AIMS: The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern 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, 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 follow-up of 13.6 years (range = 0-15), we recorded 4 973 all-cause, 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.

In this study of 35 917 subjects from southern, central, eastern, and western European countries, the Southern European Atlantic diet (traditional dietary pattern of northwestern Spain and northern Portugal) was associated with lower 13.6-year mortality from any cause, cardiovascular disease, and cancer. The associations of the Southern European Atlantic diet with lower mortality were not significantly different between countries (Spain, Czechia, Poland, and the United Kingdom). Study associations were similar as those found for existing healthy dietary patterns, suggesting that rather different diets could confer comparable benefits on health.

Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm University Tomtebodavägen 18 A SE 171 77 Stockholm Sweden

Cardiovascular and Nutritional Epidemiology Group CEI UAM CSIC IMDEA Research Institute on Food and Health Sciences Carretera de Canto Blanco 8 28049 Madrid Spain

Center for Networked Biomedical Research in Epidemiology and Public Health Avenida de Monforte de Lemos 3 5 28029 Madrid Spain

Department of Environmental Health and Population Health Monitoring National Institute of Public Health Šrobárova 49 48 100 00 Prague Czech Republic

Department of Epidemiology and Population Studies Faculty of Health Sciences Institute of Public Health Jagiellonian University Medical College Ulica Skawińska 8 31 066 Krakow Poland

Department of Epidemiology and Public Health University College London 1 19 Torrington Place London WC1E 7HB UK

Department of Preventive Medicine and Public Health Universidad Autónoma de Madrid Calle del Arzobispo Morcillo 4 28029 Madrid Spain

Independent researcher

RECETOX Faculty of Science Masaryk University Kotlářská 267 2 611 37 Brno Czech Republic

Eur J Prev Cardiol. 2024 Feb 15;31(3):356-357. doi: 10.1093/eurjpc/zwae024. PubMed

Zobrazit více v PubMed

Varela G, Moreiras O, Ansón R, Ávila JM, Cuadrado C, Estalrich P, et al. . Consumo de alimentos en Galicia: la Dieta Atlántica. [Food consumption in Galicia: the Atlantic Diet]. Madrid, Spain: Fundación Española de la Nutrición; 2004.

IV Reunión Internacional “La alimentación y la nutrición en el siglo XXI”: Dieta Atlántica. La obesidad como problema de salud pública. [IV International Meeting “Feeding and nutrition in the 21st century”: the Atlantic Diet. Obesity as a public health problem]. Madrid, Spain: Fundación Española de la Nutrición; 2008.

Velho MV, Pinheiro R, Rodrigues AS. The Atlantic diet-origin and features. Int J Food Stud 2016;5:106–119.

Oliveira A, Lopes C, Rodríguez-Artalejo F. Adherence to the Southern European Atlantic Diet and occurrence of nonfatal acute myocardial infarction. Am J Clin Nutr 2010;92:211–217. PubMed

Lorenzo PM, Izquierdo AG, Rodriguez-Carnero G, Fernández-Pombo A, Iglesias A, Carreira MC, et al. . Epigenetic effects of healthy foods and lifestyle habits from the Southern European Atlantic Diet pattern: a narrative review. Adv Nutr 2022;13:1725–1747. PubMed PMC

Stefler D, Brett D, Sarkadi-Nagy E, Kopczynska E, Detchev S, Bati A, et al. . Traditional Eastern European diet and mortality: prospective evidence from the HAPIEE study. Eur J Nutr 2021;60:1091–1100. PubMed PMC

Castro-Penalonga M, Roca-Saavedra P, Miranda JM, Porto-Arias JJ, Nebot C, Cardelle-Cobas A, et al. . Influence of food consumption patterns and Galician lifestyle on human gut microbiota. J Physiol Biochem 2018;74:85–92. PubMed

