Abstract
There is still room for further studies analyzing the long-term health impact of specific dietary patterns observable in regions belonging to the Mediterranean area. The aim of the study is to evaluate how much a diet practiced in southern Italy is associated to a risk of mortality. The study population included 2472 participants first investigated in 1985, inquiring about their frequencies of intake of 29 foods using a self-administered questionnaire covering the previous year. The population was followed up for mortality until 31 December 2017. Cox-based risk modeling referred to single foods, food groups, the results of principal component analysis (PCA), and a priori indexes. Single food analysis revealed eggs, fatty meat, and fatty/baked ham to be inversely associated with mortality. Furthermore, one of the 5 PCA derived dietary patterns, the “Farmhouse” pattern, showed a higher hazard ratio (HR), mostly driven by dairy products. In subsequent analyses, the increased risk of mortality for fresh cheese and decreased risk for fatty ham and eggs were confirmed. The a priori diet indexes (Italian Meddiet, Meddietscore, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean–DASH Intervention for Neurodegenerative Delay diet (MIND) indexes) showed borderline inverse relationships. In a Mediterranean population with an overall healthy diet, foods such as eggs and fatty meat, reflecting dietary energy and wealth, played a role in prolonging the life of individuals. Our study confirms that some dairy products might have a detrimental role in mortality in the Mediterranean setting.
Highlights
In the last decades, life expectancy has increased in most parts of the world and population aging is a global phenomenon, especially in developed countries
Study Population: In the beginning of the 1980s, the IRCCS De Bellis participated in the Multicenter Italian study on Cholelithiasis (MICOL) [12] with the aim of prospectively investigating the role of lifestyle and nutrition in gastrointestinal and other chronic diseases, including cholelithiasis [13,14]
These variables were selected as confounders for the risk modeling of the dietary variables and yielded the mutually adjusted hazard ratio (HR)
Summary
Life expectancy has increased in most parts of the world and population aging is a global phenomenon, especially in developed countries. In Europe, the life expectancy of the Italian population is the second highest, being two years longer than the European average, based on a gain of 2.8 years in life expectancy between 2000 to 2015 This advantage of the Italian population in terms of life expectancy compared to their other European peers is not reflected in a similar gain in disability-free years, as reported by the Institute for Health Metrics and Evaluation (IHME). This relatively privileged situation in terms of life expectancy in Italy might be related to the lifestyle, in particular, the diet consumed in this country. Dietary indexes defined a priori, including those foods such as the Mediterranean-Diet score [5], the Healthy Eating index [6], the Alternate Healthy
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