Dietary patterns, biological risk factors and survival in elderly European men and women

Background: The percentage of the population aged 65 and over, which started to rise sharply in the last decades of the past century, is continuing to rise. However, up until now, little is known about dietary factors and diet-related biological factors in elderly in relation to survival in old age. Aim: The aim of this thesis is to investigate the associations between dietary patterns, diet-related biological risk factors and survival.  Study population: Data from two prospective studies were used, the Healthy Ageing: a longitudinal study in Europe (HALE) and the Normative Aging Study (NAS). The HALE project which involves 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, includes 1507 apparently healthy men and 832 women in 11 European Countries, aged 70 to 90 years at baseline and who were followed for 10 years. The NAS is a longitudinal study which started in 1963 by recruiting men, 21 to 80 years of age and free of heart disease and other major health problems, around Boston. Data collected in 1993 and later were used.  Results: We observed that after fortification with folic acid, folate intake and plasma folate concentration increased significantly in three groups with different dietary patterns, derived by cluster analysis. Homocysteine tended to decrease in the group with a relatively high alcohol consumption, low fruit and vegetable dietary pattern in the NAS study. Dietary patterns defined by three European indexes were significantly associated with all-cause mortality in the HALE project. A Mediterranean type of diet was associated with an approximately 20 % lower mortality rates in both apparently healthy elderly and in post-myocardial infarction patients.  Healthy lifestyle factors (moderate alcohol consumption, being physically active and non-smoking) were also inversely associated with all-cause mortality. Weight loss was significantly associated with increased all-cause mortality in the study centres of Northern Europe while weight gain was weakly associated with increased mortality in these centres in the FINE study. HDL-cholesterol was inversely associated with mortality from cardiovascular diseases and all-causes in the HALE project. Associations between HDL and mortality were strongest in women. Conclusion: A healthy diet is associated with lower mortality risk in elderly. Besides a healthy diet, it is important for elderly people to be physically active, use alcohol in moderation and quit smoking. It is also important to maintain constant body weight and to keep blood cholesterol at a desirable level, especially to keep HDL-cholesterol high.