Table 2. Association of Mediterranean Diet Adherence With All-Cause Mortality Before and After Adjustment for Risk Factors and Cardiometabolic Biomarkers of Risk.
| Model | Risk of all-cause mortality by Mediterranean diet score, HR (95% CI)a | P for trend | ||
|---|---|---|---|---|
| 0-3 | 4-5 | ≥6 | ||
| Age, treatment, and total energy intake–adjusted model | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| Age, treatment, and total energy–adjusted model plus each of the following added 1 at a time | ||||
| Smoking | 1 [Reference] | 0.86 (0.80-0.93) | 0.81 (0.74-0.93) | <.001 |
| Alcohol consumption | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| BMI | 1 [Reference] | 0.84 (0.78-0.91) | 0.78 (0.71-0.85) | <.001 |
| Blood pressure | ||||
| Hypertension | 1 [Reference] | 0.84 (0.78-0.91) | 0.77 (0.71-0.84) | <.001 |
| Systolic | 1 [Reference] | 0.85 (0.79-0.91) | 0.78 (0.71-0.85) | <.001 |
| Diastolic | 1 [Reference] | 0.84 (0.78-0.91) | 0.77 (0.71-0.84) | <.001 |
| Traditional lipids | ||||
| LDL cholesterol | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| HDL cholesterol | 1 [Reference] | 0.85 (0.78-0.91) | 0.78 (0.72-0.85) | <.001 |
| Triglycerides | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| Total cholesterol | 1 [Reference] | 0.84 (0.78-0.90) | 0.76 (0.70-0.83) | <.001 |
| Lipoproteins | 1 [Reference] | |||
| Lipoprotein(a) | 1 [Reference] | 0.84 (0.77-0.90) | 0.76 (0.70-0.83) | <.001 |
| Apolipoprotein AI | 1 [Reference] | 0.84 (0.78-0.91) | 0.78 (0.71-0.91) | <.001 |
| Apolipoprotein B100 | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| LDL particles and size | ||||
| LDL particle concentration | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| LDL particle size | 1 [Reference] | 0.84 (0.78-0.90) | 0.76 (0.71-0.84) | <.001 |
| HDL particles and size | ||||
| HDL particle concentration | 1 [Reference] | 0.84 (0.78-0.91) | 0.78 (0.71-0.85) | <.001 |
| HDL particle size | 1 [Reference] | 0.84 (0.78-0.91) | 0.78 (0.71-0.85) | <.001 |
| TRL particles and size | ||||
| TRL particle concentration | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | .008 |
| TRL particle size | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| Glycemic measures | ||||
| Hemoglobin A1c | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.71-0.84) | <.001 |
| Insulin resistance | ||||
| Lipoprotein insulin resistance index score | 1 [Reference] | 0.84 (0.78-0.91) | 0.78 (0.71-0.85) | <.001 |
| 5-y diabetes risk factor index score | 1 [Reference] | 0.84 (0.78-0.90) | 0.76 (0.70-0.83) | <.001 |
| Inflammation | ||||
| High-sensitivity C-reactive protein | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| Fibrinogen | 1 [Reference] | 0.84 (0.78-0.91) | 0.78 (0.71-0.85) | <.001 |
| Soluble intercellular adhesion molecule 1 | 1 [Reference] | 0.87 (0.80-0.93) | 0.81 (0.74-0.89) | <.001 |
| Glycoprotein acetylation | 1 [Reference] | 0.84 (0.78-0.91) | 0.78 (0.71-0.85) | <.001 |
| Branched-chain amino acids | ||||
| Total branched-chain amino acids | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| Valine | 1 [Reference] | 0.84 (0.78-0.90) | 0.76 (0.70-0.83) | <.001 |
| Leucine | 1 [Reference] | 0.84 (0.78-0.90) | 0.77 (0.70-0.84) | <.001 |
| Isoleucine | 1 [Reference] | 0.84 (0.78-0.91) | 0.77 (0.70-0.84) | <.001 |
| Small molecule metabolites | ||||
| Citrate | 1 [Reference] | 0.84 (0.78-0.90) | 0.76 (0.70-0.84) | <.001 |
| Creatinine | 1 [Reference] | 0.84 (0.78-0.90) | 0.76 (0.70-0.84) | <.001 |
| Homocysteine | 1 [Reference] | 0.85 (0.79-0.92) | 0.78 (0.72-0.86) | <.001 |
| Alanine | 1 [Reference] | 0.84 (0.78-0.91) | 0.77 (0.71-0.84) | <.001 |
Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); HDL, high-density lipoprotein; HR, hazard ratio; LDL, low-density lipoprotein; TRL, triglyceride-rich lipoprotein.
a
Participants were categorized according to 3 levels of Mediterranean diet adherence score (scores of 0-3, 4-5, and 6-9). P values across 3 levels of Mediterranean diet adherence were all less than .05.