Four studies in the September 22/29, 2004 Journal of the American Medical Association indicate that lifestyle interventions such as a healthy diet and regular physical exercise provide substantial benefits, even among the elderly.

Two 10-year studies of patients between the ages of 70 and 90 found that individuals who led healthy lifestyles that included 30 minutes a day of physical activity, moderate alcohol consumption, avoidance of smoking, and a Mediterranean diet that focuses on grains, olive oil, vegetables, fruits, and fish had a 50% lower rate of all-cause mortality and showed better blood vessel functioning and less inflammation than their peers.

A second pair of studies found that seniors who were the most physically active were less likely to develop dementia than those who did not exercise.

FROM JAMA
Combination of Mediterranean Diet and Healthy Lifestyle Associated With Significant Reduction in Death Rate For Elderly

CHICAGO – Individuals 70 to 90 years old who adhered to a Mediterranean-type diet and several healthy lifestyle habits had a more than 50% lower death rate than those who did not, according to a study in the September 22/29 issue of JAMA.

Because of the cumulative effect of adverse factors throughout life, it is particularly important for older persons to adopt diet and lifestyle practices that minimize their risk of death from illness and maximize their prospects for healthful aging, according to background information in the article. Dietary patterns and lifestyle factors are associated with death from all causes, coronary heart disease, cardiovascular diseases, and cancer, but few studies have investigated these factors in combination.

Kim Knoops, MSc, of Wageningen University, the Netherlands and colleagues investigated the single and combined effect of a Mediterranean diet (rich in plant foods and fish, low in meat and dairy products, and with a high ratio of monounsaturated fatty acids to polyunsaturated fatty acids), being physically active (approximately 30 minutes of activity per day or more), moderate alcohol use, and nonsmoking on all-cause and cause-specific death in European elderly individuals. The study, HALE (Healthy Ageing: a Longitudinal study in Europe), was conducted between 1988 and 2000 and was comprised of individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands , Elderly (FINE) studies. It included 1,507 apparently healthy men and 832 women, aged 70 to 90 years in 11 European countries.

The researchers found that adhering to a Mediterranean diet was associated with a 23% lower risk of all-cause death; moderate alcohol use, a 22 % lower risk; physical activity, a 37% lower risk; and nonsmoking, a 35% lower risk. Similar results were observed for death from coronary heart disease, cardiovascular diseases, and cancer. Having all four low risk factors lowered the all-cause death rate by 65%. In total, 60 % of all deaths, 64% of deaths from coronary heart disease, 61% from cardiovascular diseases, and 60 % from cancer were associated with lack of adherence to this low-risk pattern. (JAMA. 2004; 292:1433-1439. Available at www.jama.com)

Mediterranean-Style Diet May Be Effective in Reducing Prevalence of Metabolic Syndrome and Associated Cardiovascular Risk Factors

In another study in this issue of JAMA, Katherine Esposito, MD, of the Second University of Naples, Italy, and colleagues demonstrated that a Mediterranean-style diet had beneficial effects on endothelial (a layer of flat cells lining the closed internal spaces of the body, including the blood vessels) function and in reducing vascular inflammatory markers in patients with the metabolic syndrome.

According to background information in the article, the metabolic syndrome consists of several factors that increase the risk of cardiovascular disease and type 2 diabetes. Recent estimates indicate that the metabolic syndrome is highly prevalent in the United States, with an estimated 24% of the adult population affected. Its clinical identification is based on measures of abdominal obesity, atherogenic dyslipidemia (the formation of high levels of lipid deposits in the arteries), elevated blood pressure, and glucose intolerance. The metabolic syndrome has been identified as a target for dietary therapies to reduce risk of cardiovascular disease; however, the role of diet as contributing to the metabolic syndrome is poorly understood.

The randomized trial was conducted from June 2001 to January 2004 at a university hospital in Italy among 180 patients (99 men and 81 women) with the metabolic syndrome. Patients in the intervention group (n=90) were instructed to follow a Mediterranean-style diet and received detailed advice about how to increase daily consumption of whole grains, fruits, vegetables, nuts, and olive oil; patients in the control group (n=90) followed a prudent diet (carbohydrates, 50%-60%; proteins, 15%-20% ; total fat, less than 30%).

The researchers found that after 2 years, patients in the Mediterranean diet intervention group had significant decreases in body weight, blood pressure, levels of glucose, insulin, total cholesterol, and triglycerides and a significant increase in levels of high-density lipoprotein cholesterol, all of which were greater than those recorded in the control group. Serum concentrations of interleukins 6 (IL-6), 7 (IL-7), and 18 (IL-18) and high-sensitivity C-reactive protein (hs-CRP) were significantly reduced in patients in the intervention group compared with those in the control group. Endothelial function score improved in the intervention group but remained stable in the control group. Forty patients consuming the intervention diet still had features of the metabolic syndrome, compared with 78 patients consuming the control diet. Participants who followed the intervention diet showed a reduction in the number of the components of the syndrome such that the overall prevalence of the metabolic syndrome was reduced by approximately one half.

“The results of this study represent the first demonstration, to our knowledge, that a Mediterranean-style diet rich in whole grains, fruits, vegetables, legumes, walnuts, and olive oil might be effective in reducing both the prevalence of the metabolic syndrome and its associated cardiovascular risk,” the authors conclude.
(JAMA. 2004; 292:1440-1446. Available at www.jama.com)

Editorial: Diet, Lifestyle, and Longevity—The Next Steps?

In an accompanying editorial, Eric B. Rimm, ScD, and Meir J. Stampfer, MD, DrPH, of the Harvard School of Public Health, Boston, write that although understanding of the relation of lifestyle and health outcomes will continue to be refined, information available now is sufficient to take action.

“Knoops et al have identified a simple set of lifestyle practices that can reduce the mortality rate among elderly individuals by nearly two-thirds. Esposito and colleagues provide evidence of the possible mechanisms for such effects. Both studies are supported by prior data. As a society, the United States spends billions on chronic disease treatments and interventions for risk factors. Although these are useful and important, a fraction of that investment to promote healthful lifestyles for primary prevention among individuals at all ages would yield greater benefit,” the authors write.