by Geoffrey Modest MD<\/p>\n
A recent review of the data from the Nurses’ Health Study and the Health Professionals Follow-up Study from 1998 to 2010 found that mortality tracks\u00a0with changes in diet (see\u00a0DOI: 10.1056\/NEJMoa1613502).<\/p>\n
Details:<\/strong><\/p>\n — 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study were assessed, correlating changes in diet quality from over 8- to\u00a016-year time periods\u00a0and hazard ratios for total and cause-specific mortality<\/p>\n — the diet metrics used were the Alternate Healthy Eating Index–2010 score\u00a0(Including 11 food components, each\u00a0scored 0-10), the Alternate Mediterranean Diet score\u00a0(including 9 components, each scored 0- 1), and the Dietary Approaches to Stop Hypertension (DASH) diet score\u00a0(including 8 components, each scored 1- 5)<\/p>\n –Dietary changes were assessed at baseline and every 4 years thereafter<\/p>\n –Covariates: information on the participants lifestyle and risk factors for cardiovascular disease were assessed and updated every other year, including age, weight\/BMI, smoking status, use of aspirin, multivitamins, postmenopausal hormone replacement therapy\/oral contraceptives, menopausal status, physical activity, hypertension\/ hypercholesterolemia\/diabetes recently diagnosed by a physician, alcohol use,\u00a0smoking, quintiles of total energy intake and changes in these levels<\/p>\n — They assess both shorter-term clinical changes (baseline to 8 \u00a0year follow-up, 1986-1994) as well as longer-term changes (baseline to 12 and\u00a016 year follow-ups, 1986- 2002)<\/p>\n —\u00a0Those with greater improvement\u00a0in diet quality were younger, had a lower baseline diet score (ie less good diet), engaged in more physical activity, had lower alcohol intake, and in general reported increased consumption of whole grains, vegetables, and n-3 fatty acids, and less sodium intake.<\/p>\n — Those with consistently high quality diet at baseline and 12 years later were older,\u00a0had lower BMI, were less likely to be current smokers, and were\u00a0more physically active than those with consistently poor diet quality.<\/p>\n Results:<\/strong><\/p>\n —\u00a0In the Nurses’ Health Study: 5967 deaths, including 1115 deaths from cardiovascular disease and\u00a02089 deaths from cancer, over 544,973 person-years of follow-up<\/p>\n —\u00a0In the\u00a0Health Professionals Follow-up Study\u200b, 3979 deaths, including 1226 deaths from cardiovascular disease\u00a0and 1192 deaths from cancer, over\u00a0286,402 person-years of follow-up<\/p>\n — All-cause mortality:<\/p>\n \u200b– those with the greatest diet quality improvement (13-33%), relative to those with a stable diet, had an 9% decreased mortality by the Alternate Healthy Eating Index–2010 score, HR 0.91 (0.85-0.97); 16% by the Alternate Mediterranean Diet score, HR 0.84 (0.78-0.91); and 11% by the DASH diet score, HR\u00a00.89\u00a0(0.84- 0.95\u200b)<\/p>\n \u200b– those with decreasing diet quality (vs stable\u00a0change)\u00a0had a 12%\u00a0increased mortality by the Alternate Healthy Eating Index–2010 score, HR 1.12 (1.05-1.19); 6% by the Alternate Mediterranean Diet score, HR 1.06\u00a0(0.99-1.13, nonsignificant); and 6% by the DASH diet score, HR 1.06\u00a0(1.00-1.12\u200b)\u200b<\/p>\n \u200b–those with the most impressive decrease in death from any cause were those who\u00a0had the largest improvement from\u00a0poor quality diet vs those who remained on a poor quality\u00a0diet 12 years later:\u00a015% decreased mortality by the Alternate Healthy Eating Index–2010 score; 23%\u00a0by the Alternate Mediterranean Diet score;\u00a0and 28% by the DASH diet score<\/p>\n –those with a consistently high quality diet had a 14% decreased mortality by the Alternate Healthy Eating Index–2010 score; 11%\u00a0by the Alternate Mediterranean Diet score;\u00a0and 9% by the DASH diet score<\/p>\n — a\u00a020 percentile improvement in diet scores was significantly associated with a 8- 17% decrease in total mortality with the use of the 3 diet indexes<\/p>\n — cardiovascular mortality:<\/p>\n — a 20 percentile improvement in diet scores was\u00a0associated with a 7-15% decrease with the use of the\u00a0Alternate Healthy Eating Index–2010 \u00a0and\u00a0the Alternate Mediterranean Diet scores<\/p>\n —\u00a0In the fully-adjusted model, a 20 percentile improvement\u00a0during the 12 year period of 1986-1998 was associated with:<\/p>\n — by\u00a0Alternate Healthy Eating Index score —\u00a0 death from any cause: 17%, death from cardiovascular cause: 15%, death from cancer: 6% (cancer nonsignificant)<\/p>\n — by Alternate\u00a0Mediterranean Diet score — death from any cause 8%, death from cardiovascular cause 7%, death from cancer 2% (cancer nonsignificant)<\/p>\n — by\u00a0DASH score —\u00a0death from any cause 10%, death from cardiovascular disease 4% (nonsignificant), death from cancer 9% (significant, and largely due to deaths from lung cancer)<\/p>\n — there was a graded improvement in death from any cause in all of the indexes\u200b when assessing the 20 percentile diet improvement from 8 years to 12 years\u00a0\u200bto 16 years. Also true for cardiovascular deaths but not cancer<\/p>\n Commentary:<\/strong><\/p>\n