Population Impact of Adhering to the Mediterranean Diet and Physical Activity on All-cause Mortality: The Seguimiento Universidad De Navarra (SUN) Cohort (P18-018-19)

Abstract

ObjectivesWe assessed the population impact of the joint effect of the Mediterranean Diet (MedDiet) and physical activity (PA) in a Spanish cohort. MethodsWe used data from the SUN (“Seguimiento Universidad de Navarra) study, a dynamic cohort of university graduates. We used a MedDiet score (MDS) of 0–9 points and PA score of 0–8 points. Adjusted multivariable Cox regression models were used to study the individual and joint effects of the MedDiet and PA on all-cause mortality. To assess adherence to MDS, PA, or the combination of both, the highest tertiles of each served as references. P-values for interaction were calculated for the Relative Risk due to Interaction (RERI) and the attributable proportion due to interaction. We calculated the population attributable risk (PAR) and the rate advancement period (RAP) as the aging effect attributable to the lowest combination of MDS and PA score. ResultsWe recruited 20,127 participants, 61.5% female and 37 years-old mean age. After a mean follow-up of 10.9 months, 347 deaths were confirmed. The lowest adherence to PA was associated with a 69% increased risk of all-cause mortality compared with the highest tertile (95%CI;1.32–2.17). MDS, as a continuous variable, was also inversely significantly associated with total mortality. The joint effect showed a trend towards an increased risk for all-cause mortality. Using the highest MedDiet and PA as reference, the HR for death in participants with lowest adherence to both was 2.08 (1.28–3.37). We observed a positive but non-significant additive interaction between MedDiet and PA (RERI for the lowest MedDiet and PA = 0.54, (95% CI;0.64–1.72, P = 0.367). We estimated that 48% (95%CI; −0.33–1.30) of the joint effect was attributable to the interaction between MedDiet and PA. The RAP for participants with the lowest tertiles of both MedDiet and PA was 10 years (95% CI: 2.97–17.13). An estimated 28% (95% CI: 11%–43%) of all premature deaths may have been prevented if all participants exhibited high MedDiet and PA levels. ConclusionsA combination of poor MedDiet adherence and low PA levels account for almost 30% of all-cause mortality. Public health interventions combining both diet and PA could have a substantial impact at the population level. Funding SourcesSpanish Government-Instituto de Salud Carlos III, European Fund for Regional & Economic Development, CIBER-OBN, Navarra Government. Supporting Tables, Images and/or Graphs▪