Gabriela Cárdenas-Fuentes1,2, Isaac Subirana1,3, Miguel A Martinez-Gonzalez4,5,6, Jordi Salas-Salvadó5,7, Dolores Corella5,8, Ramon Estruch5,9, Montserrat Fíto1,5, Carlos Muñoz-Bravo10, Miguel Fiol5,11, José Lapetra5,12, Fernando Aros5,13, Luis Serra-Majem5,14, Josep A Tur5,15, Xavier Pinto5,16, Emilio Ros5,17, Oscar Coltell5,18, Andres Díaz-López5,7, Miguel Ruiz-Canela4,5, Helmut Schröder19,20. 1. Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. 2. PhD Programme in Biomedicine, Department of Experimental and Health Sciences, Universidad Pompeu Fabra, Barcelona, Spain. 3. CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. 4. Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain. 5. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain. 6. Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA. 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. 8. Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain. 9. Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. 10. Department of Public Health and Psychiatry, University of Málaga, Málaga, Spain. 11. Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain. 12. Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Research Unit, Seville, Spain. 13. Department of Cardiology, University Hospital Araba, Vitoria, Spain. 14. Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. 15. Research Group on Community Nutrition and Oxidative Stress, Universitat de les Illes Balears, Palma de Mallorca, Spain. 16. Lipids and Vascular Risk Units, Internal Medicine, University Hospital of Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. 17. Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain. 18. Department of Computer Languages and Systems, Universitat Jaume I, Castellon, Spain. 19. Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. hschroeder@imim.es. 20. CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. hschroeder@imim.es.
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.
RCT Entities:
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.
Authors: Laural K English; Jamy D Ard; Regan L Bailey; Marlana Bates; Lydia A Bazzano; Carol J Boushey; Clarissa Brown; Gisela Butera; Emily H Callahan; Janet de Jesus; Richard D Mattes; Elizabeth J Mayer-Davis; Rachel Novotny; Julie E Obbagy; Elizabeth B Rahavi; Joan Sabate; Linda G Snetselaar; Eve E Stoody; Linda V Van Horn; Sudha Venkatramanan; Steven B Heymsfield Journal: JAMA Netw Open Date: 2021-08-02