Guallar-Castillón P, Oliveira A, Lopes C, López-García E, Rodríguez-Artalejo F. The Southern European Atlantic Diet is associated with lower concentrations of markers of coronary risk. Atherosclerosis 2013;226:502–509. PubMed

Moreira C, Santos R, Moreira P, Lobelo F, Ruiz JR, Vale S, et al. . Cardiorespiratory fitness is negatively associated with metabolic risk factors independently of the adherence to a healthy dietary pattern. Nutr Metab Cardiovasc Dis 2013;23:670–676. PubMed

Agostinis-Sobrinho C, Abreu S, Moreira C, Lopes L, García-Hermoso A, Ramírez-Vélez R, et al. . Muscular fitness, adherence to the Southern European Atlantic Diet and cardiometabolic risk factors in adolescents. Nutr Metab Cardiovasc Dis 2017;27:695–702. PubMed

Agostinis-Sobrinho C, Brand C, Moreira C, Lopes L, Oliveira-Santos J, Silva P, et al. . Muscular fitness, Southern European Atlantic Diet and inflammation in adolescents. Azorean Physical Activity and Health Study II. Eur J Sport Sci 2018;18:104–111. PubMed

Agostinis-Sobrinho C, Dias AF, Brand C, Norkiene S, Abreu S, Gaya ACA, et al. . Adherence to Southern European Atlantic Diet and physical fitness on the atherogenic index of plasma in adolescents. Cad Saude Publica 2019;35:e00200418. PubMed

Rodríguez-Martín C, Garcia-Ortiz L, Rodriguez-Sanchez E, Maderuelo-Fernandez C, Lugones-Sanchez A, Martin-Cantera M, et al. . The relationship of the Atlantic diet with cardiovascular risk factors and markers of arterial stiffness in adults without cardiovascular disease. Nutrients 2019;11:742. PubMed PMC

Calvo-Malvar M, Benítez-Estévez AJ, Sánchez-Castro J, Leis R, Gude F. Effects of a community-based behavioral intervention with a traditional Atlantic diet on cardiometabolic risk markers: a cluster randomized controlled trial (“the GALIAT study”). Nutrients 2021;13:1211. PubMed PMC

Carballo-Casla A, Ortolá R, García-Esquinas E, Oliveira A, Sotos-Prieto M, Lopes C, et al. . The Southern European Atlantic Diet and all-cause mortality in older adults. BMC Med 2021;19:36. PubMed PMC

Papier K, Knuppel A, Syam N, Jebb SA, Key TJ. Meat consumption and risk of ischemic heart disease: a systematic review and meta-analysis. Critic Rev Food Sci Nutr 2023;63:426–437. PubMed

Bouvard V, Loomis D, Guyton KZ, Grosse Y, El Ghissassi F, Benbrahim-Tallaa L, et al. . Carcinogenicity of consumption of red and processed meat. Lancet Oncol 2015;16:1599–1600. PubMed

Schwingshackl L, Schwedhelm C, Hoffmann G, Lampousi AM, Knüppel S, Iqbal K, et al. . Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2017;105:1462–1473. PubMed

Schwingshackl L, Schwedhelm C, Hoffmann G, Boeing H. Potatoes and risk of chronic disease: a systematic review and dose–response meta-analysis. Eur J Nutr 2019;58:2243–2251. PubMed PMC

Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. . Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet 2018;391:1513–1523. PubMed PMC

Ortolá R, García-Esquinas E, López-García E, León-Muñoz LM, Banegas JR, Rodríguez-Artalejo F. Alcohol consumption and all-cause mortality in older adults in Spain: an analysis accounting for the main methodological issues. Addiction 2019;114:59–68. PubMed

Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, et al. . Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 2012;142:1009–1018. PubMed PMC

Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med 2008;168:713–720. PubMed

Rodríguez-Artalejo F, Graciani A, Guallar-Castillón P, León-Muñoz LM, Zuluaga MC, López-García E, et al. . Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA). Rev Esp Cardiol 2011;64:876–882. PubMed

