Mediterranean diet linked to longer survival for cancer survivors, study finds

A long-running Italian study finds that cancer survivors who closely follow a Mediterranean–style diet may live longer than those who do not, according to researchers publishing in the European Heart Journal. The analysis drew on data from 779 Italian adults with a history of cancer who took part in the Moli‑sani Study in southern Italy, and participants were tracked for an average of about 14 years.

At the study’s outset, researchers assessed cardiovascular health using Life’s Simple 7 (LS7), a score developed by the American Heart Association to measure seven modifiable factors: smoking, physical activity, diet, body mass index, blood pressure, total cholesterol and blood glucose. Diet was evaluated using broad healthy‑eating guidelines—such as consuming plenty of fruit and vegetables, choosing high‑fiber foods, including fish and limiting salt and sugary drinks—rather than adherence to any single named diet.

Over the follow‑up period, 269 participants died. Of these, 141 deaths were from cancer, 67 from heart disease and 54 from other causes, including respiratory, cerebrovascular and neurodegenerative conditions. When researchers replaced the general LS7 diet measure with a score reflecting how closely people followed a Mediterranean‑style pattern, the benefits became clearer. Those whose diets most closely resembled a Mediterranean pattern were around 15 to 20 percent less likely to die during the study, depending on the cause.

The Mediterranean diet has previously been associated with lower risks of heart disease and premature death in the general population. This study suggests its benefits may also extend to people living with or beyond cancer. More broadly, the researchers found that overall cardiovascular health, as measured by the full LS7 score, was strongly linked to survival after cancer. Participants with “ideal” cardiovascular health—defined as an LS7 score of 10 to 14—had a 38 percent lower risk of death from any cause compared with those with “poor” cardiovascular health (LS7 score 0 to 6), after accounting for age, sex, cancer type, cancer treatment, prior cardiovascular disease and social factors. The analysis also showed a graded relationship: each one‑point increase in LS7 score was associated with about a 10 percent reduction in cancer mortality.

“Our study shows that a score based on traditional cardiovascular risk factors, already validated in the general population, can also predict better survival in people with a history of cancer,” said Marialaura Bonaccio, the study’s first author and a researcher at the Epidemiology and Prevention Unit of IRCCS Neuromed. The findings support the idea that cancer and cardiovascular disease share common biological pathways—sometimes referred to as the “common soil” hypothesis. To explore this, researchers analyzed blood markers linked to inflammation, heart rate and vitamin D status. Together, these factors explained more than half of the observed association between healthier lifestyles and lower mortality. Low‑grade inflammation alone accounted for nearly one‑fifth of the link between cardiovascular health and overall survival, while resting heart rate explained around 30 percent of the association with both all‑cause and cancer mortality, and vitamin D levels also played a significant role.

The researchers also compared results in cancer survivors with more than 21,000 cancer‑free participants from the same study. The relationship between lifestyle‑related cardiovascular health and mortality was similar in both groups, suggesting the same risk factors matter regardless of cancer history. However, the authors caution that the findings do not prove cause and effect. Lifestyle and cardiovascular health were assessed at the study’s initial visit, an average of 8.4 years after cancer diagnosis, meaning more aggressive disease may not have been represented. Still, the researchers say the results reinforce the importance of diet and other healthy habits— including physical activity, avoiding tobacco and weight control— in the long‑term care of cancer survivors. They add that the findings support more integrated approaches to prevention and follow‑up, linking cancer care and cardiovascular health within the growing field of cardio‑oncology.