ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1607522
This article is part of the Research TopicMultidimensional Benefits of the Mediterranean Diet Across the Lifespan and CulturesView all 6 articles
Adherence to the Mediterranean Diet and Mortality in Cancer Survivors: A Nationwide Study with Mediation and Subgroup Analyses
Provisionally accepted
- National Cancer Center of China, Beijing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Mediterranean diet adherence is linked to improved health outcomes, yet evidence among cancer survivors remains limited. This study investigated the association between MDS adherence and all-cause mortality in cancer survivors. Methods: We analyzed data from 2,669 cancer survivors participating in the National Health and Nutrition Examination Survey (2005 -2018). Dietary adherence was assessed using the Mediterranean Diet Score (MDS) based on two-day dietary recalls. Multivariable Cox regression, mediation, subgroup, and sensitivity analyses were conducted. Results: Higher MDS adherence was significantly associated with reduced all-cause mortality (HR = 0.845, 95% CI: 0.779-0.917, P < 0.001), with a linear dose-response trend. Mediation analysis showed that red blood cell distribution width and neutrophils explained 18.5% and 7.8% of the association, respectively. Subgroup analyses revealed stronger protective effects in females, older adults, individuals with lower BMI or higher socioeconomic status, smokers, drinkers, and survivors of digestive, urinary, and skin cancers. Sensitivity analyses confirmed the robustness of the findings. Conclusions: Greater adherence to the Mediterranean diet is associated with lower all-cause mortality in cancer survivors, partly mediated by inflammatory biomarkers. Integrating Mediterranean dietary counseling into survivorship care may help improve long-term outcomes.
Keywords: mediterranean diet, cancer survivors, All-cause mortality, NHANES, Cox regression, Mediation analysis
Received: 07 Apr 2025; Accepted: 22 Aug 2025.
Copyright: © 2025 Zha, Dou, Zhang, He and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bowen Zha, National Cancer Center of China, Beijing, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.