Key result
Smokers with low adherence to the Mediterranean diet had a significantly higher risk of all-cause mortality compared with never smokers with high adherence (HR 2.20; 95% CI 1.45-3.34).
Why the study?
Although low-quality diets and smoking independently increase mortality risk, their joint association and potential effect modification had not been sufficiently studied.
Does the combination of smoking and poor adherence to the Mediterranean diet increase mortality in a Spanish cohort?
Cohort (n=18,948)
Does the combination of smoking and poor adherence to the Mediterranean diet increase mortality in a Spanish cohort?
Smoking and poor adherence to the Mediterranean diet exert a multiplicative effect, significantly increasing all-cause and cancer-related mortality.
Low MedDiet adherence with smoking was associated with highest mortality risk multiplicatively; leaves open whether joint interventions reduce deaths beyond separate counseling.
OBJECTIVES: Although low-quality diets and smoking are independently associated with higher mortality risk, a joint analysis of both risk factors in relation to mortality has not been sufficiently studied. The aim of this study was to explore the effect modification between level of adherence to a Mediterranean dietary pattern (MedDiet) and smoking status on all-cause, cancer, and cardiovascular mortality. METHODS: We conducted a prospective analysis to assess the association between diet and smoking status in the SUN (Seguimiento Universidad de Navarra) cohort study. Deaths were confirmed by review of the National Death Index. Participants were classified into six categories according to the MedDiet (adherence/non-adherence) and their exposure to smoking (never/former/current smoker). Multivariate-adjusted Cox regression models were fitted to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for mortality. During a mean follow-up of 11.5 y (SD 4.5), we observed 18 948 participants (mean age 38.4 y; SD 12.4) and 431 deaths (51.3% cancer deaths). RESULTS: A higher risk for death was found among smokers with a low adherence to the MedDiet (HR, 2.20; 95% CI, 1.45-3.34) compared with never smokers with high adherence to the MedDiet. The P value for supra-multiplicative effect modification was not statistically significant, meaning that the effect of both factors is multiplicative. A higher risk for premature death from cancer was found in smokers and in those non-adherent with the MedDiet. CONCLUSION: Smoking and poor adherence to the MedDiet exerted a multiplicative effect in increasing all-cause mortality and cancer-related mortality in a Spanish population of university graduates.
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Pardavila‐Belio et al. (2022) conducted a cohort in General population (n=18,948). Smoking and low adherence to the Mediterranean diet vs. Never smokers with high adherence to the Mediterranean diet was evaluated on All-cause mortality (HR 2.20, 95% CI 1.45-3.34). Smokers with low adherence to the Mediterranean diet had a significantly higher risk of all-cause mortality compared with never smokers with high adherence (HR 2.20; 95% CI 1.45-3.34).
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