Search Results (258)

Background/Objectives: The Mediterranean (Med)-style and Dietary Approaches to Stop Hypertension (DASH) eating patterns are evidence-based nutrition interventions given their protective effects from cardiometabolic diseases. Little is known about adherence to each eating pattern among the Hispanic/Latine population. The objective of this cross-sectional analysis is to assess the alignment of reported dietary intakes of Hispanic/Latine adults to Med-style and DASH eating patterns and associations with clinical outcomes for diabetes mellitus and cardiovascular diseases. Methods: A sample of 5406 Hispanic/Latine adults from the National Health and Nutrition Examination Survey (2007–2018) was utilized. Alignment to the Med-style and DASH eating patterns was calculated by scoring indices tailored for overconsumption in the United States. Multiple linear regression determined associations between each respective eating pattern and clinical outcomes. Results: Hispanic/Latine adults in the United States have a mean DASH score of 11.2 and a Med-style score of 8.4 (out of 100), indicating poor alignment. Adjusted regression analysis showed increased alignment of both eating patterns was associated with a decrease in average blood pressure (DASH ꞵ = −0.095, p = <0.0001; Med-style: ꞵ = −0.128, p = 0.0002). Greater adherence to a Med-style eating pattern score was also associated with improved average hemoglobin A1c (ꞵ −0.007, p = 0.017). Neither diet pattern score was associated with total cholesterol. Conclusions: Evidence of low alignment to the Med-style and DASH eating patterns among Hispanic/Latine populations exacerbates the need for future work to understand cultural tailoring of evidence-based eating patterns to increase adherence and support improved cardiometabolic outcomes. Full article

Background/Objectives: Sex and gender influence dietary habits, eating behaviors, mental health, and obesity risk. Women exhibit a higher prevalence of emotional eating and mental health problems, which may contribute to sex-specific differences in adiposity. This study aimed to explore the associations between adiposity, diet quality, eating behaviors, mental health, and well-being, and to examine whether eating behaviors mediate the relationship between mental health and adiposity, stratified by sex. Methods: One hundred twenty-three adults (35.6 ± 7.9 years; 63.4% women) with overweight and obesity participated in this cross-sectional study. Adiposity parameters (BMI, body fat, waist and hip circumferences), biochemical parameters, eating behaviors (Three-Factor Eating Questionnaire-R21), well-being (WHO-5), perceived stress (Perceived Stress Scale), diet quality (17-item MedDiet questionnaire), and physical activity (International Physical Activity Questionnaire) were evaluated. Linear regression and path analyses were used to examine associations and mediation effects. Results: Women reported higher emotional eating and cognitive restraint scores (p = 0.017 and p = 0.034, respectively) and greater adherence to the Mediterranean diet (p < 0.001) than men. In men, well-being was positively associated with diet quality, while higher stress, cognitive restraint, and poorer diet quality were linked to greater adiposity. In women, well-being and diet quality were inversely associated with adiposity, while emotional and uncontrolled eating were related to higher adiposity and poorer biochemical markers. Emotional and uncontrolled eating mediated the relationship between well-being and adiposity only in women. Conclusions: Our results underscore the importance of incorporating sex- and gender-sensitive approaches in obesity prevention and treatment. For women, interventions should focus on emotional regulation and coping strategies, whereas for men, improving diet quality may be more effective. Full article

Introduction: “The dog is a man’s best friend” and research has showed that this idea is extended beyond the degree of loyalty. Dog ownership has been linked to several positive health outcomes for the owner. The aim of the present cross-sectional case–control study was to assess differences in the physical activity level (PAL), body composition, quality of life (QoL), and diet quality and dietary knowledge between dog owners and non-owners. Methods: A total of 55 dog owners and an equal amount of non-dog owners (all aged between 18 and 60 years old) formed the case and control groups, respectively. Basic anthropometric measurements were performed, including body fat (BF) and diet, assessed with the Mediterranean Diet Score (MedDietScore) and the Eating Assessment Table (EAT). Physical activity was recorded for 3 consecutive days using activity monitors. QoL was evaluated using the brief version of the World Health Organization QoL (WHOQOL-BREF) tool. Results: The two groups demonstrated a similar PAL, but lower BF% (p = 0.009), hip circumference (p < 0.001), triceps (p = 0.012), and subscapular skinfolds (p = 0.003) were recorded among dog owners. The EAT score was greater among dog owners (p = 0.0023), indicating improved dietary intake and knowledge, even after adjustment for education attained and BMI (p = 0.026). On the other hand, greater adherence to the Mediterranean diet was exhibited among those not having dogs (p = 0.018). Regarding dog measurements and their owners’ anthropometry, dog neck circumference was negatively correlated to the owners’ biceps and triceps skinfolds (r = −0.327, p = 0.016; r = −0.320, p = 0.018, respectively). Additionally, dog breed size was negatively correlated to the owners’ triceps skinfold (r = −0.325, p = 0.015), sum of skinfolds (r = −0.311, p = 0.021), hip circumference (r = −0.341, p = 0.011), body fat (r = −0.357, p = 0.007), and fat mass index (r = −0.307, p = 0.023). Conclusions: Dog ownership is associated with improved body composition and smaller skinfold thickness at specific body sites, as well as with a more health-conscious lifestyle, including better diet quality and knowledge. Full article

