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Healthy Eating Patterns And Risk Of Total And Cause-specific Mortality

Abstract

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. 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). 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. 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.

Generated Summary

This prospective cohort study, published in JAMA Internal Medicine, investigated the associations between adherence to different dietary patterns and the long-term risk of total and cause-specific mortality. The study utilized data from the Nurses’ Health Study (NHS; 1984-2020) and the Health Professionals Follow-up Study (HPFS; 1986-2020). The research aimed to examine the associations of dietary scores for four healthy eating patterns—the Healthy Eating Index 2015 (HEI-2015), Alternate Mediterranean Diet (AMED) score, Healthful Plant-based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI)—with total and cause-specific mortality, overall and stratified by race and ethnicity and other potential risk factors. The study followed participants for up to 36 years and assessed dietary intake through validated questionnaires. The primary outcomes were total and cause-specific mortality.

Key Findings & Statistics

  • The final study sample included 75,230 women from the NHS and 44,085 men from the HPFS.
  • 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.
    • 0.80 (95% CI, 0.77-0.82) for AHEI (P < .001 for trend for all).
  • In the NHS, during up to 36 years of follow-up (2,343,144 person-years), the study documented 31,263 deaths, including 6,128 deaths from CVD and 8,733 deaths from cancer.
  • In the HPFS, during 34 years of follow-up (1,215,912 person-years), the study documented 22,900 deaths, including 6,641 deaths from CVD and 5,710 deaths from cancer.
  • In multivariate analyses, the 4 dietary scores were inversely associated with the risk of most major causes of death.
  • Significant inverse associations were observed between 4 dietary scores and deaths due to CVD (HEI-2015: HR, 0.87 [95% CI, 0.83-0.92]; AMED score: HR, 0.94 [95% CI, 0.91-0.97]; HPDI: HR, 0.94 [95% CI, 0.89-0.99]; and AHEI: HR, 0.88 [95% CI, 0.84-0.92]), cancer (HEI-2015: HR, 0.82 [95% CI, 0.78-0.86]; AMED score: HR, 0.93 [95% CI, 0.90-0.96]; HPDI: HR, 0.90 [95% CI, 0.86-0.95]; and AHEI: HR, 0.84 [95% CI, 0.81-0.88]), and respiratory disease (HEI-2015: HR, 0.54 [95% CI, 0.49-0.59]; AMED score: HR, 0.65 [95% CI, 0.61-0.69]; HPDI: HR, 0.63 [95% CI, 0.58-0.70]; and AHEI: HR, 0.56 [95% CI, 0.52-0.61]).
  • The AMED score and AHEI were associated with lower risk of mortality caused by neurodegenerative disease.
  • The associations between dietary patterns and total mortality did not differ significantly by race and ethnicity.
  • The HRs of total mortality per 25-percentile difference in HEI-2015 were 0.55 (95% CI, 0.33-0.89; P = .21 for interaction) in Hispanic women, 0.59 (95% CI, 0.41-0.84; P = .19 for interaction) in non-Hispanic Black women, 0.75 (95% CI, 0.72-0.78) in non-Hispanic White women, and 0.72 (95% CI, 0.62-0.85; P = .65 for interaction) in other racial and ethnic minority groups.
  • When comparing the highest with the lowest quintiles, the pooled HRs of all-cause 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).

Other Important Findings

  • The study found a significant dose-dependent inverse association between adherence to various dietary patterns and total mortality after adjusting for potential confounders.
  • The inverse associations were observed for mortality from CVD, cancer, and respiratory diseases and persisted across different racial and ethnic groups and other subgroups.
  • Significant interactions were detected between the 4 dietary scores and total mortality by sex and smoking status.
  • The significant inverse associations between dietary scores and total mortality remained largely unchanged when pack-years of smoking were further adjusted.

Limitations Noted in the Document

  • Because dietary intake information was self-reported, some measurement error was inevitable.
  • The possibility of residual and unmeasured confounding could not be completely ruled out due to the observational nature of the study.
  • The study did not examine the association between each dietary component and mortality because the diet was considered as a combination of multiple components that act synergistically.
  • Generalizability may be limited because participants were mostly health professionals.

Conclusion

The study’s findings support the recommendations of the Dietary Guidelines for Americans, which advocate for multiple healthy eating patterns. The consistent inverse associations between various healthy eating patterns and a lower risk of total and cause-specific mortality, observed across different racial and ethnic groups, reinforce the importance of adopting dietary approaches tailored to individual food traditions and preferences. The dose-dependent nature of the associations further emphasizes the benefits of increased adherence to these patterns. The researchers also note the study’s limitations, including the potential for measurement error due to self-reported dietary information and the observational design, which may not fully account for unmeasured confounding factors. Despite these limitations, the study’s findings provide valuable insights into the relationships between dietary patterns and health outcomes. The study’s consistent findings across different racial and ethnic groups highlight the potential for dietary guidelines to be adapted to diverse populations. These results encourage the adoption of healthy eating patterns that align with personal food traditions and preferences, which may improve long-term health. The study also suggests that future research should focus on the impact of specific dietary components and the synergistic effects of various dietary patterns on health outcomes. The research underscores the need for continued efforts to promote healthy eating habits as a key component of public health strategies, recognizing the importance of individual choices within the framework of evidence-based dietary recommendations.

DOI

10.1001/jamainternmed.2022.6117

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Original Source

Healthy Eating Patterns And Risk Of Total And Cause-specific Mortality

JAMA Internal Medicine

Journal Article

8 January 2023

Zhilei Shan, Fenglei Wang, Yanping Li, Megu Y. Baden, Shilpa N. Bhupathiraju, Dong D. Wang, Qi Sun, Kathryn M. Rexrode, Eric B. Rimm, Lu Qi, Fred K. Tabung, Edward L. Giovannucci, Walter C. Willett, JoAnn E. Manson, Qibin Qi, Frank B. Hu

Funding

This study was supported by grant RO1HL060712 from the NHLBI (Drs Hu and Qi). The Nurses' Health Studies and Health Professional Follow-up Studies are supported by the grants UM1 CA186107, PO1 CA87969, RO1 CA49449, RO1 HL034594, RO1 HL088521, U01 CA176726, RO1 CA67262, U01 CA167552, RO1 HL35464, and U01 HL145386 from the NIH. Dr Qi is supported by grants KO1HL129892 and RO1 HL140976 from the NHLBI and grant RO1 DK119268 and RO1 DK120870 from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr F. Wang is supported by postdoctoral fellowship grant 897161 from the American Heart Association.

Conflict of Interest

Dr Baden reported receiving financial support from Kubara Honke Co, Ltd to her institution during the conduct of the study and receiving grants from Grants-in-Aid for Scientific Research, the G-7 Scholarship Foundation, the Japan Diabetes Society, and the LOTTE Foundation outside the submitted work. Dr Bhupathiraju reported receiving personal fees from LayerIV. Dr Bhupathiraju reported being a consultant for LayerIV outside the submitted work. Dr Rimm reported receiving grants from and serving on the scientific advisory board for the US Department of Agriculture/US Highbush Blueberry Growers. Dr Manson reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and receiving grants from the NIH and Mars Edge outside the submitted work. Dr Q. Qi reported receiving grants from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. No other disclosures were reported.

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