Top

Published in:

Open Access 01-12-2021 | Research article

The Southern European Atlantic Diet and all-cause mortality in older adults

Authors: Adrián Carballo-Casla, Rosario Ortolá, Esther García-Esquinas, Andreia Oliveira, Mercedes Sotos-Prieto, Carla Lopes, Esther Lopez-Garcia, Fernando Rodríguez-Artalejo

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and North-Western Spain. Higher adherence to the SEAD has been associated with lower levels of some cardiovascular risk factors and reduced risk for myocardial infarction, but whether this translates into lower all-cause mortality is uncertain. We hence examined the association between adherence to the SEAD and all-cause mortality in older adults.

Methods

Data were taken from the Seniors-ENRICA-1 cohort, which included 3165 individuals representative of the non-institutionalized population aged ≥ 60 years in Spain. Food consumption was assessed with a validated diet history, and adherence to the SEAD was measured with an index comprising 9 food components: fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. Vital status was ascertained with the National Death Index of Spain. Statistical analyses were performed with Cox regression models and adjusted for the main confounders.

Results

During a median follow-up of 10.9 years, 646 deaths occurred. Higher adherence to the SEAD was associated with lower all-cause mortality (fully adjusted hazard ratio [95% confidence interval] per 1-SD increment in the SEAD score 0.86 [0.79, 0.94]; p-trend < 0.001). Most food components of the SEAD showed some tendency to lower all-cause mortality, especially moderate wine consumption (hazard ratio [95% confidence interval] 0.71 [0.59, 0.86]). The results were robust in several sensitivity analyses. The protective association between SEAD and all-cause death was of similar magnitude to that found for the Mediterranean Diet Adherence Screener (hazard ratio [95% confidence interval] per 1-SD increment 0.89 [0.80, 0.98]) and the Alternate Healthy Eating Index (0.83 [0.76, 0.92]).

Conclusions

Adherence to the SEAD is associated with a lower risk of all-cause death among older adults in Spain.

Available only for authorised users

Varela G, Moreiras O, Ansón R, Ávila JM, Cuadrado C, Estalrich P, et al. Consumo de alimentos en Galicia: la Dieta Atlántica. [food consumption in Galicia: the Atlantic diet]. Madrid: Fundación Española de la Nutrición; 2004. https://www.fen.org.es/storage/app/media/imgPublicaciones/09-COnsumoalimentos.pdf.

IV Reunión Internacional “La alimentación y la nutrición en el siglo XXI”: Dieta Atlántica. La obesidad como problema de salud pública. [IV Intern. Meeting “Feeding and nutrition in the 21st century”: the Atlantic Diet. Obesity as a public health problem]. Madrid, Spain: Fundación Española de la Nutrición; 2008. https://www.fen.org.es/storage/app/media/imgPublicaciones/7720085444.pdf.

Vaz Velho M, Pinheiro R, Rodrigues AS. The Atlantic diet-origin and features. Int J Food Stud. 2016;5:106–19 https://doi.org/10.7455/ijfs/5.1.2016.a10.CrossRef

Oliveira A, Lopes C, Rodríguez-Artalejo F. Adherence to the Southern European Atlantic Diet and occurrence of nonfatal acute myocardial infarction. Am J Clin Nutr. 2010;92:211–7 https://doi.org/10.3945/ajcn.2009.29075.CrossRef

Castro-Penalonga M, Roca-Saavedra P, Miranda JM, Porto-Arias JJ, Nebot C, Cardelle-Cobas A, et al. Influence of food consumption patterns and Galician lifestyle on human gut microbiota. J Physiol Biochem. 2018;74:85–92 https://doi.org/10.1007/s13105-017-0570-4.CrossRef

Guallar-Castillón P, Oliveira A, Lopes C, López-García E, Rodríguez-Artalejo F. The Southern European Atlantic Diet is associated with lower concentrations of markers of coronary risk. Atherosclerosis. 2013;226:502–9 https://doi.org/10.1016/j.atherosclerosis.2012.11.035.CrossRef

Moreira C, Santos R, Moreira P, Lobelo F, Ruiz JR, Vale S, et al. Cardiorespiratory fitness is negatively associated with metabolic risk factors independently of the adherence to a healthy dietary pattern. Nutr Metab Cardiovasc Dis. 2013;23:670–6 https://doi.org/10.1016/j.numecd.2012.01.011.CrossRef

Agostinis-Sobrinho C, Abreu S, Moreira C, Lopes L, García-Hermoso A, Ramírez-Vélez R, et al. Muscular fitness, adherence to the Southern European Atlantic Diet and cardiometabolic risk factors in adolescents. Nutr Metab Cardiovasc Dis. 2017;27:695–702 https://doi.org/10.1016/j.numecd.2017.04.008.CrossRef

Agostinis-Sobrinho C, Brand C, Moreira C, Lopes L, Oliveira-Santos J, Silva P, et al. Muscular fitness, Southern European Atlantic Diet and inflammation in adolescents. Azorean Physical Activity and Health Study II. Eur J Sport Sci. 2018;18:104–11 https://doi.org/10.1080/17461391.2017.1394368.CrossRef

10.

