OBJECTIVE:To assess the influence of a specific dietary pattern on overall survival. DESIGN:Cohort study. SETTING:Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life. SUBJECTS:182 elderly residents of the three villages. MAIN OUTCOME MEASURE:Overall mortality. RESULTS:Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%). CONCLUSION:A diet meeting currently understood health criteria does predict survival among people.