Multiple healthy eating patterns reduce mortality risk

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 T.H. Chan School of Public Health, and colleagues wrote in JAMA Internal Medicine.

“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 Hu, MD, PhD, MPH, Fredrick J. Stare Professor of Nutrition and Epidemiology, chair of the department of nutrition at Harvard T.H. 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:

• Healthy Eating Index 2015 (HEI-2015), which measures adherence to DGA;
• Alternate Healthy Eating Index (AHEI), which was developed by Harvard researchers as an alternative to the Healthy Eating Index;
• Alternate Mediterranean Diet (AMED) score, which measures adherence to what has been named the best diet 6 years in a row; and
• Healthful Plant-based Diet Index (HPDI), which measures a plant-based diet rich in whole grains, fruits, vegetables and nuts.

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; and
• 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; and
• 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; and
• 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.”

References:

• Healthy Eating Index. https://www.fns.usda.gov/healthy-eating-index-hei#. Accessed Jan. 10, 2023.
• Scoring highly on Alternative Healthy Eating Index lowers risk for many illnesses. https://www.health.harvard.edu/blog/scoring-highly-on-alternative-healthy-eating-index-lowers-risk-for-many-illnesses-202202082681#:~: Accessed Jan. 10, 2023.
• Shan Z, et al. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2022.6117.
• Variety of healthy eating patterns linked with lower risk of premature death. https://www.eurekalert.org/news-releases/975799. Published Jan. 9, 2023. Accessed Jan. 10, 2023.