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Aims:
The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of north-western Spain and northern Portugal, but it may resemble that of central, eastern and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations, and if it is similar as that found in its countries of origin.
Methods and results:
We conducted a prospective analysis of four cohorts with 35,917 subjects aged 18-96 years: ENRICA (Spain), HAPIEE (Czechia and Poland) and Whitehall-II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, 13 dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption.
Associations were adjusted for sociodemographic variables, energy intake, lifestyle and morbidity. After a median followup of 13.6 years (range = 0-15), we recorded 4,973 all-cause deaths, 1,581 cardiovascular and 1,814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89,0.95), 0.91 (0.86,0.96) and 0.94 (0.89,0.99) for all-cause, cardiovascular and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88,0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85,0.93), United Kingdom = 0.98 (0.89,1.07); p for interaction = 0.16].
Conclusion:
The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patterns.
