Diet is a key component of good health. As scientifically sound evidence has so far often been available only for a limited range of foods, large cohort studies such as the German National Cohort (NAKO) make a crucial contribution to investigating these relationships more precisely.
Dr Paula Stürmer, a researcher at the Institute of Epidemiology at the University of Kiel, is investigating unresolved issues relating to healthy eating in Germany. At the International NAKO Conference on 3 and 4 September 2026 in Munich, she presented her research in a poster presentation (Poster: ‘Associations of major food groups with all-cause mortality in a large sample from the German general population’, Stürmer P et al.) and as a speaker (NAKO Research Session 1: ‘Regional differences in associations of adherence to a Mediterranean and a Nordic diet with all-cause mortality’).
What food is healthy?
For red meat and vegetables, the links between health and life expectancy have been relatively well studied. For dairy products, eggs and white meat, however, the findings are less clear. Furthermore, little is currently known about how individual food groups and regional dietary habits relate to long-term health and life expectancy.
How healthily do people in Germany eat? An analysis of the NAKO Health Study, involving 9,035 participants, examined dietary intake over a five-year period (2014–2019, 2019–2024) and found no noticeable change in dietary patterns, although the consumption of meat, dairy products and alcohol decreased significantly over time (Poster: ‘Habitual dietary intake from baseline to first re-examination – Results from the German National Cohort (NAKO)’, Wawro N et al.).
Nutrition for Longevity
The findings presented in the poster by Paula Stürmer and her team examined the associations between 14 main food groups and all-cause mortality. The NAKO cohort comprised 135,534 participants (follow-up: 7.4 years). The analysis was based on data from food lists, consumption data in grams per day and energy intake from the baseline survey.
A higher intake of fruit, vegetables, nuts and whole grains was associated with a lower risk of death, whilst a higher consumption of eggs, red meat, processed meat products and sugary soft drinks was associated with a reduced life expectancy. No clear associations with survival rates were observed for white flour products and dairy products (both in total and low-fat varieties), fish and white meat.
Nordic or Mediterranean food?
In her presentation, Paula Stürmer presented findings that examined regional differences in mortality risk amongst people who follow a Mediterranean or Nordic diet. The Nordic diet is based on eating habits in Scandinavian countries and includes fruit and vegetables (such as apples, cabbage and root vegetables), rye bread, oat products and fish. The Mediterranean diet involves the regular consumption of fruit and vegetables (such as tomatoes, courgettes and citrus fruits), nuts, pulses and fish, and comparatively low intake of meat and dairy products.
The study involved 135,534 middle-aged NAKO participants, of whom 19,996 were from a northern region of Germany (study centres in Kiel, Hamburg and Bremen) and 29,539 from a southern region (study centres in Regensburg, Freiburg and Augsburg).
The questions Paula Stürmer addressed in her talk were:
- Is there a link between a Mediterranean or Nordic diet and longer survival?
- Are there differences in mortality risks associated with the Mediterranean and Nordic diets in the northern and southern regions of Germany?
The statistical analysis utilised two region-specific dietary patterns/scores: the Modified Mediterranean Diet Score, or MMDS for short (Mediterranean diet), and the Healthy Nordic Food Index, or HNFI for short (Nordic diet). During 7.4 years of follow-up, 2,684 participants died.
The results confirmed the well-established association between the Mediterranean diet and a reduced risk of mortality. What is new is that, contrary to what is described in the specialist literature, the Nordic diet was not clearly associated with overall mortality. MMDS and HNFI data were comparable in both study regions, meaning that the study participants showed similar adherence to both dietary patterns. No evidence of region-specific associations with survival was found, which is also a new finding.
„”A healthy, predominantly plant-based diet is thought to have a positive effect on survival time, regardless of differences in regional dietary habits,” concludes Paula Stürmer.
Autor: Eberhard J. Wormer
Further information
NAKO’s Expert Group on Nutrition
Expert Group Lifestyle, nutrition – German National Cohort (NAKO)
Publications
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Knüppel S, Clemens M, Conrad J et al. Design and characterization of dietary assessment in the German National Cohort. Eur J Clin Nutr 2019;73:1480–1491. https://doi.org/10.1038/s41430-018-0383-8
Kouris-Blazos A, Gnardellis C, Wahlqvist ML et al. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Br J Nutr 1999;82:57–61.
Nucci D, Ragusa FS, Mazza E, Veronese N, Gianfredi V, Volpe M et al. Adherence to the Mediterranean Diet and all-cause mortality: a systematic review and meta-analysis within the Italian National Guidelines “La Dieta Mediterranea”. Nutrition 2026:113189.
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Stürmer P, Ratjen I, Weber KS, Övermöhle C, Liedtke TP, Waniek S et al. Greater adherence to the Healthy Nordic Food Index is associated with lower all-cause mortality in a population-based sample from northern Germany. Eur J Nutr 2024;63(2):365–75.
Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E et al. Diet and overall survival in elderly people. BMJ 1995;311(7018):1457–60.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003;348(26):2599–608.
Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocké MC, Peeters PHM et al. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 2005;330(7498):991.
Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 2014;17(12):2769–82.
Event: International NAKO Conference 2026
Website: www.nako.de/conference
Scientific Board: Dr. Marie-Theres Huemer, Prof. Dr. Wolfgang Lieb, Prof. Dr. Annette Peters, Prof. Dr. Tobias Pischon, Prof. Dr. Tamara Schikowski
Date: 03.09.2026–04.09.2026
Location: Kongresszentrum Helmholtz Munich, Ingolstädter Landstr. 1, D-85764 Neuherberg
Host: Helmholtz Munich
Organization: NAKO e.V.
Contact: conference@nako.de