Association of Changes in Diet Quality with Total and Cause-Specific Mortality
- 13 July 2017
- journal article
- research article
- Published by Massachusetts Medical Society in The New England Journal of Medicine
- Vol. 377 (2), 143-153
- https://doi.org/10.1056/nejmoa1613502
Abstract
Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986–1998) were assessed with the use of the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower — by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score — than the risk among participants with consistently low diet scores over time. Improved diet quality over 12 years was consistently associated with a decreased risk of death. (Funded by the National Institutes of Health.)Keywords
This publication has 34 references indexed in Scilit:
- Changes in Diet Quality Scores and Risk of Cardiovascular Disease Among US Men and WomenCirculation, 2015
- Healthy Eating and Risks of Total and Cause-Specific Death among Low-Income Populations of African-Americans and Other Adults in the Southeastern United States: A Prospective Cohort StudyPLoS Medicine, 2015
- High Diet Quality Is Associated with a Lower Risk of Cardiovascular Disease and All-Cause Mortality in Older MenJournal of Nutrition, 2014
- Diet quality indexes and mortality in postmenopausal women: the Iowa Women’s Health StudyThe American Journal of Clinical Nutrition, 2013
- Primary Prevention of Cardiovascular Disease with a Mediterranean DietThe New England Journal of Medicine, 2013
- Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in WomenCirculation, 2009
- Primary Prevention of Coronary Heart Disease in Women through Diet and LifestyleThe New England Journal of Medicine, 2000
- Prospective study of alcohol consumption and risk of coronary disease in menThe Lancet, 1991
- Food-Based Validation of a Dietary Questionnaire: The Effects of Week-to-Week Variation in Food ConsumptionInternational Journal of Epidemiology, 1989
- REPRODUCIBILITY AND VALIDITY OF A SEMIQUANTITATIVE FOOD FREQUENCY QUESTIONNAIREAmerican Journal of Epidemiology, 1985