Introduction Within Europe large difference exist in all-cause mortality with high rates in Eastern Europe and low rates in Western Europe. 1 In men aged 45-74 there is a more than twofold difference in all-cause mortality between men in Iceland and the Ukraine. From a public health point of view it is important to know what the determinants of these population differences in all-cause mortality are. This question could be addressed by using data of the Seven Countries Study. In this study that

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... started in 1958, 13 European cohorts were enrolled, one from the US and two from Japan. Associations between nutrient intake, cigarette smoking and alcohol intake were investigated at the population level because only nutrient and alcohol intake data representing the average intake of each cohort were available. Earlier reports on the results of the Seven Countries Study addressed the associations between nutrient intake and major diet-related chronic diseases e.g. coronary heart disease, colon cancer and stomach cancer. The population intake of saturated fat was positively associated with population coronary heart disease mortality rates. 2 Flavonoids, powerful dietary antioxidants, present in tea, onions, apples and red wine, were protective against coronary heart disease at the population level. 3 Population colorectal cancer rates were inversely related with dietary fibre 4 and population stomach cancer rates with vitamin C intake. 5 These diet-related diseases are major causes of death in developed countries. Therefore it may be hypothesized that dietary determinants of these diseases are also major determinants of all-cause mortality. In addition the effect of other important lifestyle-related determinants of population all-cause for the Seven Countries Study Group Background The Seven Countries Study has shown that population mortality rates for various chronic diseases are related to diet and smoking. This paper addresses the associations between diet, smoking and 25-year all-cause mortality. Methods Baseline surveys were carried out between 1958 and 1964 on 12 763 middleaged men constituting 16 cohorts in seven countries. In 1987/88 equivalent food composites representing the average food intake of each cohort at baseline were collected and chemically analysed in one central laboratory. During 25 years of follow-up 5973 men died and age-adjusted population mortality rates were calculated for each cohort. Results Multivariate linear regression analyses showed that the population intake of saturated fat and the prevalence of smoking were positively associated with population all-cause mortality rates. Population vitamin C intake was inversely associated with all-cause mortality. It was calculated that a reduction in saturated fat intake of 5% of energy, a 20 mg/d increase in vitamin C and a 10% decrease in the prevalence of smokers may decrease the 25-year all-cause population mortality rate by 12.4% (95% CI : 5.6, 19.4%) at an average population all-cause mortality rate of 45%. Conclusion At the population level saturated fat, vitamin C and cigarette smoking are important determinants of all-cause mortality.