Top 25% for Mediterranean Lifestyle Had 30% Lower Risk of Death: 100,000 People Followed for 13 Years

A large cohort analysis finding that a Mediterranean lifestyle overall, not just a Mediterranean "diet," is associated with lower mortality risk has been published in the American Journal of Clinical Nutrition. Researchers at the Autonomous University of Madrid in Spain and the University of Groningen in the Netherlands followed 105,812 adults in the Lifelines cohort from enrolment in 2006 to 2013 until 2025. Over a median of 13.25 years, 3,976 people died.

The researchers scored baseline lifestyle with the MEDLIFE index (Mediterranean Lifestyle index), made up of 23 items covering food intake, eating habits, physical activity, rest and social habits. In a multivariable Cox model, the hazard ratio for all-cause mortality in the top quartile compared with the bottom was 0.70 (95% confidence interval 0.64 to 0.77), and a dose-response relationship was observed in which higher scores meant lower risk.

Income mattered more than education

A feature of this study is that it examined the association separately by socioeconomic level. The association between a Mediterranean lifestyle and lower mortality risk was seen in both low-income, low-education groups and high-income, high-education groups. However, in the combined analysis, the hazard ratio for "high score plus high income" was 0.54 (0.46 to 0.63), lower than 0.67 (0.57 to 0.78) for "high score plus high education," so income appeared to be the stronger modifying variable. The researchers saw healthy lifestyles as possibly helping to narrow socioeconomic gaps in mortality.

A limitation is that both lifestyle and income and education were measured only once at baseline by self-report, so changes during follow-up were not reflected. Because this is an observational study, it cannot be interpreted as causation, and the characteristics of the population of the northern Netherlands may not apply directly to other regions.