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Dietary patterns among older Europeans: the EPIC-Elderly study

  • Christina Bamia (a1), Philippos Orfanos (a1), Pietro Ferrari (a2), Kim Overvad (a3), Heidi H. Hundborg (a4), Anne Tjønneland (a5), Anja Olsen (a5), Emmanuelle Kesse (a6), Marie-Christine Boutron-Ruault (a7), Françoise Clavel-Chapelon (a6), Gabriele Nagel (a8), Paolo Boffetta (a2) (a8), Heiner Boeing (a9), Kurt Hoffmann (a9), Dimitrios Trichopoulos (a1) (a10), Nikos Baibas (a1), Theodora Psaltopoulou (a1), Teresa Norat (a2), Nadia Slimani (a2), Domenico Palli (a11), Vittorio Krogh (a12), Salvatore Panico (a13), Rosario Tumino (a14), Carlotta Sacerdote (a15), H. B. Bueno-de-Mesquita (a16), Marga C. Ocké (a16), Petra H. Peeters (a17), Caroline T. van Rossum (a16), José-Ramón Quirós (a18), Maria-José Sánchez (a19), Carmen Navarro (a20), Aurelio Barricarte (a21), Miren Dorronsoro (a22), Göran Berglund (a23), Elisabet Wirfält (a23), Göran Hallmans (a24), Ingegerd Johansson (a24), Sheila Bingham (a25), Kay-Tee Khaw (a26), Elizabeth A. Spencer (a27), Andrew W. Roddam (a27), Elio Riboli (a2) and Antonia Trichopoulou (a1)...


Overall dietary patterns have been associated with health and longevity. We used principal component (PC) and cluster analyses to identify the prevailing dietary patterns of 99 744 participants, aged 60 years or older, living in nine European countries and participating in the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort) and to examine their socio-demographic and lifestyle correlates. Two PC were identified: PC1 reflects a ‘vegetable-based’ diet with an emphasis on foods of plant origin, rice, pasta and other grain rather than on margarine, potatoes and non-alcoholic beverages. PC2 indicates a ‘sweet- and fat-dominated’ diet with a preference for sweets, added fat and dairy products but not meat, alcohol, bread and eggs. PC1 was associated with a younger age, a higher level of education, physical activity, a higher BMI, a lower waist:hip ratio and never and past smoking. PC2 was associated with older age, less education, never having smoked, a lower BMI and waist:hip ratio and lower levels of physical activity. Elderly individuals in southern Europe scored positively on PC1 and about zero on PC2, whereas the elderly in northern Europe scored negatively on PC1 and variably on PC2. The results of cluster analysis were compatible with the indicated dietary patterns. ‘Vegetable-based’ and a ‘sweet- and fat-dominated’ diets are prevalent among the elderly across Europe, and there is a north–south gradient regarding their dietary choices. Our study contributes to the identification of groups of elderly who are likely to have different prospects for long-term disease occurrence and survival.


Corresponding author

*Corresponding author: Professor Antonia Trichopoulou, fax +30 210 746 2079, email