Background: Impaired bone health is a recognized complication of type 1 diabetes. This study evaluated the effects of low-carbohydrate (LC) and Mediterranean (MED) diets on bone turnover markers in adolescents and young adults. Methods: In a 24-week randomized controlled trial, 40 individuals aged 12–21 years, with type 1 diabetes, were assigned to an LC or MED intervention (20 participants per group). C-terminal telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) were measured at baseline and 24 weeks. Results: The groups had similar baselines. At 24 weeks, the between-group difference in delta glucose time in range was not statistically significant; median daily carbohydrate intake was 86 g (68–95) in LC and 130 g (102–173) in MED (p < 0.001). Comparing LC to MED, the median BMI z-score was lower (−0.1 [−0.3 to −0.1] vs. 0.0 [−0.1 to −0.1], p = 0.10), and calcium (p = 0.035) and magnesium intakes (p = 0.030) were lower. These associations did not remain statistically significant after false-discovery-rate correction. The median-adjusted alkaline phosphatase level decreased significantly in the LC group (p = 0.009). The median CTX changed following LC from 395 pg/mL (232–591) to 423 pg/mL (289–591) (p = 0.278); and following MED, from 357 pg/mL (244–782) to 296 pg/mL (227–661) (p = 0.245). P1NP changed in LC from 95 ng/mL (68–112) to 88 ng/mL (62–97) (p = 0.056) and in MED from 76 ng/mL (54–198) to 71 ng/mL (55–122) (p = 0.594). Conclusions: Exploratory analyses of bone turnover markers showed insignificant differences following LC and MED diets. Full article

Background/Objectives: The Mediterranean Diet (MD) is globally recognized for its nutritional, environmental, and cultural value. Although several indices assess adherence to the MD and its food environments, none evaluate the alignment of individual recipes with MD principles. This study aimed to develop and validate the Mediterranean Diet Recipe Index (MedRI), a novel scoring tool designed to quantify the concordance of recipes with MD guidelines. Methods: The MedRI was conceptualized through a comprehensive literature review and expert panel assessment, integrating two main dimensions: consumption context and recipe composition. The index evaluates ingredient selection, preparation methods, and food group inclusion, with criteria adapted to specific recipe categories. Validation was conducted using a structured questionnaire administered to 244 adults living in Portugal. Statistical analyses included descriptive statistics, Spearman correlations, intra-class correlation coefficients (ICCs), Cohen’s kappa, Chi-square tests, Cramer’s V, and principal component analysis (PCA). Results: Validation results demonstrated strong internal consistency and construct validity, confirming the reliability and applicability of the MedRI in assessing recipe alignment with MD principles. Conclusions: The MedRI thus represents a reliable and innovative tool to assess and promote culinary practices consistent with the MD. It holds potential applications in nutrition education, public health policymaking, and gastronomic research, supporting the advancement of sustainable and health-promoting dietary models. Full article

Background and Objectives: There is adherence to a healthy Mediterranean diet (MedDiet), but adherence varies widely. Precision nutrition is increasingly interested in individual characteristics influencing diet adherence, but few studies have examined personality traits. Our main aim was to investigate the association between personality traits and MedDiet adherence. Our secondary aims were to explore genome-wide genetic variants associated with neuroticism, including replication of previous findings, as well as to explore gene–MedDiet interactions. Methods: We analyzed participants (aged 55–75) in the PREDIMED-Plus-Valencia study and measured clinical, lifestyle, and genetic factors. The Eysenck Personality Questionnaire-Revised (EPQ-R) was used to measure neuroticism, psychoticism, and extraversion. Genotyping was undertaken, and associations with candidate SNPs, genome-wide association studies (GWAS), genetic risk scores (GRS), and gene–MedDiet interactions were explored. Results: Neuroticism was inversely (beta = −0.09; p = 0.001) associated with adherence to the Mediterranean diet (MEDAS-17). Likewise, the probability of low MedDiet adherence increased neuroticism (OR: 1.27; 95% CI: 1.02–1.60; p = 0.031 per SD). In the GWAS for this trait, several SNPs surpassed the suggestive level of statistical significance. The most strongly associated was rs10181407-NDUFA10 (NADH dehydrogenase 1 alpha subcomplex subunit 10) (beta = −2.39; p = 2.70 × 10⁻⁶). The GRS for neuroticism was significantly associated with MedDiet adherence (beta = −0.18; p = 0.020), increasing the causality level. We replicated some candidate SNPs, and among them, the rs2243873-EHMT2 (euchromatic histone lysine methyltransferase 2) gene. The analysis of gene–MedDiet interactions revealed the role of these dietary modulations. Conclusions: Neuroticism was the personality trait most inversely associated with MedDiet adherence, suggesting its integration in precision nutrition analysis. Moreover, neuroticism-related genetics and MedDiet modulations will also be important. Full article

Background/Objectives: The nutrition and lifestyle choices made during pregnancy significantly impact the long-term health of both mother and child. This observational study, conducted at the Jersey Maternity Unit, investigated how maternal diet and weight influence delivery outcomes and newborn feeding methods among 81 pregnant women. The aim of the study was to assess whether maternal diet, weight changes, and infant feeding practices vary according to ethnicity and duration of residence in Jersey, in order to inform culturally sensitive health improvement strategies. Methods: The FFQ was used to characterise the diet before and during pregnancy. Diet quality was assessed by the 9-item aMED score. Data on anthropometric measurements (including gestational weight gain, GWG), socioeconomic characteristics, and infant feeding methods (including breastfeeding rates) were collected. Results: The statistical analyses evaluate differences and distribution of data in the groups of women based on the ethnicity and period the mothers had lived on the island. For all the women, there were significant changes in the weight gained at week 28 compared to weeks 8 and 12 (+8.0 (4.0; 12.1) kg, p ≤ 0.001), as well as the period before pregnancy until the 34th week of gestation (+11.9 (8.0; 12.1) kg, p ≤ 0.001). The intake of low-fat dairy, whole grains, and fruit changed through the gestation period and differed between pregnant women with different periods of island residence. There were no changes in the aMED score and adherence. Conclusions: Maternal weight gain followed a consistent pattern during pregnancy, whereas dietary behaviours—particularly the consumption of key food groups—varied by cultural background and length of residence. These findings emphasise the need for culturally sensitive antenatal care and tailored nutrition strategies to improve maternal outcomes, support breastfeeding, and reduce long-term health risks for mothers and children in Jersey’s multicultural population. Full article

Background/Objectives: Chronic inflammatory diseases (CIDs) often present a preclinical phase influenced by genetic and environmental factors, including nutrition. Early dietary habits may modulate long-term health trajectories by shaping the intestinal microbiota. Previous work showed that weaning with fresh foods from the Mediterranean diet (MD) improved dietary habits and microbiota composition at 3 years of age. This study aimed to assess whether such benefits persist at 9 years. Methods: This long-term follow-up included 191 children (96 MD, 95 controls) from the original randomized cohort (ClinicalTrials.gov NCT05297357). The primary endpoint was adherence to MD (KidMed score ≥ 8). Secondary endpoints included BMI, incidence of CID, maternal dietary adherence, and intestinal microbiota composition in a subset of 36 children. Results: At 9 years, no difference was found in overall MD adherence (27.4% controls vs. 27.1% MD; p > 0.99) or BMI (17.7 vs. 18.1 kg/m²; p = 0.384). However, children from the MD group reported higher daily vegetable intake (71.9% vs. 51.6%; p = 0.005). Microbiota analyses revealed persistent differences between groups, with higher alpha diversity in the MD group. Although not statistically significant, the MD group showed lower prevalence of atopic dermatitis, allergic rhinitis, autism spectrum disorder, and ADHD. Maternal adherence to MD did not differ between groups. Conclusions: Early introduction of Mediterranean-style foods during weaning exerts lasting effects on dietary patterns and gut microbiota, with a potential protective trend against CID. While overall MD adherence converged between groups by 9 years, these findings suggest that early-life nutritional interventions may induce durable microbiome-mediated benefits and contribute to preventive strategies for chronic disease, warranting confirmation in larger, extended cohorts. Moreover, this study highlights the value of the collaboration between the Italian primary care pediatric system and the integration of the pediatric residency program, demonstrating a feasible and cost-effective methodology to generate large-scale prospective data within routine clinical practice. Larger studies and a longer follow-up period are necessary to confirm these results. Full article

Background/Objectives: Perinatal mental disorders are important health issues that affect both mothers and their children. The Mediterranean diet (MD) is one of the most well-recognized healthy dietary patterns worldwide. Recent evidence suggests that MD may prevent or reduce the risk of perinatal mental disorders. This study investigated the association between MD adherence during pregnancy and psychological distress in a large cohort of Japanese births. Methods: Data were obtained from 80,271 pregnant women who participated in the Japan Environment and Children’s Study. Adherence to the MD was assessed using three scoring methods: the Mediterranean Diet Score (MDS), relative Mediterranean Diet (rMED), and Mediterranean Diet Score for Pregnancy (PMDS). Psychological distress was defined as a score of ≥13 on the Kessler 6-item Psychological Distress Scale (K6). Modified Poisson regression models were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs). Population attributable fractions (PAFs) were calculated to quantify the proportion of psychological distress attributable to low MD adherence. Results: The adjusted RR for psychological distress in the low PMDS group was 1.17 (95% CI: 1.07, 1.28) compared with the high PMDS group. The adjusted PAF for low PMDS was 10.43% (95% CI: 4.81, 16.06). No statistically significant associations were detected between psychological distress and the MDS or rMED scores. Conclusions: This study suggests that high adherence to MD based on the PMDS during pregnancy may reduce the risk of psychological distress in Japanese women. Therefore, promoting MD during pregnancy could be a potential strategy for preventing perinatal mental disorders. Full article

Background/Objectives: Adherence to the Mediterranean Diet (MedDiet) has declined even within Mediterranean regions, while its adoption has become more common in non-Mediterranean contexts. This study compares Germany and Türkiye, two culturally contrasting contexts traditionally classified as non-Mediterranean and Mediterranean, respectively, to examine cross-cultural differences and patterns in MedDiet adherence and related lifestyle behaviors. Specifically, it aims to compare adherence to the Mediterranean lifestyle (MedLife), physical activity, and social participation, and to analyze their associations within each country. Methods: Using data from the MEDIET4ALL survey, 1184 valid responses (609 from Germany and 575 from Türkiye) were analyzed for dietary behaviors, perceived barriers to MedDiet adherence, physical activity, and social engagement, with adherence assessed via the MEDLIFE index. Results: The majority of respondents were healthy (79%), employed (67%), young adults (56%), of normal weight (51%), living in urban environments (72%), and showed a gender balance (52.5% female). Most were classified as medium MedDiet adherent in both Germany (45%) and Türkiye (56%), with no significant difference in total MedLife scores. However, block- and item-level analyses revealed that Turkish participants showed higher adherence to Mediterranean food consumption (p < 0.001), particularly in limiting processed meat and consuming legumes, dairy, nuts/olives, and olive oil. In contrast, German participants adhered more closely to recommendations for red meat and cereal intake. German participants also scored higher on lifestyle-related behaviors (e.g., regular napping and recommended sleep duration), while no significant differences were found in the dietary habits block. Awareness of the MedDiet was significantly higher among German participants (p < 0.001), with country-specific differences in perceived barriers (i.e., higher total score among Germans with p = 0.03). Germans reported more barriers related to social norms and health conditions, while Turkish respondents more often cited attitudes, cost, and individual beliefs. Physical activity levels were significantly higher in Germany, whereas Turkish respondents reported greater social participation (p < 0.001). Weak to moderate correlations (r = 0.09 to 0.035) were found between MedLife adherence and both physical activity and social participation, with stronger associations observed among German participants. Conclusions: These findings highlight the culturally embedded nature of lifestyle behaviors related to MedDiet adherence. Despite similar overall adherence levels, Germans and Turks differ in specific dietary patterns, lifestyle practices, and perceived barriers, underscoring the need for culturally tailored interventions to improve adherence. Full article

Background: The ketogenic diet (KD) is one of the most widely followed dietary approaches worldwide, frequently promoted in popular media for weight loss and chronic disease management, although it also has established therapeutic applications in clinical medicine. However, our previous reviews have shown that existing clinical studies and meta-analyses on KD suffer from serious methodological limitations, raising concerns about their reliability. Considering this, the present study aimed to assess knowledge and opinions on KD among university students and academic staff. Methods: Cross-sectional, self-developed online questionnaire was distributed to 23,330 students and academic teachers at the University of Pécs, Hungary. Data was collected in October 2024. A total of 891 responses were included (710 students, 123 academic staff). Knowledge scores were calculated (maximum 17 points, including penalties for incorrect answers) and data were analyzed using descriptive statistics, ANOVA, chi-square tests, Pearson correlation, and logistic regression. Results: Only 7.3% of students and 13.5% of staff achieved ≥60% of the maximum knowledge score. Health-related faculties did not consistently outperform non–health-related ones; in fact, some non-health-related faculties achieved the highest mean scores. Completion of nutrition-related courses and reliance on PubMed were associated with higher knowledge, while current KD adherence among staff was negatively associated. Most participants (over 65%) were uncertain about the reliability of KD research. Conclusions: Knowledge of KD among both students and staff was limited, highlighting susceptibility to misinformation. Critical appraisal skills and reliable nutrition education are urgently needed at the population level to support disease prevention and to counterbalance misleading claims about KD. Full article

Background: Multiple sclerosis (MS) is a chronic auto-immune neuroinflammatory disorder presenting as a range of systemic and neurological symptoms, including cognitive impairment. Emerging evidence suggests that diets targeting brain health—such as the Mediterranean (MED) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets—may improve cognitive function; however, studies examining their role in people living with MS are limited. Methods: We examined cross-sectional associations between diet and cognition data from 967 participants in the United Kingdom Multiple Sclerosis Register (UKMSR). Dietary pattern scores (alternate Mediterranean; aMED, and MIND) were derived from the 130-item EPIC-Norfolk food frequency questionnaire. Cognition was assessed using the MS-specific Cognitron-MS (C-MS) battery (13 tasks) and summarised as overall cognition (global G factor) and four domains (object memory, problem solving, information processing speed [IPS], and words memory). Cognitive outcomes were expressed as Deviation-from-Expected (DfE) scores standardised to demographic and device characteristics using external regression-based norms. Linear models were adjusted for total energy intake, MS phenotype, disease duration since diagnosis, and current disease-modifying therapy (DMT) use. Interactions tested moderation by MS phenotype (relapsing vs. progressive MS) and current DMT use (yes vs. no). Sensitivity analyses included within-domain multiple-comparison control, rank-based inverse-normal transformation, and winsorisation. Results: Greater alignment with aMED and MIND dietary patterns were associated with higher scores in specific cognitive domains but not in overall cognition. Higher aMED scores were associated most consistently with better IPS, while higher MIND scores were additionally associated with better words memory. In categorical models, participants with the middle or highest tertiles of aMED or MIND scores performed up to ~0.4 SD better on tasks of Verbal Analogies, Word Definitions, Simple Reaction Time, Words Memory Immediate, or Words Memory Delays compared with those in the lowest tertile. These findings were robust across sensitivity analyses. Stratified analyses showed differential cognitive performance and diet-cognition associations by MS phenotype and DMT use. Conclusions: Mediterranean and MIND dietary patterns showed modest cross-sectional associations with specific cognition domains, with differential cognitive performance in different subgroups according to MS phenotype and DMT use. Although causal inference is not possible, our findings indicate future MS-related dietary studies (longitudinal and/or randomised controlled trials) examining cognitive function domains across different MS subgroups are warranted. Full article

Background: Frailty is known to elevate the risk of all-cause mortality and shorten life expectancy. Although the effects of diet on health are well documented, the specific interaction between diet quality and frailty remains unexplored. This research aims to examine the combined effects of various diet quality scores and frailty on all-cause mortality and life expectancy among middle-aged and older adults. Methods: A total of 151,628 participants were sourced from the UK Biobank for analysis. Frailty phenotype (FP) and frailty index (FI), as two different approaches, were used to assess frailty status. Diet quality was evaluated through seven diet quality scores: the Alternate Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension (DASH) score, Mediterranean diet (MED) score, Dietary Inflammatory Index (DII), and three plant-based diet indices (overall PDI, healthful PDI, and unhealthful PDI). Cox proportional hazards models were applied to calculate adjusted hazard ratios (HRs) for overall mortality and predict life expectancy differences. Results: Over a median follow-up period of 12.2 years, 8231 deaths were identified. After accounting for potential confounding factors, frail individuals in the unhealthier tertile of diet scores exhibited markedly elevated mortality risks, ranging from 1.99 to 2.07 based on the frailty index and 2.79 to 3.06 based on the frailty phenotype, compared to their robust counterparts in the healthier tertile. Regardless of frailty categories, a healthier diet was associated with longer life expectancy and with lower mortality risk in a dose–response relationship. Conclusions: The healthier tertile of diet scores was found to mitigate the detrimental effects of frailty, emphasizing diet quality as a modifiable factor in promoting healthier aging. Evidence suggests that it is never too late to adopt healthier dietary habits for significant health benefits. Full article

Background/Objectives: Sustainable dietary patterns in geriatrics have gained considerable attention. In this cross-sectional study, we investigated whether higher consumption of locally produced foods is associated with higher adherence to the Mediterranean diet and with better healthy aging status among Greek older adults. Methods: Sociodemographic, anthropometrical, lifestyle, dietary, cognitive, and mental characteristics assessed through validated questionnaires and procedures, were assessed. Participants (N = 449) were divided into three local food consumption groups/tertiles: “high” (≥45% of total dietary intake), “moderate” (27–44%) and “low” (≤26%). MedDietScore (0–55) was used to assess the level of adherence to the Mediterranean diet and SAI (0–10) to assess healthy aging. Results: Older adults of the “high” group showed an increase of 0.817 units in the SAI index compared to older adults of the “low” group. Additionally, high local food consumption was also associated with higher SAI levels (b = 0.493, p = 0.007) compared to the “moderate” group. Among older individuals whose diet comprises over 45% local foods, an increase of approximately 2.8 and 1.95 units in the MedDietScore was detected when compared to the “low” and “moderate” groups. Conclusions: Higher consumption of local foods, and more specifically consuming local foods in more than 45% of the total dietary intake, is associated with greater adherence to the Mediterranean diet and better healthy aging. The results suggest that food locality may play an important role in shaping better dietary habits, health trajectories, and quality of life of older adults. Full article

Background/Objectives: A higher adherence to the Mediterranean diet (MedDiet) has been associated with a lower risk of death in different populations, but this association has been insufficiently investigated in the elderly Spanish population. In this study, we assess the association between adherence to three MedDiet indexes and all-cause, cardiovascular disease (CVD), and cancer mortality in a population aged 65 years and older in Spain. Methods: The population included 903 participants from two population-based surveys. Diet was assessed at baseline by using validated food-frequency questionnaires (FFQ). We calculated scores of adherence to the MedDiet for three indexes: alternate Mediterranean Diet Score (aMED), relative Mediterranean Diet Score (rMED) and 17-item energy-restricted Mediterranean Diet Adherence Screener (erMEDAS). Deaths were ascertained through the National Death Index of Spain and the Mortality Registry in the Valencian Region during a 12 year follow-up period. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI), adjusting for relevant confounders. Results: During the 12 years of follow-up, 403 deaths occurred: 160 due to CVD and 90 to cancer. Compared to participants in the lowest tertile of adherence to aMED, those in the highest tertile showed a 30% lower risk of all-cause mortality, HR = 0.70 (95% CI 0.51–0.96). In addition, per two-point increase in aMED, we observed a 17% lower risk of all-cause mortality, HR = 0.83 (95% CI 0.73–0.95), and a 21% lower risk of CVD mortality, HR = 0.79 (95% CI 0.64–0.99). A 9% lower risk of all-cause mortality was also observed per two-point increase in the rMED score, HR = 0.91 (95% CI 0.84–0.99). Compared to participants in the lowest tertile of adherence to rMED, those in the highest tertile showed evidence of a marginally significant, lower risk of cancer mortality, HR = 0.55 (95% CI 0.29–1.04). No association was observed between the erMEDAS index and mortality for any cause. Conclusions: High adherence to the MedDiet, as measured by aMED and rMED indexes, was associated with lower all-cause, CVD, and cancer mortality in an older Mediterranean population after 12 years of follow-up. Full article