Healthy Eating Linked to Lower Risk of Total Mortality

Adhering to healthy eating patterns was associated with lower risk of total and cause-specific mortality, a prospective cohort study with up to 36 years of follow-up showed.

Among 75,230 women from the Nurses’ Health Study and 44,085 men from the Health Professionals Follow-up Study, those who scored in the highest quintile for healthy eating patterns recommended by the Dietary Guidelines for Americans (DGAs) had a 14% to 20% lower risk of total mortality versus those in the lowest quintile, reported Frank Hu, MD, PhD, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues in JAMA Internal Medicine.

The pooled multivariable-adjusted hazard ratios of total mortality with four healthy eating patterns were (P<0.001 for trend for all):

• Healthy Eating Index 2015 (HEI-2015): HR 0.81 (95% CI 0.79-0.84)
• Alternate Mediterranean Diet (AMED): HR 0.82 (95% CI 0.79-0.84)
• Healthful Plant-Based Diet Index (HPDI): HR 0.86 (95% CI 0.83-0.89)
• Alternate Healthy Eating Index (AHEI): HR 0.80 (95% CI 0.77-0.82)

This lower risk was consistent across all racial and ethnic groups.

“This is one of the largest and longest-running studies that examine the associations of dietary scores for four healthy eating patterns recommended by the DGAs with the risk of total and cause-specific mortality in large cohort studies,” Hu told MedPage Today.

“Every 5 years, the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) release an updated version of the Dietary Guidelines for Americans,” he explained. “It is important to evaluate adherence to DGA-recommended eating patterns and health outcomes, especially mortality, so that timely updating of DGAs can be made.”

Hu noted that these findings will be valuable for the 2025-2030 Dietary Guidelines Advisory Committee, which is being created by the USDA and HHS to evaluate the current evidence on different eating patterns and health outcomes.

Beyond total mortality, healthier diets were also significantly linked to lower risk of cause-specific mortality.

Across the four different dietary patterns, people in the highest quintile saw a 6% to 13% lower risk of death from cardiovascular disease versus those in the lowest quintile. Likewise, those in the highest quintile saw a 6% to 15% lower risk of death due to heart disease, a 7% to 18% lower risk of cancer-related death, and a 35% to 46% lower risk of respiratory disease-related death.

In addition, those with the highest scores on the AMED and AHEI also saw a modestly lower risk of death due to neurodegenerative disease (HR 0.94, 95% CI 0.90-0.99 and HR 0.93, 95% CI 0.87-0.99, respectively).

“Although previous studies have found an inverse association between healthy eating patterns and mortality, our study provides evidence that healthy eating patterns reduce the risk of cause-specific mortality including cardiovascular disease, cancer, respiratory, and neurodegenerative mortality,” said Hu. “The findings on respiratory and neurodegenerative mortality are novel.”

However, eating a healthy diet according to any of the four patterns did not appear to be protective against stroke-related deaths.

Hu said clinicians can recommend a “variety of healthy dietary patterns” to patients in order to reduce their risk for chronic diseases and premature death.

“These patterns such as the Mediterranean diet, DASH diet, vegetarian diet, or other versions of healthy diets can be adapted to meet individual health needs, food preferences, and cultural traditions,” he noted. “These healthy dietary patterns typically include high amounts of plant foods such as fruits, vegetables, whole grains, nuts, and legumes, and lower amounts of refined grains, added sugars, sodium, and red and processed meats.”

“It is also important to balance caloric intake with physical activity to maintain a healthy weight,” he added.

Among the women included in the analysis, mean baseline age was 50.2 and 98% were white; for men, mean age was 53.3 and 91% were white. In total, 31,263 women and 22,900 men died during follow-up. The leading cause of death was cancer, followed by cardiovascular disease, heart disease, neurodegenerative disease, respiratory disease, and stroke.

Dietary data were taken from semiquantitative food frequency questionnaires including more than 130 items, which were completed every 2 to 4 years.