Agostinis-Sobrinho C, Dias AF, Brand C, Norkiene S, Abreu S, Gaya ACA, et al. Adherence to Southern European Atlantic Diet and physical fitness on the atherogenic index of plasma in adolescents. Cad Saude Publica. 2019;35:e00200418 https://doi.org/10.1590/0102-311X00200418.CrossRef

11.

Rodríguez-Martín C, Garcia-Ortiz L, Rodriguez-Sanchez E, Maderuelo-Fernandez C, Lugones-Sanchez A, Martin-Cantera M, et al. The relationship of the Atlantic diet with cardiovascular risk factors and markers of arterial stiffness in adults without cardiovascular disease. Nutrients. 2019;11:742 https://doi.org/10.3390/nu11040742.CrossRef

12.

Abete I, Romaguera D, Vieira AR, Lopez de Munain A, Norat T. Association between total, processed, red and white meat consumption and all-cause, CVD and IHD mortality: a meta-analysis of cohort studies. Br J Nutr. 2014;112:762–75 https://doi.org/10.1017/S000711451400124X.CrossRef

13.

Bouvard V, Loomis D, Guyton KZ, Grosse Y, El Ghissassi F, Benbrahim-Tallaa L, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015;16:1599–600 https://doi.org/10.1016/S1470-2045(15)00444-1.CrossRef

14.

Schwingshackl L, Schwedhelm C, Hoffmann G, Lampousi AM, Knüppel S, Iqbal K, et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2017;105:1462–73 https://doi.org/10.3945/ajcn.117.153148.PubMed

15.

Schwingshackl L, Schwedhelm C, Hoffmann G, Boeing H. Potatoes and risk of chronic disease: a systematic review and dose–response meta-analysis. Eur J Nutr. 2019;58:2243–51 https://doi.org/10.1007/s00394-018-1774-2.CrossRef

16.

Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72:30–43 https://doi.org/10.1038/ejcn.2017.58.CrossRef

17.

Schwingshackl L, Bogensberger B, Hoffmann G. Diet quality as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and health outcomes: an updated systematic review and meta-analysis of cohort studies. J Acad Nutr Diet. 2018;118:74–100 e11. https://doi.org/10.1016/j.jand.2017.08.024.CrossRef

18.

Rodríguez-Artalejo F, Graciani A, Guallar-Castillón P, León-Muñoz LM, Zuluaga MC, López-García E, et al. Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA). Rev Española Cardiol. 2011;64:876–82 https://doi.org/10.1016/j.rec.2011.05.023.CrossRef

19.

Ortolá R, Struijk EA, García-Esquinas E, Rodríguez-Artalejo F, Lopez-Garcia E. Changes in dietary intake of animal and vegetable protein and unhealthy aging. Am J Med. 2019;133:231–9 https://doi.org/10.1016/j.amjmed.2019.06.051.CrossRef

20.

Guallar-Castillón P, Sagardui-Villamor J, Balboa-Castillo T, Sala-Vila A, Ariza Astolfi MJ, Sarrión Pelous MD, et al. Validity and reproducibility of a Spanish dietary history. PLoS One. 2014;9:e86074 https://doi.org/10.1371/journal.pone.0086074.CrossRef

21.

Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011;141:1140–5 https://doi.org/10.3945/jn.110.135566.CrossRef

22.

Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, et al. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012;142:1009–18 https://doi.org/10.3945/jn.111.157222.CrossRef

23.

Ministerio de Sanidad Consumo y Bienestar Social. Statical Site of the National Health System - Statistics and Studies - Healthcare Statistics - National Death Index. https://www.mscbs.gob.es/en/estadEstudios/estadisticas/estadisticas/estMinisterio/IND_TipoDifusion.htm. Accessed 11 Jan 2021.

24.

Mortality by cause of death: Spain. Statical Site of the National Health System - Statistics, Reports and Compilations of the Ministry of Health, Social Services and Equality. https://www.mscbs.gob.es/en/estadEstudios/estadisticas/estadisticas/estMinisterio/mortalidad/mortalidad.htm. Accessed 11 Jan 2021.

25.

García-Esquinas E, Andrade E, Martínez-Gómez D, Caballero FF, López-García E, Rodríguez-Artalejo F. Television viewing time as a risk factor for frailty and functional limitations in older adults: results from 2 European prospective cohorts. Int J Behav Nutr Phys Act. 2017;14 https://doi.org/10.1186/s12966-017-0511-1.

26.

Pols MA, Peeters PH, Ocké MC, Slimani N, Bueno-de-Mesquita HB, Collette HJ. Estimation of reproducibility and relative validity of the questions included in the EPIC Physical Activity Questionnaire. Int J Epidemiol. 1997;26:181–9 https://doi.org/10.1093/ije/26.suppl_1.s181.CrossRef

27.

James WPT, Schofield EC. Energy cost of physical activity classified in alphabetical order. Human energy requirements. A manual for planners and nutritionists. Vol. 35. Oxford, New York, Tokyo: Oxford University Press; 1991. https://doi.org/10.1002/food.19910351014

28.

