Mediterranean diet and physical activity decrease the initiation of medication use for chronic non-cardiovascular diseases in older adults: A cohort study

Background and objectives: We aim to assess whether long-term adherence to Mediterranean diet (MedDiet) and leisure-time physical activity (LTPA) were linked to less initiation of chronic, non-cardiovascular medications. Methods: We assessed the relationship between the cumulative average of MedDiet adherence and LTPA and initiation of the 20 most prescribed chronic, non-cardiovascular medication families in older adults (PREvención con DIeta MEDiterránea trial; sample size: 5,940 [anxiolytics]-6,989 [folate supplements]). Associations per each one-point increase in the MedDiet adherence score and 100 metabolic equivalents of task-minute/day (METs-min/day) of LTPA were studied by multivariable Cox regressions (multiple comparisons: False Discovery Rate 5%). We explored non-linear exposure-outcome associations if models using restricted cubic splines fitted the data better than linear terms. We finally evaluated whether MedDiet and LTPA were synergistically linked to lower drug initiation by applying likelihood ratio tests to Cox models with/without the interaction product-term "MedDiet adherence x LTPA". Results: One-point increases in MedDiet adherence were related to less initiation of: antidepressants (hazard ratio [HR] 0.72, [95% confidence interval 0.67-0.77]), anxiolytics (HR 0.74 [0.69-0.80]), antipsychotics (HR 0.76 [0.64-0.89]), anticonvulsants (HR 0.77 [0.69-0.85]), antiparkinsonian drugs (HR 0.72 [0.59-0.89]), anti-dementia drugs (HR 0.78 [0.67-0.92]), benign prostatic hyperplasia drugs (HR 0.82 [0.75-0.90]), anti-gout drugs (HR 0.80 [0.71-0.89]), hypothyroidism medication (HR 0.77 [0.67-0.89]), laxatives (HR 0.85 [0.75-0.97]), bronchodilators (HR 0.82 [0.74-0.90]), corticosteroids (HR 0.80 [0.73-0.88]), opioids (HR 0.86 [0.77-0.95]), folate supplements (HR 0.69 [0.56-0.85]), iron supplements (HR 0.76 [0.67-0.87]), calcium supplements (HR 0.88 [0.81-0.96]), vitamin D supplements (HR 0.90 [0.83-0.98]), bisphosphonates (HR 0.85 [0.77-0.93]), and cartilage medications (HR 0.86 [0.77-0.95]). LTPA was linearly associated (per +100 METs-min/day) with less initiation of anticonvulsants (HR 0.83 [0.73-0.94]), benign prostatic hyperplasia drugs (HR 0.91 [0.85-0.98]) and bronchodilators (HR 0.80 [0.72-0.89]), and non-linearly linked to less initiation of antidepressants, anxiolytics, anti-dementia drugs, anti-gout drugs, hypothyroidism medication, laxatives, corticosteroids, opioids, iron, calcium and vitamin D supplements, and cartilage medications (mini