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. 2017 Apr;147(4):612-620.
doi: 10.3945/jn.116.241919. Epub 2017 Feb 8.

Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated With All-Cause and Cause-Specific Mortality in Adults

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Free PMC article

Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated With All-Cause and Cause-Specific Mortality in Adults

Kristine A Whalen et al. J Nutr. .
Free PMC article

Abstract

Background: Poor diet quality is associated with a higher risk of many chronic diseases that are among the leading causes of death in the United States. It has been hypothesized that evolutionary discordance may account for some of the higher incidence and mortality from these diseases.Objective: We investigated associations of 2 diet pattern scores, the Paleolithic and the Mediterranean, with all-cause and cause-specific mortality in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a longitudinal cohort of black and white men and women ≥45 y of age.Methods: Participants completed questionnaires, including a Block food-frequency questionnaire (FFQ), at baseline and were contacted every 6 mo to determine their health status. Of the analytic cohort (n = 21,423), a total of 2513 participants died during a median follow-up of 6.25 y. We created diet scores from FFQ responses and assessed their associations with mortality using multivariable Cox proportional hazards regression models adjusting for major risk factors.Results: For those in the highest relative to the lowest quintiles of the Paleolithic and Mediterranean diet scores, the multivariable adjusted HRs for all-cause mortality were, respectively, 0.77 (95% CI: 0.67, 0.89; P-trend < 0.01) and 0.63 (95% CI: 0.54, 0.73; P-trend < 0.01). The corresponding HRs for all-cancer mortality were 0.72 (95% CI: 0.55, 0.95; P-trend = 0.03) and 0.64 (95% CI: 0.48, 0.84; P-trend = 0.01), and for all-cardiovascular disease mortality they were 0.78 (95% CI: 0.61, 1.00; P-trend = 0.06) and HR: 0.68 (95% CI: 0.53, 0.88; P-trend = 0.01).Conclusions: Findings from this biracial prospective study suggest that diets closer to Paleolithic or Mediterranean diet patterns may be inversely associated with all-cause and cause-specific mortality.

Keywords: Mediterranean diet; Paleolithic diet; cohort study; diet patterns; mortality.

Conflict of interest statement

Author disclosures: KA Whalen, S Judd, ML McCullough, WD Flanders, TJ Hartman, and RM Bostick, no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Associations of the Paleolithic diet score with all-cause mortality, according to selected participant characteristics at baseline in the REGARDS cohort (n = 21,423). From the Cox model, only the comparison of the fifth relative to the first quintile of each diet score with all-cause mortality is shown; model covariates included sex, race (black or white), total energy intake (kilocalories per day), BMI [kg/m2, categorized by WHO criteria (58) into underweight, normal, overweight, or obese], physical activity (0, 1–3, or ≥4 exercise sessions/wk), smoking (current, former, or never), annual income (refused, <$20,000, $20,000–$34,000, $35,000–$74,000, or ≥$75,000/y), and hormone replacement therapy use (in women) at baseline in an age-as-time-scale. P-trend was calculated by assigning the median of each diet score quintile to each quintile, and treating this quintile exposure as continuous. Comorbidities include history of any cancer, kidney failure, type II diabetes, stent, heart surgery, aneurysm, or myocardial infarction. Comorbidities: yes (n = 7436; Q1, n = 1643; Q5, n = 1348), no (n = 13,987; Q1, n = 3425; Q5, n = 2433); race: black (n = 7163; Q1, n = 1882; Q5, n = 1127), white (n = 14,260; Q1, n = 3186; Q5, n = 2654); sex: male (n = 9457; Q1, n = 2346; Q5, n = 1566), female (n = 11,966; Q1, n = 2722; Q5, n = 2215); age at baseline: ≤65 y (n = 11,663; Q1, n = 3128; Q5, n = 1875), >65 y (n = 9760; Q1, n = 1940; Q5, n = 1906); self-reported health: poor or fair (n = 3435; Q1, n = 1010; Q5, n = 416), good, very good, or excellent (n = 17,953; Q1, n = 4049; Q5, n = 3360); BMI: underweight or normal (n = 5480; Q1, n = 1263; Q5, n = 1082), overweight or obese (n = 15,803; Q1, n = 3768; Q5, n = 2679); years of follow-up: ≤6.25 y (n = 10,773; Q1, n = 2640; Q5, n = 1807), >6.25 y (n = 10,649; Q1, n = 2428; Q5, n = 1974); exercise habits: sedentary (n = 6924; Q1, n = 2031; Q5, n = 888), ≥1 session/wk (n = 14,207; Q1, n = 2949; Q5, n = 2855); smoking status: never smoked (n = 9607; Q1, n = 1925; Q5, n = 1978), former smoker (n = 8818; Q1, n = 1910; Q5, n = 1602), current smoker (n = 2916; Q1, n = 1210; Q5, n = 189); region: Southern United States (n = 12,050; Q1, n = 2861; Q5, n = 2075), Western, Midwestern, or Eastern United States (n = 9373; Q1, n = 2207; Q5, n = 1706). LN, natural logarithm; Q, quintile; REGARDS, REasons for Geographic and Racial Differences in Stroke.
FIGURE 2
FIGURE 2
Associations of the Mediterranean diet score with all-cause mortality, according to selected participant characteristics at baseline in the REGARDS cohort (n = 21,423). From the Cox model, only the comparison of the fifth relative to the first quintile of each diet score with all-cause mortality is shown; model covariates included sex, race (black or white), total energy intake (kilocalories per day), BMI [kg/m2, categorized by WHO criteria (58) into underweight, normal, overweight, and obese], physical activity (0, 1–3, or ≥4 exercise sessions/wk), smoking (current, former, or never), annual income (refused, <$20,000, $20,000–$34,000, $35,000–$74,000, or ≥$75,000/y), and hormone replacement therapy use (in women) at baseline in an age-as-time-scale. P-trend was calculated by assigning the median of each diet score quintile to each quintile, and treating this quintile exposure as continuous. Comorbidities include history of any cancer, kidney failure, type II diabetes, stent, heart surgery, aneurysm, or myocardial infarction. Comorbidities: yes (n = 7436; Q1, n = 1791; Q5, n = 1077), no (n = 13,987; Q1, n = 3038; Q5, n = 2500); race: black (n = 7163; Q1, n = 1802; Q5, n = 974), white (n = 14,260; Q1, n = 3027; Q5, n = 2603); sex: male (n = 9457; Q1, n = 2130; Q5, n = 1584), female (n = 11,966; Q1, n = 2699; Q5, n = 1993); age at baseline: ≤65 y (n = 11,663; Q1, n = 2729; Q5, n = 1884), >65 y (n = 9760; Q1, n = 2100; Q5, n = 1693); self-reported health: poor/fair (n = 3435; Q1, n = 1094; Q5, n = 338), good/very good/excellent (n = 17,953; Q1, n = 3724; Q5, n = 3235); BMI: underweight/normal (n = 5480; Q1, n = 1222; Q5, n = 1039), overweight/obese (n = 15,803; Q1, n = 3568; Q5, n = 2523); years of follow-up: ≤6.25 y (n = 10,773; Q1, n = 2611; Q5, n = 1642), >6.25 y (n = 10,649; Q1, n = 2218; Q5, n = 1934); exercise habits: sedentary (n = 6924; Q1, n = 1944; Q5, n = 815), ≥1 session/wk (n = 14,207; Q1, n = 2806; Q5, n = 2730); smoking status: never smoked (n = 9607; Q1, n = 1932; Q5, n = 1797), former smoker (n = 8818; Q1, n = 1813; Q5, n = 1549), current smoker (n = 2916; Q1, n = 1059; Q5, n = 215); region: Southern United States (n = 12,050; Q1, n = 2863; Q5, n = 1848), Western/Midwestern/Eastern United States (n = 9373; Q1, n = 1966; Q5, n = 1729). LN, natural logarithm; Q, quintile; REGARDS, REasons for Geographic and Racial Differences in Stroke.

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