Martínez-González MA, López-Fontana C, Varo JJ, Sánchez-Villegas A, Martinez JA. 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. 2005;8:920–7 https://doi.org/10.1079/phn2005745.CrossRef

29.

Gutiérrez-Fisac JL, Guallar-Castillón P, León-Muñoz LM, Graciani A, Banegas JR, Rodríguez-Artalejo F. Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study. Obes Rev. 2012;13:388–92 https://doi.org/10.1111/j.1467-789X.2011.00964.x.CrossRef

30.

Wood AM, Kaptoge S, Butterworth A, Nietert PJ, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391:1513–23 https://doi.org/10.1016/S0140-6736(18)30134-X.CrossRef

31.

Ortolá R, García-Esquinas E, López-García E, León-Muñoz LM, Banegas JR, Rodríguez-Artalejo F. Alcohol consumption and all-cause mortality in older adults in Spain: an analysis accounting for the main methodological issues. Addiction. 2019;114:59–68 https://doi.org/10.1111/add.14402.CrossRef

32.

Clifton PM, Keogh JB. A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease. Nutr Metab Cardiovasc Dis. 2017;27:1060–80 https://doi.org/10.1016/j.numecd.2017.10.010.CrossRef

33.

Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2020;2020 https://doi.org/10.1002/14651858.CD003177.pub5.

34.

Chan R, Leung J, Woo J. High protein intake is associated with lower risk of all-cause mortality in community-dwelling Chinese older men and women. J Nutr Heal Aging. 2019;23:987–96 https://doi.org/10.1007/s12603-019-1263-1.CrossRef

35.

Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng CW, Madia F, et al. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014;19:407–17 https://doi.org/10.1016/j.cmet.2014.02.006.CrossRef

36.

Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Intern Med. 2016;176:1453–63 https://doi.org/10.1001/jamainternmed.2016.4182.CrossRef

37.

Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019;393:434–445. https://doi.org/10.1016/S0140-6736(18)31809-9.

38.

Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, et al. Dietary intake and blood concentrations of antioxidants and the risk of cardiovascular disease, total cancer, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. Am J Clin Nutr. 2018;108:1069–91 https://doi.org/10.1093/ajcn/nqy097.CrossRef

39.

Huang YC, Lee MS, Wahlqvist ML. Prediction of all-cause mortality by B group vitamin status in the elderly. Clin Nutr. 2012;31:191–8 https://doi.org/10.1016/j.clnu.2011.10.010.CrossRef

40.

Mohammadifard N, Gotay C, Humphries KH, Ignaszewski A, Esmaillzadeh A, Sarrafzadegan N. Electrolyte minerals intake and cardiovascular health. Crit Rev Food Sci Nutr. 2019;59:2375–85 https://doi.org/10.1080/10408398.2018.1453474.CrossRef

41.

Mohammadifard N, Humphries KH, Gotay C, Mena-Sánchez G, Salas-Salvadó J, Esmaillzadeh A, et al. Trace minerals intake: risks and benefits for cardiovascular health. Crit Rev Food Sci Nutr. 2019;59:1334–46 https://doi.org/10.1080/10408398.2017.1406332.CrossRef

42.

Cespedes EM, Hu FB. Dietary patterns: from nutritional epidemiologic analysis to national guidelines. Am J Clin Nutr. 2015;101:899–900 https://doi.org/10.3945/ajcn.115.110213.CrossRef

43.

Wyness L. The role of red meat in the diet: nutrition and health benefits. Proc Nutr Soc. 2016;75:227–32 https://doi.org/10.1017/S0029665115004267.CrossRef

44.

MacMahon S, Peto R, Collins R, Godwin J, MacMahon S, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990;335:765–774. https://doi.org/10.1016/0140-6736(90)90878-9.

45.

European Survey of Health in Spain. Methodology. Instituto Nacional de Estadística 2009. https://www.ine.es/en/metodologia/t15/t153042009_en.pdf. Accessed 11 Jan 2021.

46.

Greenland S. The effect of misclassification in the presence of covariates. Am J Epidemiol. 1980;112:564–9 https://doi.org/10.1093/oxfordjournals.aje.a113025.CrossRef

47.

Willett W. Nutritional epidemiology. Vol. 30: 332–33. 2nd edition. United States of America: Oxford University Press; 1998.

Title: The Southern European Atlantic Diet and all-cause mortality in older adults
Authors: Adrián Carballo-Casla
Rosario Ortolá
Esther García-Esquinas
Andreia Oliveira
Mercedes Sotos-Prieto
Carla Lopes
Esther Lopez-Garcia
Fernando Rodríguez-Artalejo
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-01911-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Southern European Atlantic Diet and all-cause mortality in older adults

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

5mC regulator-mediated molecular subtypes depict the hallmarks of the tumor microenvironment and guide precision medicine in bladder cancer

Glycolysis-associated lncRNAs identify a subgroup of cancer patients with poor prognoses and a high-infiltration immune microenvironment

Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

Association of sickle cell disease with anthropometric indices among under-five children: evidence from 2018 Nigeria Demographic and Health Survey

Oral vitamin D supplementation induces transcriptomic changes in rectal mucosa that are linked to anti-tumour effects

Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial