Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Table 3 Association between quartiles of the MEDLIFE index and risk of all-cause and cardiovascular death over 8.7 years of follow-up

	Categories of adherence to MEDLIFE					p for trend	Per +2-point increment
	Q1 (4–11 p)	Q2 (12–13 p)		Q3 (14–15 p)	Q4 (16–23 p)	p for trend	Per +2-point increment
All-cause mortality
N	3042	3435		2917	1696
Deaths	118	106		76	30
Person-years	9,716,596	10,978,581		9,323,908	5,381,351
Model 1, HR (95% CI)	1 Ref.	0.92 (0.70, 1.21)		0.68 (0.48, 0.95)	0.54 (0.36, 0.83)	0.004		0.87 (0.79, 0.96)
Model 2, HR (95% CI)	1 Ref.	0.91 (0.69, 1.22)		0.70 (0.49, 0.99)	0.55 (0.36, 0.85)	0.010		0.88 (0.80, 0.97)
Model 3, HR (95% CI)	1 Ref.	0.88 (0.65, 1.18)		0.68 (0.48, 0.96)	0.55 (0.35, 0.85)	0.014		0.88 (0.79, 0.97)
Model 4, HR (95% CI)	1 Ref.	0.92 (0.68, 1.25)		0.72 (0.51, 1.02)	0.58 (0.37, 0.90)	0.025		0.89 (0.81, 0.99)
CVD mortality
Deaths	29		21	19	5
Person-years	9,716,596		10,978,581	9,323,908	5,381,351
Model 1, HR (95% CI)	1 Ref.		0.50 (0.27, 0.93)	0.72 (0.37, 1.37)	0.26 (0.08, 0.79)	0.02		0.78 (0.64, 0.97)
Model 2, HR (95% CI)	1 Ref.		0.55 (0.29, 1.04)	0.82 (0.42, 1.58)	0.30 (0.10, 0.94)	0.06		0.82 (0.67, 1.01)
Model 3, HR (95% CI)	1 Ref.		0.55 (0.28, 1.07)	0.83 (0.43, 1.62)	0.31 (0.10, 0.94)	0.08		0.83 (0.68, 1.02)
Model 4, HR (95% CI)	1 Ref.		0.57 (0.29, 1.14)	0.87 (0.44, 1.70)	0.33 (0.11, 1.02)	0.11		0.84 (0.68, 1.04)

The ENRICA cohort, June 2008 to December 2017
Number of morbidities includes the following self-reported physician-diagnosed diseases (coronary heart disease, stroke and heart failure, osteoarthritis, rheumatoid arthritis, respiratory disease, hip fracture, urinary infection, sleep apnea, depression, Alzheimer’s disease, cirrhosis, Parkinson’s disease, stomach ulcers, intestinal polysp, cataracts, periodontal disease, cancer)
Model 1: adjusted for sex, age, educational level (no formal or primary education, secondary education, university)
Model 2: adjusted for Model 1 + smoking (never, former, current), total energy intake (Kcal/day), and BMI
Model 3: Model 2 + prevalence of cancer, respiratory disease, depression, number of morbidities (excluding the previously mentioned conditions), number of drug treatments
Model 4: Model 3 + other clinical risk factors, including abdominal obesity (waist circumference ≥ 102 cm in men, or ≥ 88 cm in women), fasting blood glucose (100–126 mg/dl and not treated with antidiabetic drugs), high blood pressure (systolic ≥ 130 mmHg or diastolic ≥ 85 mmHg) or receiving antihypertensive drugs, triglycerides ≥ 150 mg/dl and serum high-density lipoprotein (HDL) cholesterol < 40 mg/dl in men or < 50 mg/dl in women)
HR hazard ratio, CI confidence interval

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