Adherence to the Mediterranean diet assessed by a novel dietary biomarker score and mortality in older adults: the InCHIANTI cohort study

Nicole Hidalgo-Liberona,Tomás Meroño,Toshiko Tanaka,Raul Zamora-Ros,Antonio Cherubini,Montserrat Rabassa,Richard Semba,Cristina Andres-Lacueva,Stefania Bandinelli,Luigi Ferrucci

doi:10.1186/s12916-021-02154-7

Abstract

BackgroundDietary biomarkers may complement dietary intake assessment made by dietary questionnaires. We developed an a-posteriori dietary biomarkers score based on Mediterranean diet food groups and evaluated its association with mortality.Methods642 participants (56% female), aged ≥65 years, with complete data on dietary biomarkers were followed during 20 years in the InCHIANTI cohort study (Tuscany, Italy). The main outcomes were all-cause, cardiovascular, and cancer mortality. Dietary biomarkers were selected from literature and from correlation analyses with dietary intakes of Mediterranean diet food groups in the study. The baseline levels of the following dietary biomarkers were chosen: urinary total polyphenols and resveratrol metabolites, and plasma carotenoids, selenium, vitamin B12, linolenic, eicosapentaenoic and docosahexaenoic acids, and the mono-unsaturated/saturated fatty acid ratio. Associations of the Mediterranean diet score using dietary biomarkers and a validated food frequency questionnaire (FFQ) (as tertiles) with mortality were assessed through Cox regression.ResultsDuring the 20-year follow-up [median (Q1–Q3), 14 (8–18) years], and 435 deaths occurred (139 from cardiovascular diseases and 89 from cancer-related causes). In the fully adjusted models, the dietary biomarker-Mediterranean diet score was inversely associated with all-cause (HRT3vs.T1 0.72; 95%CI 0.56–0.91) and cardiovascular (HRT3vs.T1 0.60; 95%CI 0.38–0.93), but not with cancer mortality. Associations between the FFQ-Mediterranean diet score and mortality were not statistically significant.ConclusionsA greater adherence at baseline to a Mediterranean diet assessed by a dietary biomarker score was associated with a lower risk of mortality in older adults during a 20-year follow-up. The measurement of dietary biomarkers may contribute to guide individualized dietary counseling to older people.Trial registrationNCT01331512

Highlights

Dietary biomarkers may complement dietary intake assessment made by dietary questionnaires
For the dietary biomarker-Mediterranean diet (MD) scores (MDS), we grouped the categories of vegetables, fruits and nuts, legumes, and cereals because the selected dietary biomarker were ubiquitously distributed among these food groups
Alcohol intake in the food frequency questionnaire (FFQ)-MDS and urine resveratrol in the dietary biomarker-MDS were highly correlated

Summary

Introduction

Dietary biomarkers may complement dietary intake assessment made by dietary questionnaires. We developed an a-posteriori dietary biomarkers score based on Mediterranean diet food groups and evaluated its association with mortality. Strategies to promote healthy aging are one of the pillars to minimize the health care and socio-economic impact of the increasing proportion of older adults in Europe [2]. Healthy aging can help to reduce the burden of chronic diseases, disability, and increasing health expenditure related to a longer life expectancy of older adults [3, 4]. Several observational studies, including the European Prospective study into Cancer and Nutrition (EPIC)-elderly study, a cohort of 74,607 men and women aged ≥60 years, have shown inverse associations between a greater adherence to different MD scores (MDS), in both the Mediterranean and non-Mediterranean countries, and total mortality [8]

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