Abstract
As the global population ages, it is critical to identify diets that, beyond preventing noncommunicable diseases, optimally promote healthy aging. Here, using longitudinal questionnaire data from the Nurses’ Health Study (1986–2016) and the Health Professionals Follow-Up Study (1986–2016), we examined the association of long-term adherence to eight dietary patterns and ultraprocessed food consumption with healthy aging, as assessed according to measures of cognitive, physical and mental health, as well as living to 70 years of age free of chronic diseases. After up to 30 years of follow-up, 9,771 (9.3%) of 105,015 participants (66% women, mean age = 53 years (s.d. = 8)) achieved healthy aging. For each dietary pattern, higher adherence was associated with greater odds of healthy aging and its domains. The odds ratios for the highest quintile versus the lowest ranged from 1.45 (95% confidence interval (CI) = 1.35–1.57; healthful plant-based diet) to 1.86 (95% CI = 1.71–2.01; Alternative Healthy Eating Index). When the age threshold for healthy aging was shifted to 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01–2.50). Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated. Our findings suggest that dietary patterns rich in plant-based foods, with moderate inclusion of healthy animal-based foods, may enhance overall healthy aging, guiding future dietary guidelines.
Generated Summary
This research, employing a longitudinal study design, investigates the link between dietary patterns and healthy aging. The study utilized data from the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS), two large prospective cohorts in the United States. The primary goal was to identify dietary patterns associated with healthy aging, defined by cognitive, physical, and mental health, as well as the absence of chronic diseases. The study examined the long-term adherence to eight dietary patterns, including the Alternative Healthy Eating Index (AHEI), Alternative Mediterranean Index (aMED), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), healthful plant-based diet (hPDI), the Planetary Health Diet Index (PHDI), the empirically inflammatory dietary pattern (EDIP), and the empirical dietary index for hyperinsulinemia (EDIH), along with the consumption of ultraprocessed food (UPF), and their association with healthy aging over a 30-year follow-up period. The analysis involved assessing associations in subgroups, considering factors such as sex, ancestry, socioeconomic status, and lifestyle. Furthermore, the study examined the relationships between individual foods and nutrients and their contributions to the observed dietary patterns. This comprehensive approach aimed to provide insights into how dietary choices influence the aging process, with the potential to inform public health recommendations and dietary guidelines.
Key Findings & Statistics
The study included a total of 105,015 participants. Out of these, 70,091 were women (NHS) and 34,924 were men (HPFS). After a follow-up period of up to 30 years, 9,771 (9.3%) participants achieved healthy aging. Of these, 7,602 (10.8%) were from the NHS and 2,169 (6.2%) from the HPFS. In the pooled cohorts, 39,769 (37.9%) reached the age of 70 years.
The study found that higher adherence to all dietary patterns was associated with greater odds of healthy aging. The multivariable-adjusted odds ratios (ORs) (95% confidence intervals (CIs)) comparing the highest quintile to the lowest ranged from 1.45 (1.35–1.57; P<0.0001) for the healthful plant-based diet to 1.86 (1.71–2.01; P<0.0001) for the Alternative Healthy Eating Index.
The AHEI showed the strongest association, and the hPDI showed the weakest. Using dietary pattern scores as continuous variables, the associations with healthy aging were also the strongest for the AHEI and the weakest for the hPDI.
The OR (95% CI) per standardized unit increase (representing the increment between the 10th and 90th percentiles) ranged from 1.40 (1.32–1.49) to 1.71 (1.60–1.82).
Higher adherence to all dietary patterns was associated with greater odds of each healthy aging domain. The significant multivariable-adjusted ORs (95% CIs) comparing the highest quintile to the lowest ranged from 1.22 (1.15-1.28; P < 0.0001) to 1.65 (1.57-1.74; P<0.0001) for intact cognitive health, with the PHDI showing the strongest association and the hPDI showing the weakest association. For intact physical function, the ORs (95% CIs) ranged from 1.38 (1.30-1.46; P < 0.0001) to 2.30 (2.16-2.44; P < 0.0001), with the AHEI showing the strongest association and the rEDIP showing the weakest association.
