Anatomy of the Mediterranean Diet and Mortality Among Older Women with Frailty

Oleg Zaslavsky, Shira Zelber-Sagi, James M. Shikany, Tonya Orchard, Robert Wallace, Linda Snetselaar, Lesley Tinker

Research output: Contribution to journalArticlepeer-review


We examined individual components of the Mediterranean Diet (Med) and evaluated their relative contribution to mortality rates in older women with frailty. A sample (N = 10,431) included Women’s Health Initiative Observational Study participants aged 65-84 y with complete frailty diagnostic criteria and dietary data. Frailty was assessed with modified Fried’s criteria, and dietary data were collected through food frequency questionnaire. Over a mean follow-up of 12.4 y (range 3–21.0), 3,259 (31.2%) deaths occurred. Crude death rates demonstrated a decrease in mortality with higher intake of individual Med components. However, in the mutually adjusted models, most Med components on their own were not significantly associated with mortality. Exceptions were vegetables, nuts, and whole grains. A higher intake of vegetables, nuts, and whole grains were associated with a significantly decreased hazard of mortality, by 9% (P = 0.02), 13% (P < 0.001), and 17% (P < 0.001), respectively. The relative contribution of these components to diet mortality associations were 21%, 42%, and 57% for vegetables, nuts, and whole grains, respectively. Subgroup analyses by chronic morbidity, smoking status, or excluding women with early death did not substantially change these results.

Original languageEnglish
Pages (from-to)269-281
Number of pages13
JournalJournal of Nutrition in Gerontology and Geriatrics
Issue number3-4
StatePublished - 2 Oct 2018

Bibliographical note

Funding Information:
The WHI program is funded by the National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through Contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600002C, and HHSN268201600004C.

Publisher Copyright:
© 2018, © 2018 Taylor & Francis.


  • Dietary pattern
  • longitudinal
  • nutrition
  • population
  • women’s health initiative

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Geriatrics and Gerontology


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