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Expanded question: What are the best diets for optimal health span and longevity? Rank them from highest significant impact on benefit for health span and longevity. Provide details of the protocol to achieve the benefits.

Answered on December 3, 2024
The best diets for optimal health span and longevity, ranked by their significant impact, are:
1. Mediterranean Diet: This diet emphasizes high intake of fruits, vegetables, whole grains, legumes, nuts, and olive oil, with moderate consumption of fish and poultry, and limited intake of red meat and sweets. It has been associated with reduced all-cause mortality, cardiovascular mortality, stroke, and non-fatal myocardial infarction.[1-2]
2. Okinawan Diet: Characterized by high consumption of vegetables, particularly sweet potatoes, and low intake of calories, this diet is rich in antioxidants and anti-inflammatory foods. It is linked to lower rates of age-related diseases and increased longevity.[3]
3. DASH Diet (Dietary Approaches to Stop Hypertension): This diet focuses on fruits, vegetables, whole grains, and lean proteins, while reducing sodium, red meat, and sweets. It has been shown to lower blood pressure and reduce the risk of cardiovascular diseases.[3-4]
4. Caloric Restriction (CR): Involves reducing calorie intake without malnutrition. CR has been shown to extend lifespan and delay the onset of age-related diseases by modulating nutrient-sensing pathways and reducing metabolic rates.[2][5]
5. Intermittent Fasting (IF): This dietary pattern alternates periods of eating with periods of fasting. IF has been associated with improved metabolic health, reduced inflammation, and increased longevity.[2-3]
Protocol to Achieve Benefits:
• Mediterranean Diet: Consume a variety of plant-based foods, use olive oil as the primary fat source, eat fish at least twice a week, and limit red meat to a few times per month.
• Okinawan Diet: Focus on a plant-based diet with high vegetable intake, particularly sweet potatoes, and maintain a low-calorie intake.
• DASH Diet: Increase intake of fruits, vegetables, and whole grains, choose lean protein sources, and limit sodium, red meat, and sweets.
• Caloric Restriction: Reduce daily caloric intake by 20-30% while ensuring adequate nutrient intake to avoid malnutrition.
• Intermittent Fasting: Implement fasting periods such as 16/8 (16 hours fasting, 8 hours eating) or alternate-day fasting, ensuring nutrient-dense meals during eating periods.
These dietary patterns share common elements such as high intake of plant-based foods and reduced consumption of red and processed meats, which are crucial for promoting health span and longevity.[1-3][5-6]

1.
Comparison of Seven Popular Structured Dietary Programmes and Risk of Mortality and Major Cardiovascular Events in Patients at Increased Cardiovascular Risk: Systematic Review and Network Meta-Analysis.

Karam G, Agarwal A, Sadeghirad B, et al.

BMJ (Clinical Research Ed.). 2023;380:e072003. doi:10.1136/bmj-2022-072003.

Leading Journal

Objective: To determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased risk of cardiovascular disease.

Design: Systematic review and network meta-analysis of randomised controlled trials.

Data Sources: AMED (Allied and Complementary Medicine Database), CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov were searched up to September 2021.

Study Selection: Randomised trials of patients at increased risk of cardiovascular disease that compared dietary programmes with minimal intervention (eg, healthy diet brochure) or alternative programmes with at least nine months of follow-up and reporting on mortality or major cardiovascular events (such as stroke or non-fatal myocardial infarction). In addition to dietary intervention, dietary programmes could also include exercise, behavioural support, and other secondary interventions such as drug treatment.

Outcomes And Measures: All cause mortality, cardiovascular mortality, and individual cardiovascular events (stroke, non-fatal myocardial infarction, and unplanned cardiovascular interventions).

Review Methods: Pairs of reviewers independently extracted data and assessed risk of bias. A random effects network meta-analysis was performed using a frequentist approach and grading of recommendations assessment, development and evaluation (GRADE) methods to determine the certainty of evidence for each outcome.