For intact mental health, the ORs (95% CIs) ranged from 1.37 (1.30-1.45; P < 0.0001) to 2.03 (1.92-2.15; P < 0.0001), with the AHEI showing the strongest association and the hPDI showing the weakest association. For being free of chronic diseases, the ORs (95% CIs) ranged from 1.32 (1.25-1.40; P < 0.0001) to 1.75 (1.65-1.87; P < 0.0001), with the rEDIH showing the strongest association and the hPDI showing the weakest association. For surviving to the age of 70 years, the ORs (95% CIs) ranged from 1.33 (1.26-1.41; P<0.0001) to 2.17 (2.05-2.30; P<0.0001), with the PHDI showing the strongest association and the hPDI showing the weakest association.
When the age threshold for healthy aging was shifted to 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01–2.50). Higher UPF consumption (comparing the highest quintile to the lowest) was associated with 32% lower odds of healthy aging (95% CI = 27-37%).
Other Important Findings
- Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy products were linked to greater odds of healthy aging.
- Higher intakes of trans fats, sodium, sugary beverages, and red or processed meats (or both) were inversely associated with healthy aging.
- The AHEI showed the strongest association with healthy aging, followed by the rEDIH. The hPDI showed the weakest association.
- The PHDI was most strongly associated with maintaining intact cognitive health and surviving to the age of 70 years.
- The rEDIH was most strongly associated with being free of chronic diseases.
- The study identified that higher intakes of trans fats, sodium, total meats, and red and processed meats were associated with lower odds of healthy aging and also with each healthy aging domain.
- Associations between dietary factors and healthy aging were stronger in women.
- A significant interaction between SES and rEDIH (Pinteraction = 0.013) and rEDIP (Pinteraction = 0.017) was observed.
- No interaction was found for ancestry (European versus non-European).
Limitations Noted in the Document
- Reverse causation could not be completely excluded, although results remained consistent after accounting for factors such as SES and lifestyle.
- Cognitive and physical function domains were assessed using self-reported questionnaires instead of objective measurements, which limits in-depth assessment and classification.
- The population included health professionals, which may limit the generalizability of the results.
- Standardization of a composite healthy aging outcome is warranted to allow proper comparison of research studies.
- Deaths should be considered as usual agers and be included in the analyses to avoid selection bias.
Conclusion
The findings of this study provide compelling evidence that adherence to specific dietary patterns during midlife is associated with greater odds of healthy aging later in life. The AHEI, characterized by its emphasis on fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and moderate inclusion of healthy animal-based foods, emerged as the most strongly associated pattern. This underscores the critical role of diet in promoting overall healthy aging, encompassing cognitive, physical, and mental health, as well as the prevention of chronic diseases. The consistent associations across different dietary patterns and healthy aging domains highlight the multifaceted benefits of a balanced diet rich in plant-based foods. Moreover, the study’s findings on the inverse associations with UPF consumption, trans fats, sodium, and red or processed meats emphasize the importance of reducing these dietary components to enhance healthy aging. The results support the development of dietary guidelines that prioritize plant-based foods, with a measured inclusion of healthy animal-based foods, as a key strategy for enhancing healthy aging. This research provides insights into how dietary choices during mid-life can significantly influence the aging process, suggesting that dietary interventions can be an effective strategy for promoting longevity and well-being in older adults. Future research may focus on clarifying the precise mechanisms underlying these associations and examining the impacts of specific food combinations. The study’s findings underscore the importance of dietary interventions as a tool for promoting healthy aging, potentially offering a means to improve both the quality and the length of life. The strong associations seen with the AHEI and other plant-based diets indicate that there may be an effective strategy for enhancing longevity and overall well-being.