Multiple healthy eating patterns reduce mortality risk

January 13, 2023

3 min read


Shan reports no disclosures. Please see the study for all other authors’ relevant disclosures.

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A number of healthy eating patterns were linked to a lower mortality risk, supporting the idea that individuals can adapt multiple healthy eating patterns to their preferences, according to experts.

Although Dietary Guidelines for Americans recommend several health eating patterns, few studies have looked at connections between adherence to different dietary patterns and long-term total and cause-specific mortality risk, Zhilei Shan, MD, PhD, a postdoctoral fellow on nutritional epidemiology at Harvard TH Chan School of Public Health, and colleagues wrote in JAMA Internal Medicine.

Data derived from: Shan Z, et al. JAMA Internal Med. 2023;doi:10.1001/jamainternmed.2022.6117.

“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,” Frank HuMD, PhD, MPH, Fredrick J. Stare Professor of Nutrition and Epidemiology, chair of the department of nutrition at Harvard TH Chan School of Public Health and corresponding author, said in a press release.

The researchers assessed data from 75,230 women participating in the Nurses’ Health Study and 44,085 men in the Health Professionals Follow-up Study. The studies collected data up to 36 years. None of the participants had CVD, cancer or diabetes at baseline. They completed dietary questionnaires every 4 years and were then scored based on their adherence to each of the four dietary pattern indexes:

The researchers found that 31,263 women and 22,900 men died during follow up. The multivariable-adjusted HRs of total mortality were 0.86 (95% CI, 0.83-0.89) for HPDI; 0.82 (95% CI, 0.79-0.84) for AMED; 0.81 (95% CI, 0.79-0.84) for HEI-2015; and 0.8 (95% CI, 0.77-0.82) for AHEI.

“The reason for the similarity in the associations between the diet quality scores and mortality is probably that these dietary patterns share several components, such as whole grains, fruits, vegetables, nuts and legumes,” Shan, Hu and colleagues wrote. “However, there are also some distinct components for each dietary score; for example, the AMED score encourages fish intake, but the HPDI discourages all animal foods.”

Along with the “significant dose-dependent inverse association between adherence to various dietary patterns and total mortality after adjusting for potential confounders,” the researchers found inverse associations for mortality from cancer, CVD and respiratory diseases, with consistent results regardless of racial and ethnic groups and other subgroups.

Specifically, the HRs for mortality from cancer were:

  • 0.93 (95% CI, 0.9-0.96) for AMED;
  • 0.9 (95% CI, 0.86-0.95) for HPDI;
  • 0.84 (95% CI, 0.81-0.88) for AHEI; other
  • 0.82 (95% CI, 0.78-0.86) for HEI-2015.

For CVD, the HRs for mortality were:

  • 0.94 (95% CI, 0.91-0.97) for AMED;
  • 0.94 (95% CI, 0.89-0.99) for HPDI;
  • 0.88 (95% CI, 0.84-0.92) for AHEI; other
  • 0.87 (95% CI, 0.83-0.92) for HEI-2015.

For respiratory disease, the HRs for mortality were:

  • 0.65 (95% CI, 0.61-0.69) for AMED;
  • 0.63 (95% CI, 0.58-0.7) for HPDI;
  • 0.56 (95% CI, 0.52-0.61) for AHEI; other
  • 0.54 (95% CI, 0.49-0.59) for HEI-2015.

Notably, two scores — AMED and AHEI — were also inversely associated with neurodegenerative disease mortality, “which may suggest benefits of some unique dietary components in two dietary patterns, such as nuts and monounsaturated fat,” the researchers wrote.

“However, these findings require confirmation in further studies,” they added.

The researchers concluded that “greater adherence to various healthy eating patterns was consistently associated with lower risk of total and cause-specific mortality” — findings that “support the recommendations of Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.”

“It is important to evaluate adherence to DGAs-recommended eating patterns and health outcomes, including mortality, so that timely updates can be made,” Hu said in the release. “Our findings will be valuable for the 2025 to 2030 Dietary Guidelines Advisory Committee, which is being formed to evaluate current evidence surrounding different eating patterns and health outcomes.”


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