Results: 40 eligible trials were identified with 35 548 participants across seven named dietary programmes (low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; Pritikin, 1). At last reported follow-up, based on moderate certainty evidence, Mediterranean dietary programmes proved superior to minimal intervention for the prevention of all cause mortality (odds ratio 0.72, 95% confidence interval 0.56 to 0.92; patients at intermediate risk: risk difference 17 fewer per 1000 followed over five years), cardiovascular mortality (0.55, 0.39 to 0.78; 13 fewer per 1000), stroke (0.65, 0.46 to 0.93; 7 fewer per 1000), and non-fatal myocardial infarction (0.48, 0.36 to 0.65; 17 fewer per 1000). Based on moderate certainty evidence, low fat programmes proved superior to minimal intervention for prevention of all cause mortality (0.84, 0.74 to 0.95; 9 fewer per 1000) and non-fatal myocardial infarction (0.77, 0.61 to 0.96; 7 fewer per 1000). The absolute effects for both dietary programmes were more pronounced for patients at high risk. There were no convincing differences between Mediterranean and low fat programmes for mortality or non-fatal myocardial infarction. The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence.

Conclusions: Moderate certainty evidence shows that programmes promoting Mediterranean and low fat diets, with or without physical activity or other interventions, reduce all cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean programmes are also likely to reduce stroke risk. Generally, other named dietary programmes were not superior to minimal intervention.

Systematic Review Registration: PROSPERO CRD42016047939.

2.
Molecular Mechanisms of Healthy Aging: The Role of Caloric Restriction, Intermittent Fasting, Mediterranean Diet, and Ketogenic Diet-a Scoping Review.

Surugiu R, Iancu MA, Vintilescu ȘB, et al.

Nutrients. 2024;16(17):2878. doi:10.3390/nu16172878.

New Research

As the population ages, promoting healthy aging through targeted interventions becomes increasingly crucial. Growing evidence suggests that dietary interventions can significantly impact this process by modulating fundamental molecular pathways. This review focuses on the potential of targeted dietary strategies in promoting healthy aging and the mechanisms by which specific nutrients and dietary patterns influence key pathways involved in cellular repair, inflammation, and metabolic regulation. Caloric restriction, intermittent fasting, the Mediterranean diet, as well as the ketogenic diet showed promising effects on promoting healthy aging, possibly by modulating mTORC1 AMPK, an insulin signaling pathway. By understanding the intricate interplay between diet and molecular pathways, we can develop personalized dietary strategies that not only prevent age-related diseases, but also promote overall health and well-being throughout the aging process.

3.
Dietary Strategies With Anti-Aging Potential: Dietary Patterns and Supplements.

Duan H, Pan J, Guo M, et al.

Food Research International (Ottawa, Ont.). 2022;158:111501. doi:10.1016/j.foodres.2022.111501.

Leading Journal

Dietary intervention is a safe, broad-spectrum, and low-cost preventive strategy for slow aging. The Okinawan, Mediterranean, and Dietary approaches to stop hypertension (DASH) diets, as well as caloric restriction (CR) and intermittent fasting (IF), are classic and reliable dietary patterns that slow aging by regulating nutrient-sensing pathways, gut microbiota, metabolism, and immunity. Moreover, the proportion of the three macronutrients (carbohydrate, protein and fat) is also vital for slowing aging, but the debates about the appropriate proportion, especially the ratio of carbohydrates and proteins, remain unknown. Strict and lifelong adherence to these regimens is difficult, thereby promoting the emergence of various dietary supplements, including natural CR mimics, probiotics, natural senolytics, vitamins and essential minerals. Combinations of different dietary patterns and supplements with distinct pathways may have additive effects. Individuals' aging speed and dietary response are highly variable, thus highlighting the need for precise anti-aging dietary intervention. Nutrigenomics plays an important role in personalized dietary strategies. Therefore, this review critically compares the anti-aging effects of various dietary patterns and supplements, analyzes their mechanisms and combined use, and proposes future research directions to achieve personalized dietary strategies for slowing aging.

4.
Higher Diet Quality Is Associated With Decreased Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality Among Older Adults.

Reedy J, Krebs-Smith SM, Miller PE, et al.

The Journal of Nutrition. 2014;144(6):881-9. doi:10.3945/jn.113.189407.

Increased attention in dietary research and guidance has been focused on dietary patterns, rather than on single nutrients or food groups, because dietary components are consumed in combination and correlated with one another. However, the collective body of research on the topic has been hampered by the lack of consistency in methods used. We examined the relationships between 4 indices--the Healthy Eating Index-2010 (HEI-2010), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)--and all-cause, cardiovascular disease (CVD), and cancer mortality in the NIH-AARP Diet and Health Study (n = 492,823). Data from a 124-item food-frequency questionnaire were used to calculate scores; adjusted HRs and 95% CIs were estimated. We documented 86,419 deaths, including 23,502 CVD- and 29,415 cancer-specific deaths, during 15 y of follow-up. Higher index scores were associated with a 12-28% decreased risk of all-cause, CVD, and cancer mortality. Specifically, comparing the highest with the lowest quintile scores, adjusted HRs for all-cause mortality for men were as follows: HEI-2010

