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Mediterranean Lifestyle Linked to Lower Death Risk Across Income Levels

A large European cohort study finds that healthy eating, movement, rest and social habits track with lower death risk no matter your paycheck or diploma.

By Dr. Axe Editorial Team · October 19, 2026 · 1 source · Watch

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A study published October 9, 2026 in The American Journal of Clinical Nutrition found that adults with the highest adherence to a Mediterranean lifestyle pattern had a 30% lower risk of death from any cause compared with those who adhered the least.

105,812adults tracked

13.25-yearfollow-up

30%lower risk, top group

Researchers analyzed data from 105,812 adults in the Lifelines cohort, recruited between 2006 and 2013 and followed until 2025, a median of 13.25 years. Using a 23-item MEDLIFE index covering food choices, dietary habits, physical activity, rest and social habits, they tracked 3,976 deaths. After adjusting for general, lifestyle and clinical risk factors, people in the highest adherence quartile had a hazard ratio of 0.70 compared with the lowest quartile, meaning a 30% lower risk of death from any cause. When adherence was combined with socioeconomic status, the highest-adherence, highest-income group had a hazard ratio of 0.54, a 46% lower risk, while the highest-adherence, highest-education group had a hazard ratio of 0.67, a 33% lower risk.

The researchers describe an inverse dose-response relationship, meaning the more lifestyle items a person followed, the lower their death risk was, in a steady gradient rather than an all-or-nothing effect. They also report that a poor lifestyle was linked to similarly higher mortality whether someone had high or low education, while income changed the size of the association more than education did. The authors conclude that promoting Mediterranean lifestyle habits broadly could help narrow the gap in death rates seen between richer and poorer groups.

Death Risk by Mediterranean Lifestyle Adherence and Socioeconomic Status

American Journal of Clinical Nutrition, 2026, Maroto-Rodriguez

Income and education were self-reported at the start of the study, and lifestyle adherence was scored only at baseline rather than tracked over time. As an observational cohort, this shows a link between lifestyle habits and death risk, not proof that one causes the other.

Dr. Axe’s Take

This is a strong signal that daily habits can offset some of the health disadvantage tied to lower income, and I take that seriously. The lifestyle items here are things anyone can start this week: more vegetables, legumes, olive oil and fish, regular movement, enough sleep, and real social connection instead of isolation. I would focus first on the lowest-cost, highest-leverage pieces: a daily walk, home-cooked meals built around vegetables and legumes, and protecting sleep, since the data suggest the benefit scales with how many of these habits you stack.

— Dr. Axe

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Study summary

Who: 105,812 adults in the Lifelines cohort, recruited 2006-2013
Design: Prospective cohort study, median follow-up 13.25 years, 3,976 deaths recorded
Dose: 23-item MEDLIFE lifestyle index scored at baseline (diet, activity, rest, social habits)
Primary result: Highest vs lowest adherence quartile: hazard ratio 0.70, a 30% lower risk of death from any cause
Secondary: Highest adherence plus highest income: hazard ratio 0.54 (46% lower risk); highest adherence plus highest education: hazard ratio 0.67 (33% lower risk)
Funding / conflicts: Funders listed in the journal record: European Social Fund Plus; State Agency of Research; Autonomous University of Madrid; Universitair Medisch Centrum Groningen; Ministerie van Volksgezondheid, Welzijn en Sport; Carlos III Health Institute; Ministerie van Economische Zaken; Rijksuniversiteit Groningen. Conflict statement in the PubMed record: Authors declare that they have no competing interests.
Date: Oct 9, 2026