The HALE population cohort study was conducted in 11 European countries between 1988 and 2000 and followed 1,507 apparently healthy men and 832 women, aged 70 to 90 years, enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies. In this cohort, the investigators studied the association of individual and combined dietary patterns and lifestyle factors, including alcohol use, smoking status, and physical activity, with 10-year mortality from all causes, CHD, CVD, and cancer.

Of 935 participants who died during follow-up, 371 deaths were from CVD, 233 from cancer, 145 from other causes, and 186 from unknown causes. Factors associated with a lower risk of all-cause mortality, after controlling for age, sex, years of education, body mass index, study, and other pertinent factors, were adhering to a Mediterranean diet.

"Among individuals aged 70 to 90 years, adherence to a Mediterranean diet and healthful lifestyle is associated with a more than 50% lower rate of all-causes and cause-specific mortality," the authors write. "Establishing a causal relationship would require an intervention study, and the number of years an individual needs to maintain such a lifestyle to realize a benefit is unknown. However, a Mediterranean diet, rich in plant foods in combination with nonsmoking, moderate alcohol consumption, and at least 30 minutes of physical activity per day is associated with a significantly lower mortality rate, even in old age."

In an accompanying editorial, Eric B. Rimm, ScD, and Meir J. Stampfer, MD, DrPH, from the Harvard School of Public Health in Boston, Massachusetts, note that to be protective, healthful behaviors need not be extreme. For example, the physical activity criterion could be met by half an hour of walking daily. They also discuss a research article in the same issue showing that the Mediterranean diet is superior to a reduced-fat diet in patients with metabolic syndrome.