Lassale, CamilleHernaez, AlvaroToledo, EstefaníaCastaner, OlgaSorli, Jose VSalas-Salvado, JordiEstruch, RamonRos, EmilioAlonso-Gomez, Angel MLapetra, JoseCueto, RaquelFiol Sala, MiquelSerra-Majem, LluisPinto, XavierGea, AlfredoCorella, DoloresBabio, NancyFito, MontserratSchroder, Helmut2024-09-182024-09-182021-05Lassale C, Hernaez A, Toledo E, Castaner O, Sorli JV, Salas-Salvado J, et al. Energy Balance and Risk of Mortality in Spanish Older Adults. Nutrients. 2021 May;13(5):1545.https://hdl.handle.net/20.500.13003/19572https://hdl.handle.net/20.500.12105/23261Clinical data on the direct health effects of energy deficit or surplus beyond its impact on body weight are scarce. We aimed to assess the association with all-cause, cardiovascular and cancer mortality of (1) sustained energy deficit or surplus, calculated according to each individual's en-ergy intake (EI) and theoretical energy expenditure (TEE), and (2) mid-term change in total EI in a prospective study. In 7119 participants in the PREDIMED Study (PREvencion con DIeta MEDi-terranea) with a mean age of 67 years, energy intake was derived from a 137-item food frequency questionnaire. TEE was calculated as a function of age, sex, height, body weight and physical ac-tivity. The main exposure was the proportion of energy requirement covered by energy intake, cumulative throughout the follow-up. The secondary exposure was the change in energy intake from baseline. Cox proportional hazard models were used to estimate hazard ratios and 95% con-fidence intervals for all-cause, cardiovascular and cancer mortality. Over a median follow-up of 4.8 years, there were 239 deaths (excluding the first 2 years). An energy intake exceeding energy needs was associated with an increase in mortality risk (continuous HR10% over energy needs = 1.10; 95% CI 1.02, 1.18), driven by cardiovascular death (HR = 1.26; 95% CI 1.11, 1.43). However, consum-ing energy below estimated needs was not associated with a lower risk. Increments over time in energy intake were associated with greater all-cause mortality (HR10% increase = 1.09; 95% CI 1.02, 1.17). However, there was no evidence that a substantial negative change in energy intake would reduce mortality risk. To conclude, in an older Mediterranean cohort, energy surplus or increase over a 5-year period was associated with greater risk of mortality, particularly cardiovascular mortality. Energy deficit, or reduction in energy intake over time were not associated with mortal-ity risk.enghttp://creativecommons.org/licenses/by/4.0/Energy balanceMortalityEpidemiologyCardiovascular DiseasesAgedEnergy IntakeEnergy MetabolismSpainHumansCause of DeathDiet SurveysNeoplasmsDietMaleProspective StudiesFemaleProportional Hazards Modelsresearch articleAttribution 4.0 International34064328135154510.3390/nu130515452072-6643Nutrientsopen accessModelos de Riesgos ProporcionalesFemeninoDietaMasculinoEncuestas sobre DietasMetabolismo EnergéticoHumanosNeoplasiasIngestión de EnergíaEstudios ProspectivosCausas de MuerteAncianoEnfermedades CardiovascularesEspaña2-s2.0-85105181586662344000001L2007083975