AHA News: Mediterranean Lifestyle, Not Just Diet, May Greatly Improve Health

WEDNESDAY, March 1, 2023 (American Heart Association News) -- Much is known about the heart-health benefits of adopting a Mediterranean-style diet, with its heavy focus on whole grains, fruits, vegetables, fish and healthy oils. But what about the rest of the Mediterranean lifestyle?

Short of lounging on the beaches of southern Italy or an island in Greece, could adopting the focus on relaxed, familial dining, afternoon naps and strong communal bonds also improve health?

A group of researchers explored what would happen if middle-aged and older British adults – who live about 1,500 miles northwest of the Mediterranean Sea and its convivial way of life – adopted not just the dietary but also the physical activity and social habits of their southern neighbors. And they found that the more they adhered to this lifestyle, the lower their risk of dying from cancer, cardiovascular disease and other health conditions.

The findings, presented Tuesday at the American Heart Association's Epidemiology, Prevention, Lifestyle and Cardiometabolic Health conference in Boston, are considered preliminary until full results are published in a peer-reviewed journal.

"This study suggests that adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations is possible and can be part of a healthy lifestyle," said the study's senior researcher, Mercedes Sotos-Prieto, an assistant professor in the department of preventive medicine and public health at the Autonomous University of Madrid, Spain. She also is an adjunct professor at the Harvard T.H. Chan School of Public Health in Boston.

Prior research has shown the Mediterranean-style eating pattern helps protect against cardiovascular disease, lowering the risk for heart attacks and strokes. In this latest study, researchers analyzed the impact of other Mediterranean lifestyle factors – including physical activity, rest, social habits and conviviality – on 110,799 middle-aged and older adults living in England, Scotland and Wales.

Participants were drawn from the UK Biobank, a multi-center, population-based study of people ages 40 to 75 who were free of cancer and cardiovascular disease when they enrolled between 2009 and 2012. They were followed until 2021.

A 25-point MEDLIFE index was used to score their adherence to the Mediterranean lifestyle. The index was broken down into three blocks: Mediterranean food consumption (12 points), which looked at what people ate; Mediterranean dietary habits (7 points), which looked at additional factors such as whether they snacked, added salt to their meals or preferred whole grains to refined grains; and other lifestyle factors (6 points).

The last block included questions on whether people ate meals with family and friends (conviviality); engaged in physical activity with others, for example by going on walks together; how often they met with family and friends (social habits); and how much sleep they got, both at night and through naps (rest).

After a median follow-up time of 9.4 years, death records were used to compare death rates for cancer, cardiovascular disease and all other causes between those with higher and lower MEDLIFE index scores. The analysis showed the more people adhered to the Mediterranean lifestyle, the lower their risk of dying from cancer or from any cause.

Specifically, compared to those with the lowest MEDLIFE index scores, adults with the highest adherence to the Mediterranean lifestyle had a 29% lower risk of dying from any cause and a 28% lower risk of dying from cancer. Higher scores for each of the three blocks of the MEDLIFE index were associated with lower cancer and all-cause death risks. Higher scores for the third block, related to lifestyle activities, also were associated with lower cardiovascular death risks.

The study highlights the important roles community and social engagement play in good health, said Marie-Pierre St-Onge, an associate professor of medicine and director of the Center of Excellence for Sleep and Circadian Research at Columbia University in New York City.

"The Mediterranean lifestyle involves interactions with others," she said, a component that is particularly important for people as they age. Studies have shown social isolation may increase a person's risk of having or dying from a heart attack or stroke.

The findings emphasize why "we should be paying attention to other aspects of lifestyle, beyond just physical activity," said St-Onge, who was not involved in the study. "Maybe we need to look at more and more of these social factors."

One thing the study did not explore and would be of interest in future studies is the impact of stress, she said. "When you think about the Mediterranean lifestyle, you think about living at a slower pace, but this study does not seem to capture that."

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email editor@heart.org.

By Laura Williamson, American Heart Association News