A Mediterranean diet score at 70 did not predict survival after adjustment

A Swedish team has now followed 1,298 people from the age of 70 for twenty years and compared how closely each of them ate a Mediterranean-style diet with what happened to them afterwards: death from any cause, cardiovascular disease, cancer and dementia. The study was published online on 28 October 2026 in The Journal of Nutrition, Health and Aging by researchers from the University of Skövde, the University of Gothenburg and Kristianstad University. Participants came from the general population of Gothenburg, recruited through the Gothenburg H70 study and the Population Study of Women in Gothenburg; 56.2% were women.

How the Swedish cohort was measured

Diet was recorded once, at age 70, in a face-to-face diet history interview. From it the authors built the Mediterranean Diet Score from eight food groups, leaving alcohol out. What happened next was taken from Swedish national health and death registers. The models were adjusted for body mass index, smoking, marital status, physical activity and education, and men and women were analysed separately.

For death from any cause, men with higher scores looked slightly better at ten years: hazard ratio 0.90 (95% CI 0.82 to 0.99). After full adjustment the association lost statistical significance: 0.92 (0.84 to 1.01). In women there was no association. The score was not linked to cardiovascular disease or cancer in either sex over the available follow-up (10 and 20 years, up to 18 years for cancer); for cardiovascular disease in men over twenty years the hazard ratio was 0.98 (0.88 to 1.08).

The only signal was dementia in men: over twenty years, a higher score went with a lower risk, hazard ratio 0.83 (0.71 to 0.96). It did not survive correction for multiple testing, and the difference between men and women was only borderline (p = 0.048). The authors say the result requires confirmation in larger studies.

The same city gave a different answer sixteen years ago

In 2010 part of the same research group published an analysis of 1,037 seventy-year-olds from the Gothenburg H70 studies, with deaths followed until 2009. There, a refined Mediterranean diet index was linked to lower mortality: each extra point carried a hazard ratio of 0.93 (0.89 to 0.98). The new paper uses a different score, a larger sample, twenty years of follow-up and separate analyses by sex, and at that horizon the link with survival no longer holds up after adjustment.

The authors name the weak spots themselves. Diet was measured only once, so changes after 70 are invisible. Dementia was taken from registers, which are estimated to miss more than half of cases, especially among people living at home. This is an observational study: it cannot show cause and effect in either direction. The authors declared no competing interests; the work was supported by research councils and foundations, among them the Swedish Research Council.

What the PREDIMED trial tested

The firmest data on the Mediterranean diet come not from cohorts but from a trial. In PREDIMED, 7,447 participants in Spain aged 55 to 80 at high cardiovascular risk but without cardiovascular disease were assigned to a Mediterranean diet supplemented with extra-virgin olive oil, one supplemented with mixed nuts, or a control diet with advice to reduce dietary fat. Over a median of 4.8 years, major cardiovascular events (heart attack, stroke or cardiovascular death) were less frequent in both Mediterranean groups: hazard ratios 0.69 and 0.72. The original 2013 report was withdrawn after protocol deviations were found, and the 2018 re-analysis took them into account. The trial's main outcome was cardiovascular events, not death from all causes, and the people in it were at high risk.

Read together, the studies answer different questions. The Swedish cohort measured diet once at 70 and does not establish whether that score affects survival; PREDIMED tested cardiovascular events in adults already at high cardiovascular risk. Neither study establishes a mortality benefit for people aged 40 to 70 without diagnosed disease, and one score taken at one point in life is a rough measure of how a person ate for decades. Changes to diet in the presence of chronic conditions or medicines are best discussed with a doctor.

Sources

• Tognon G, et al. Sex-specific associations between Mediterranean Diet Score and long-term risk of mortality, dementia and other chronic diseases. 20-year evidence from a Swedish population study of 70-year old individuals. The Journal of Nutrition, Health and Aging, 28 October 2026. PubMed 42950712

• Tognon G, et al. Does the Mediterranean diet predict longevity in the elderly? A Swedish perspective. Age (Dordrecht), 2011. PubMed 21110231

• Estruch R, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. The New England Journal of Medicine, 2018. PubMed 29897866