maira Bes-Rastrollo & Alfredo Gea

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

    Miguel A. Martínez-González

Authors
  1. Gladys Morales
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  2. Miguel A. Martínez-González
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  3. María Barbería-Latasa
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  4. Maira Bes-Rastrollo
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  5. Alfredo Gea
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Contributions

Conceptualization, A.G. and M.A.M.G.; methodology, A.G. and M.A.M.G.; formal analysis, G.M. and A.G.; resources, M.A.M.G. and M.B.R.; data curation, M.B.; writing—Original draft preparation, A.G., G.M.; writing—review and editing, all authors; supervision M.B.R., M.A.M.G.; funding acquisition, M.A.M.G. and M.B.R. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Maira Bes-Rastrollo.

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The present study was approved by the Institutional Review Board of the University of Navarra.

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All authors reviewed and approved the final version of the manuscript.

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Morales, G., Martínez-González, M.A., Barbería-Latasa, M. et al. Mediterranean diet, alcohol-drinking pattern and their combined effect on all-cause mortality: the Seguimiento Universidad de Navarra (SUN) cohort. Eur J Nutr 60, 1489–1498 (2021). https://doi.org/10.1007/s00394-020-02342-w

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  • DOI: https://doi.org/10.1007/s00394-020-02342-w

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