Summary: Following at least one of four healthy eating patterns reduces the risk of death as a result of cardiovascular disease, cancer, or respiratory disease.
A variety of healthy eating patterns are linked to reduced risk of premature death, according to a new study led by Harvard TH Chan School of Public Health researchers.
They found that participants who scored high on adherence to at least one of four healthy eating patterns were less likely to die during the study period from any cause and less likely to die from cardiovascular disease, cancer, or respiratory disease, compared with people with lower scores.
The findings are consistent with the current Dietary Guidelines for America, which recommend multiple healthy eating patterns.
“The Dietary Guidelines for Americans are intended to provide science-based dietary advice that promotes good health and reduces major chronic diseases. Thus, it is critical to examine the associations between DGAs-recommended dietary patterns and long-term health outcomes, especially mortality,” said corresponding author Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair of the Department of Nutrition.
The study will be published online January 9, 2023, in JAMA Internal Medicine.
Few studies have evaluated whether greater adherence to the DGAs-recommended dietary patterns is associated with long-term risk of total and cause-specific mortality. The researchers used health data collected over 36 years from 75,230 women participating in the Nurses’ Health Study and 44,085 men in the Health Professionals Follow-up Study.
All participants were free of cardiovascular disease or cancer at the beginning of the study and completed dietary questionnaires every four years. Their information was scored based on each of the four dietary pattern indexes (Healthy Eating Index 2015, Alternate Mediterranean Diet, Healthy Plant-based Diet Index, and Alternate Healthy Eating Index).
All share key components including whole grains, fruits, vegetables, nuts, and legumes, although other components differ across different eating patterns.
A higher score on at least one of the indexes was associated with lower risk of premature death from all causes, and from cardiovascular disease, cancer, and respiratory disease. Higher scores on the AMED and the AHEI were associated with lower risk of death from neurogenerative disease. The results were consistent for non-Hispanic white, non-Hispanic Black, and Hispanic people.
The current DGAs (2015–2020) recommend multiple healthy eating patterns that can be adapted to individual food traditions and preferences. An updated version of the Guidelines is released every five years by the US Departments of Health and Human Services (HHS) and Agriculture (USDA).
“It is important to evaluate adherence to DGAs-recommended eating patterns and health outcomes, including mortality, so that timely updates can be made,” said Hu. “Our findings will be valuable for the 2025-2030 Dietary Guidelines Advisory Committee, which is being formed to evaluate current evidence surrounding different eating patterns and health outcomes.”
Other Harvard Chan School co-authors of the study included Zhilei Shan, Fenglei Wang, Yanping Li, Megu Baden, Shilpa Bhupathiraju, Dong Wang, Qi Sun, Eric Rimm, Lu Qi, Fred Tabung, Edward Giovannucci, Walter Willett, JoAnn Manson, and Qibin Qi.
Funding: Funding for the study came from grant R01HL060712 from the NHLBI. The Nurses’ Health Studies and Health Professional Follow-up Studies are supported by the grants UM1 CA186107, P01 CA87969, R01 CA49449, R01 HL034594, R01 HL088521, U01 CA176726, R01 CA67262, U01 CA167552, R01 HL35464, and U06 H14538 . Q. Qi is supported by grants K01HL129892 and R01 HL140976 from the NHLBI and grant R01 DK119268 and R01 DK120870 from the National Institute of Diabetes and Digestive and Kidney Diseases. F. Wang is supported by postdoctoral fellowship grant 897161 from the American Heart Association.
About this diet and mortality research news
Author: Todd Datz
Contact: Todd Datz-Harvard
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“Healthy Eating Patterns and Risk of Total and Cause-Specific Mortality”by Zhilei Shan et al. JAMA Internal Medicine
Healthy Eating Patterns and Risk of Total and Cause-Specific Mortality
The current Dietary Guidelines for Americans recommend multiple healthy eating patterns. However, few studies have examined the associations of adherence to different dietary patterns with long-term risk of total and cause-specific mortality.
To examine the associations of dietary scores for 4 healthy eating patterns with risk of total and cause-specific mortality.
Design, Setting, and Participants
This prospective cohort study included initially healthy women from the Nurses’ Health Study (NHS; 1984-2020) and men from the Health Professionals Follow-up Study (HPFS; 1986-2020).
Healthy Eating Index 2015 (HEI-2015), Alternate Mediterranean Diet (AMED) score, Healthful Plant-based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI).
Main Outcomes and Measures
The main outcomes were total and cause-specific mortality overall and stratified by race and ethnicity and other potential risk factors.
The final study sample included 75,230 women from the NHS (mean [SD] baseline age, 50.2 [7.2] years) and 44,085 men from the HPFS (mean [SD] baseline age, 53.3 [9.6] years). During a total of 3,559,056 person-years of follow-up, 31,263 women and 22,900 men died. When comparing the highest with the lowest quintiles, the pooled multivariable-adjusted HRs of total mortality were 0.81 (95% CI, 0.79-0.84) for HEI-2015, 0.82 (95% CI, 0.79-0.84) for AMED score, 0.86 ( 95% CI, 0.83-0.89) for HPDI, and 0.80 (95% CI, 0.77-0.82) for AHEI (P< .001 for trend for all). All dietary scores were significantly inversely associated with death from cardiovascular disease, cancer, and respiratory disease. The AMED score and AHEI were inversely associated with mortality from neurodegenerative disease. The inverse associations between these scores and risk of mortality were consistent in different racial and ethnic groups, including Hispanic, non-Hispanic Black, and non-Hispanic White individuals.
Conclusions and Relevance
In this cohort study of 2 large prospective cohorts with up to 36 years of follow-up, greater adherence to various healthy eating patterns was consistently associated with lower risk of total and cause-specific mortality. These findings support the recommendations of Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.