Abstract
BACKGROUND Olive oil consumption has been shown to lower cardiovascular disease risk, but its associations with total and cause-specific mortality are unclear. OBJECTIVES The purpose of this study was to evaluate whether olive oil intake is associated with total and cause-specific mortality in 2 prospective cohorts of U.S. men and women. METHODS The authors used multivariable-adjusted Cox proportional-hazards models to estimate HRs for total and cause-specific mortality among 60,582 women (Nurses’ Health Study, 1990-2018) and 31,801 men (Health Professionals Follow-up Study, 1990-2018) who were free of cardiovascular disease or cancer at baseline. Diet was assessed by a semiquantitative food frequency questionnaire every 4 years. RESULTS During 28 years of follow-up, 36,856 deaths occurred. The multivariable-adjusted pooled HR for all-cause mortality among participants who had the highest consumption of olive oil (>0.5 tablespoon/day or >7 g/d) was 0.81 (95% CI: 0.78-0.84) compared with those who never or rarely consumed olive oil. Higher olive oil intake was associated with 19% lower risk of cardiovascular disease mortality (HR: 0.81; 95% CI: 0.75-0.87), 17% lower risk of cancer mortality (HR: 0.83; 95% CI: 0.78-0.89), 29% lower risk of neurodegenerative disease mortality (HR: 0.71; 95% CI: 0.64-0.78), and 18% lower risk of respiratory disease mortality (HR: 0.82; 95% CI: 0.72-0.93). In substitution analyses, replacing 10 g/d of margarine, butter, mayonnaise, and dairy fat with the equivalent amount of olive oil was associated with 8%-34% lower risk of total and cause-specific mortality. No significant associations were observed when olive oil was compared with other vegetable oils combined. CONCLUSIONS Higher olive oil intake was associated with lower risk of total and cause-specific mortality. Replacing margarine, butter, mayonnaise, and dairy fat with olive oil was associated with lower risk of mortality. (J Am Coll Cardiol 2022;79:101-112) © 2022 by the American College of Cardiology Foundation.
Generated Summary
This study investigates the association between olive oil consumption and the risk of total and cause-specific mortality in a cohort of U.S. adults. The research employed a prospective cohort study design, analyzing data from 60,582 women (Nurses’ Health Study, 1990-2018) and 31,801 men (Health Professionals Follow-up Study, 1990-2018). Participants were free of cardiovascular disease or cancer at baseline. Dietary information was collected through a semiquantitative food frequency questionnaire administered every 4 years. The primary analysis utilized multivariable-adjusted Cox proportional-hazards models to estimate hazard ratios (HRs) for total and cause-specific mortality. Statistical substitution models were also used to assess the impact of replacing other fats with olive oil. The study aimed to clarify the relationship between olive oil intake and mortality outcomes, given the existing knowledge of its cardiovascular benefits and the limited research on its effects on overall and cause-specific mortality within a U.S. population.
Key Findings & Statistics
- During the 28-year follow-up period, 36,856 deaths were recorded among the participants.
- The multivariable-adjusted pooled HR for all-cause mortality among participants with the highest olive oil consumption (>0.5 tablespoon/day or >7 g/d) was 0.81 (95% CI: 0.78-0.84) compared to those who rarely or never consumed olive oil.
- Higher olive oil intake was associated with:
- 19% lower risk of cardiovascular disease mortality (HR: 0.81; 95% CI: 0.75-0.87).
- 17% lower risk of cancer mortality (HR: 0.83; 95% CI: 0.78-0.89).
- 29% lower risk of neurodegenerative disease mortality (HR: 0.71; 95% CI: 0.64-0.78).
- 18% lower risk of respiratory disease mortality (HR: 0.82; 95% CI: 0.72-0.93).
- Replacing 10 g/d of margarine, butter, mayonnaise, and dairy fat with an equivalent amount of olive oil was associated with:
- 8%-34% lower risk of total and cause-specific mortality.
- Mean consumption of olive oil increased from 1.6 g/d in 1990 to about 4 g/d in 2010, whereas margarine consumption decreased from around 12 g/d in 1990 to ~4 g/d in 2010.
- Participants in the highest olive oil consumption category (>7 g/d) had a 19% lower risk of total and CVD mortality, a 17% lower risk of cancer mortality, a 29% lower risk of neurodegenerative mortality, and an 18% lower risk of respiratory mortality.
Other Important Findings
- Higher olive oil intake was associated with lower risk of total and cause-specific mortality.
- Replacing margarine, butter, mayonnaise, and dairy fat with olive oil was associated with lower risk of mortality.
- No significant associations were observed when olive oil was compared with other vegetable oils combined.
- Compared with those who never or rarely consumed olive oil, those in the highest category of olive oil consumption (>7 g/d) had:
- 19% lower risk of total and cardiovascular disease mortality.
- 17% lower risk of cancer mortality.
- 29% lower risk of neurodegenerative mortality.
- 18% lower risk of respiratory mortality.
- Substituting 10 g/d of other fats, including margarine, butter, mayonnaise, and dairy fat, with olive oil was associated with reductions in the risk of total and cause-specific mortality.
- Participants reporting Southern European and/or Mediterranean ancestry had a 6% lower risk of total mortality.
Limitations Noted in the Document
- The study is observational, so residual confounding cannot be entirely ruled out, despite adjustments for various factors.
- Dietary assessment relied on self-reported FFQs, which are subject to measurement errors.
- The study population primarily consisted of non-Hispanic White health professionals, which may limit the generalizability of the findings.
- The study could not distinguish between different varieties of olive oil with varying amounts of polyphenols.
- The research relied on self-reported data, potentially introducing inaccuracies.
- The observational nature of the study prevents establishing a causal relationship definitively.
- The study population’s demographic characteristics, primarily health professionals, may not fully represent the broader U.S. population.
Conclusion
The study’s findings indicate that higher olive oil consumption is associated with a lower risk of total and cause-specific mortality. Replacing other fats, such as margarine, butter, mayonnaise, and dairy fat, with olive oil also demonstrates a reduced mortality risk. These results support current dietary recommendations to increase the intake of olive oil, aligning with broader efforts to improve overall health and longevity. The data underscore the importance of olive oil as a dietary component in promoting health and reducing mortality risks in the U.S. adult population. Further research is needed to explore the underlying mechanisms behind these associations and to understand the optimal levels of olive oil intake for different populations. The study reinforces the benefits of incorporating olive oil into the diet. The substitution of olive oil for other fats was associated with a reduced risk of mortality across various causes. The results contribute to the evidence supporting dietary guidelines that recommend the use of olive oil over other fats. The study’s findings contribute to the existing body of evidence supporting the health benefits of olive oil consumption, particularly in relation to cardiovascular health. These findings underscore the importance of dietary choices in promoting overall health and reducing the risk of mortality. The study’s results are in line with the growing understanding of the health benefits associated with olive oil, particularly its role in reducing the risk of chronic diseases. The research emphasizes the significance of dietary choices, such as incorporating olive oil and replacing less healthy fats, in promoting longevity and improving health outcomes. The study provides valuable insights into the relationship between diet and mortality, suggesting that adopting dietary patterns that emphasize olive oil can contribute to better health outcomes. The findings have implications for public health recommendations, highlighting the need for continued efforts to promote healthy dietary choices. The data supports recommendations to replace animal fats with unsaturated plant oils such as olive oil. The study’s findings further strengthen the argument for the adoption of dietary patterns that prioritize olive oil consumption, contributing to improved health and longevity.