Peasey A, Bobak M, Kubinova R, Malyutina S, Pajak A, Tamosiunas A, et al. . Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: rationale and design of the HAPIEE study. BMC Public Health 2006;6:225. PubMed PMC

Brunner E, Stallone D, Juneja M, Bingham S, Marmot M. Dietary assessment in Whitehall II: comparison of 7 d diet diary and food-frequency questionnaire and validity against biomarkers. Br J Nutr 2001;86:405–414. PubMed

Brunner EJ, Mosdøl A, Witte DR, Martikainen P, Stafford M, Shipley MJ, et al. . Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Am J Clin Nutr 2008;87:1414–1421. PubMed

Knüppel A, Shipley MJ, Llewellyn CH, Brunner EJ. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep 2017;7:6287. PubMed PMC

Marmot M, Brunner E. Cohort profile: the Whitehall II study. Int J Epidemiol 2005;34:251–256. PubMed

Guallar-Castillón P, Sagardui-Villamor J, Balboa-Castillo T, Sala-Vila A, Ariza Astolfi MJ, Sarrión Pelous MD, et al. . Validity and reproducibility of a Spanish dietary history. PLoS One 2014;9:e86074. PubMed PMC

Boylan S, Welch A, Pikhart H, Malyutina S, Pajak A, Kubinova R, et al. . Dietary habits in three Central and Eastern European countries: the HAPIEE study. BMC Public Health 2009;9:439. PubMed PMC

Head J, Stansfeld SA, Ebmeier KP, Geddes JR, Allan CL, Lewis G, et al. . Use of self-administered instruments to assess psychiatric disorders in older people: validity of the General Health Questionnaire, the Center for Epidemiologic Studies Depression Scale and the self-completion version of the revised Clinical Interview Schedule. Psychol Med 2013;43:2649–2656. PubMed PMC

Cespedes EM, Hu FB. Dietary patterns: from nutritional epidemiologic analysis to national guidelines. Am J Clin Nutr 2015;101:899–900. PubMed PMC

Pedersini R, di Mauro P, Bosio S, Zanini B, Zanini A, Amoroso V, et al. . Changes in eating habits and food preferences in breast cancer patients undergoing adjuvant chemotherapy. Sci Rep 2021;11:12975. PubMed PMC

Lönn A, Kallings LV, Andersson G, Paulsson S, Wallin P, Eriksson JS, et al. . Lifestyle-related habits and factors before and after cardiovascular diagnosis: a case control study among 2,548 Swedish individuals. Int J Behav Nutr Phy Act 2023;20:41. PubMed PMC

Jacka FN, Cherbuin N, Anstey KJ, Butterworth P. Does reverse causality explain the relationship between diet and depression? J Affect Disord 2015;175:248–250. PubMed

Stefler D, Pikhart H, Jankovic N, Kubinova R, Pajak A, Malyutina S, et al. . Healthy diet indicator and mortality in Eastern European populations: prospective evidence from the HAPIEE cohort. Eur J Clin Nutr 2014;68:1346–1352. PubMed PMC

MacMahon S, Peto R, Collins R, Godwin J, MacMahon S, Cutler J, et al. . Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990;335:765–774. PubMed

Martinez-Gomez D, Cabanas-Sanchez V, Yu T, Rodriguez-Artalejo F, Ding D, Lee IM, et al. . Long-term leisure-time physical activity and risk of all-cause and cardiovascular mortality: dose–response associations in a prospective cohort study of 210 327 Taiwanese adults. Br J Sports Med 2022;56:919–926. PubMed

Martínez-Gómez D, Guallar-Castillon P, Mota J, Lopez-Garcia E, Rodriguez-Artalejo F. Physical activity, sitting time and mortality in older adults with diabetes. Int J Sports Med 2015;36:1206–1211. PubMed

Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 2015;73:643–660. PubMed PMC

Greenland S. The effect of misclassification in the presence of covariates. Am J Epidemiol 1980;112:564–569. PubMed