Mediterranean Diet May Reduce Risk of Early Death

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It’s no secret that the Mediterranean diet is one of the healthiest ways of eating on the planet. We’ve reported on numerous studies that highlight the benefits of this eating pattern, including a healthier brain, pregnancy and blood sugar. Engaging in a Mediterranean diet eating style may help you live longer by reducing your risk of heart disease, stroke, cancer, diabetes and cognitive decline—and it might even save you a few bucks.    

So why report on yet another study about the Mediterranean diet? Because when it comes to strengthening associations between two or more factors, the more evidence, the better. And in this new study published on May 31, 2024, in JAMA Network Open, researchers also wanted to know what underlying metabolic factors might contribute to a reduced risk of dying over the long term by following a Mediterranean diet eating pattern—which had not been considered much in previous studies to date. Let’s take a closer look.

How Was This Study Conducted and What Did They Find?

This study included 25,315 American women from the Women’s Health Study cohort, with an average age of 55 at the start of the study who were healthy at baseline. Race and ethnicity of participants included Black, Asian, Hispanic, White and other races and ethnicities. Participants were followed for 25 years.

At the beginning of the study, baseline data was collected, including the typical demographics—age, BMI, location, income, education, etc—plus health behaviors, like physical activity and smoking history, and menopause status and hormone use for the treatment of menopause. 

Each participant completed a food-frequency questionnaire that included 131 questions. They then received a Mediterranean diet score based on their answers regarding regular consumption of 9 dietary components. Participants received 1 point each for a higher-than-average intake of the following food groups: vegetables (excluding potatoes), fruits, nuts, whole grains, legumes and fish, and a healthy ratio of monounsaturated-to-saturated fatty acids. They also received 1 point for having a less-than-average intake of red and processed meats, and another point if their alcohol intake fell within the range of 5 to 15 grams/day—which corresponds to about one 5-ounce glass of wine, 12 ounces of regular beer or 1.5 ounces of liquor per day. 

From their scores, participants were then categorized into 3 levels based on their adherence to the Mediterranean diet: low adherence (scores of 0-3), intermediate adherence (scores of 4-5) and high adherence (scores of 6-9). 

Additionally, participants completed health questionnaires 6 months apart for the first year and then annually. They also provided blood samples. Blood tests included HbA1c, lipids and inflammatory markers. Tests to further break down cholesterol particle size were also performed (there is evidence that smaller LDL particles increase the risk of heart disease and metabolic syndrome, per a 2024 study in Diabetes, Metabolic Syndrome and Obesity

Medical records, death certificates and cause of death were tracked for 25 years. Over that time, 3,879 deaths occurred, including 935 from heart disease and 1,531 from cancer. 

Several statistical analyses were initially run and then run again after adjusting for certain factors, including age at baseline, postmenopausal status and use of hormones, physical activity and smoking. 

The researchers found that, compared to women with Mediterranean diet adherence scores of 3 or less, women with scores of 6 or more had a 23% lower risk of dying prematurely from any cause. The results also suggested that certain cardiometabolic risk factors may account for the risk reduction, particularly biomarkers related to favorable metabolism and triglyceride-rich lipoproteins, as well as lower inflammation, insulin resistance and BMI. 

How Does This Apply to Real Life?

This study adds to the mounting evidence that including more foods like fruits, vegetables, nuts, seeds, legumes, whole grains, seafood and healthy fats—and less processed and red meat—is advantageous for your health. 

It also suggests that inflammation and metabolism—in particular, small molecule metabolites—played the most significant role in reducing the risk of premature death. According to a 2023 review in Signal Transduction and Targeted Therapy, there’s a connection between small molecule metabolites and how well our bodies function at the cellular level. Small molecule metabolites are part of the process of metabolism, which involves chemical processes that take place in the cells to produce energy and other basic materials needed for our bodies to work properly, per the National Library of Medicine’s resource StatPearls. Metabolic processes that aren’t working properly can lead to disease onset and progression. 

There’s a lot of debate over whether you can improve your metabolism, per the National Library of Medicine’s resource MedlinePlus. And while some things—like adding muscle mass and drinking green tea—may bump your metabolism up some, it’s probably not enough to make a huge difference (although more research needs to be done). 

This means you need to focus on what you have more control over—like your diet and physical activity—which we know can lower inflammation and reduce the risk of chronic disease.

The study authors note that the women who scored 6 or higher on the Mediterranean diet also tended to have generally healthier lifestyles, including a lower BMI. While it wasn’t mentioned specifically in the study, one could assume that a “generally healthier lifestyle” means they probably also participated in regular physical activity, got plenty of quality sleep and managed their stress. Each of these factors can reduce inflammation, and in turn, reduce disease risk.

The Bottom Line

This study suggests that women who ate more foods that are included in the Mediterranean diet had a 23% lower risk of dying prematurely. They also had overall healthier lifestyles. Including more nutrient-dense foods that provide your body with what it needs to run efficiently and reduce inflammation will go a long way toward reducing your risk of dying early. And moving your body more, getting plenty of quality sleep and addressing your stressors will add to that protection. 

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