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Balder, HF, Virtanen, M, Brants, HA, et al. (2003) Common and country-specific dietary patterns in four European cohort studies. J Nutr 133, 42464251.
Chatfield, C & Collins, AJ (1995) Introduction to Multivariate Analysis [Chatfield, C and Zidek, JV, editors]. London: Chapman & Hall.
Costacou, T, Bamia, C, Ferrari, P, Riboli, E, Trichopoulos, D & Trichopoulou, A (2003) Tracing the Mediterranean diet through principal components and cluster analyses in the Greek population. Eur J Clin Nutr 57, 13781385.
de Groot, LC, Van Staveren, WA & Burema, J (1996) Survival beyond age 70 in relation to diet. Nutr Rev 54, 211212.
Euronut–SENECA (1991) Nutrition and the elderly in Europe. 1st European Congress on Nutrition and Health in the Elderly. The Netherlands, December 1991. Eur J Clin Nutr 45, Suppl. 31196.
Fung, TT, Rimm, EB, Spiegelman, D, Rifai, N, Tofler, GH, Willett, WC & Hu, FB (2001a) Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nut 73, 6167.
Fung, TT, Willett, WC, Stampfer, MJ, Manson, JA & Hu, FB (2001b) Dietary patterns and the risk of coronary heart disease in women. Arch Intern Med 161, 18571862.
Haines, PS, Siega-Riz, AM & Popkin, BM (1999) The Diet Quality Index revised: a measurement instrument for populations. J Am Diet Assoc 99, 697704.
Haveman-Nies, A, de Groot, LP & Van Staveren, WA (1998) Snack patterns of older Europeans. J Am Diet Assoc 98, 12971302.
Haveman-Nies, A, Tucker, KL, de Groot, LC, Wilson, PW & Van Staveren, WA (2001) Evaluation of dietary quality in relationship to nutritional and lifestyle factors in elderly people of the US Framingham Heart Study and the European SENECA study. Eur J Clin Nut 55, 870880.
Hu, FB, Rimm, E & Smith-Warner, SA (1999) Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 69, 243249.
Hu, FB, Rimm, EB, Stampfer, MJ, Ascherio, A, Spiegelman, D & Willett, WC (2000) Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 72, 912921.
Hu, FB & Willett, WC (2002) Optimal diets for prevention of coronary heart disease. JAMA 288, 25692578.
Huijbregts, PP, Feskens, EJ & Kromhout, D (1995) Dietary patterns and cardiovascular risk factors in elderly men: the Zutphen Elderly Study. Int J Epidemiol 24, 313320.
Huijbregts, P, Feskens, E, Rasanen, L, Fidanza, F, Nissinen, A, Menotti, A & Kromhout, D (1997) Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study. BMJ 315, 1317.
Kant, AK, Schatzkin, A, Graubard, BI & Schairer, C (2000) A prospective study of diet quality and mortality in women. JAMA 283, 21092115.
Kennedy, ET, Ohls, J, Carlson, S & Fleming, K (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.
Key, TJ, Schatzkin, A, Willett, WC, Allen, NE, Spencer, EA & Travis, RC (2004) Diet nutrition and the prevention of cancer. Publ Health Nutr 7, 187200.
Kumagai, S, Shibata, H, Watanabe, S, Suzuki, T & Haga, H (1999) Effect of food intake pattern on all-cause mortality in the community elderly: a 7-year longitudinal study. J Nutr Health Aging 3, 2933.
Lin, H, Bermudez, OI & Tucker, KL (2003) Dietary patterns of Hispanic elders are associated with acculturation and obesity. Nutrition 133, 36513657.
McCann, SE, Weiner, J, Graham, S & Freudenheim, JL (2001) Is principal components analysis necessary to characterise dietary behaviour in studies of diet and disease? Publ Health Nutr 4, 903908.
McCullough, ML, Feskanich, D, Stampfer, MJ, Giovannucci, EL, Rimm, EB, Hu, FB, Spiegelman, D, Hunter, DJ, Colditz, GA & Willett, WC (2002) Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76, 12611271.
Mann, JI (2002) Diet and risk of coronary heart disease and type 2 diabetes. Lancet 360, 783789.
Martinez, ME, Marshall, JR & Sechrest, L (1998) Invited commentary: factor analysis and the search for objectivity. Am J Epidemiol 148, 1719.
Martinez-Gonzalez, MA, Fernandez-Jarne, ESerrano-Martinez, MMarti, A, Martinez, JA & Martin-Moreno, JM (2002) Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Nutr 41, 153160.
Osler, M, Heitmann, BL, Gerdes, LU, Jørgensen, LM & Schroll, M (2001) Dietary patterns and mortality in Danish men and women: a prospective observational study. Br J Nutr 85, 219225.
Patterson, RE, Haines, PS & Popkin, BM (1994) Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 94, 5764.
Prevost, AT, Whichelow, MJ & Cox, BD (1997) Longitudinal dietary changes between 1984–5 and 1991–2 in British adults: association with socio-demographic, lifestyle and health factors. Br J Nutr 78, 873888.
Riboli, E, Hunt, KJ, Slimani, N, et al. (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Pubc Health Nutr 5, 11131124.
SAS Institute Inc (1999) SAS/STAT User's Guide, Version 8. Cary, NC: SAS Institute, Inc.
Schroll, K, Carbajal, A, Decarli, B, Martins, I, Grunenberger, F, Blauw, YH & de Groot, CP (1996) Food patterns of elderly Europeans. SENECA Investigators. Eur J Clin Nutr 50, Suppl. 2, S86S100.
Schulze, MB, Hoffmann, K, Kroke, A & Boeing, H (2001) Dietary patterns and their association with food and nutrient intake in the Prospective Investigation into Cancer and Nutrition (EPIC)-Postdam Study. Br J Nutr 85, 363373.
Sieri, S, Krogh, V, Pala, V, Muti, P, Micheli, A, Evangelista, A, Tagliabue, G & Berrino, F (2004) Dietary patterns and risk of breast cancer in the ORDET cohort. Cancer Epidemiol Biomarkers Prev 13, 567572.
Slattery, ML, Boucher, KM, Caan, BJ, Potter, JD & Ma, KN (1998) Eating patterns and risk of colon cancer. Am J Epidemiol 148, 416.
Slimani, N, Fahey, M, Welch, AA, et al. (2002) Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Publ Health Nutr 5, 13111328.
Slimani, N, Kaaks, R, Ferrari, P, et al. (2002) European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Publ Health Nutr 5, 11251145.
Srinath, Reddy K & Katan, MB (2004) Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Pubc Health Nutr 7, 167186.
Stata Corporation (1999) Intercooled Stata 6.0 for Windows 98/95/NT. Texas: Stata Corporation.
Terry, P, Hu, FB, Hansen, H & Wolk, A (2001) Prospective study of major dietary patterns and colorectal cancer risk in women. Am J Epidemiol 154, 11431149.
Trichopoulos, D & Lagiou, P (2001) Dietary patterns and mortality. Br J Nutr 85, 133134.
Trichopoulou, A, Costacou, T, Bamia, C & Trichopoulos, D (2003) Adherence to Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.
Trichopoulou, A, Kouris-Blazos, A, Wahlqvist, ML, Gnardellis, C, Lagiou, P, Polychronopoulos, E, Vassilakou, T, Lipworth, L & Trichopoulas, D (1995) Diet and overall survival in elderly people. BMJ 311, 14571460.
Tucker, KL, Dallal, GE & Rush, D (1992) Dietary patterns of elderly Boston-area residents defined by cluster analysis. J Am Diet Assoc 92, 14871491.
Willett, WC (1998) Diet and coronary heart disease Nutritional Epidemiology 2nd ed., pp. 414466 [Willett, WC, editor]. New York: Oxford University Press.



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