Hr: 0.78 (95%

Ci: 0.76, 0.80), AHEI-2010

Hr: 0.76 (95%

Ci: 0.74, 0.78), a

Med Hr: 0.77 (95%

Ci: 0.75, 0.79), and

Dash Hr: 0.83 (95%

Ci: 0.80, 0.85); for women, these were HEI-2010

Hr: 0.77 (95%

Ci: 0.74, 0.80), AHEI-2010

Hr: 0.76 (95%

Ci: 0.74, 0.79), a

Med Hr: 0.76 (95%

Ci: 0.73, 0.79), and

Dash Hr: 0.78 (95%

Ci: 0.75, 0.81). Similarly, high adherence on each index was protective for CVD and cancer mortality examined separately. These findings indicate that multiple scores reflect core tenets of a healthy diet that may lower the risk of mortality outcomes, including federal guidance as operationalized in the HEI-2010, Harvard's Healthy Eating Plate as captured in the AHEI-2010, a Mediterranean diet as adapted in an Americanized aMED, and the DASH Eating Plan as included in the DASH score.

5.
Nutrition and Longevity - From Mechanisms to Uncertainties.

Ekmekcioglu C.

Critical Reviews in Food Science and Nutrition. 2020;60(18):3063-3082. doi:10.1080/10408398.2019.1676698.

Leading Journal

Genetic, environmental, and lifestyle factors primarily determine the lifespan of humans. From these, nutrition is a key component affecting our health, and several studies particularly in model organisms and rodents have shown that nutrition has also the potential to increase lifespan. This review, therefore, aimed to summarize and discuss the most important nutritional components and diets which have been repeatedly associated with longevity. A brief summary of mechanistic factors involved, like for example mTor, IGF-1, and autophagy, will also be presented. Finally, the association of foods and diets with all-cause mortality will be summarized by conducting a mini umbrella review of available meta-analyses. The main conclusions of this review are that caloric restriction without malnutrition, methionine restriction, lower protein intake or supplementation of spermidine are major life-extending factors, in model organisms or rodents. In humans, certain healthy foods are associated with longer telomere length, and reductions in protein intake with lower IGF-1 levels, respectively, both relations being associated with longer lifespan. Furthermore, a high intake of whole grains, vegetables, fruits, nuts, and also coffee is associated with a reduced risk for all-cause mortality whereas a high intake of (red) meat and especially processed meat is positively related to all-cause mortality. In addition, the Mediterranean and also high-quality diets are associated with reduced all-cause mortality risk.

6.
Estimating Impact of Food Choices on Life Expectancy: A Modeling Study.

Fadnes LT, Økland JM, Haaland ØA, Johansson KA.

PLoS Medicine. 2022;19(2):e1003889. doi:10.1371/journal.pmed.1003889.

Leading Journal

Background: Interpreting and utilizing the findings of nutritional research can be challenging to clinicians, policy makers, and even researchers. To make better decisions about diet, innovative methods that integrate best evidence are needed. We have developed a decision support model that predicts how dietary choices affect life expectancy (LE).

Methods And Findings: Based on meta-analyses and data from the Global Burden of Disease study (2019), we used life table methodology to estimate how LE changes with sustained changes in the intake of fruits, vegetables, whole grains, refined grains, nuts, legumes, fish, eggs, milk/dairy, red meat, processed meat, and sugar-sweetened beverages. We present estimates (with 95% uncertainty intervals [95% UIs]) for an optimized diet and a feasibility approach diet. An optimal diet had substantially higher intake than a typical diet of whole grains, legumes, fish, fruits, vegetables, and included a handful of nuts, while reducing red and processed meats, sugar-sweetened beverages, and refined grains. A feasibility approach diet was a midpoint between an optimal and a typical Western diet. A sustained change from a typical Western diet to the optimal diet from age 20 years would increase LE by more than a decade for women from the United States (10.7 [95% UI 8.4 to 12.3] years) and men (13.0 [95% UI 9.4 to 14.3] years). The largest gains would be made by eating more legumes (females: 2.2 [95% UI 1.1 to 3.4]; males: 2.5 [95% UI 1.1 to 3.9]), whole grains (females: 2.0 [95% UI 1.3 to 2.7]; males: 2.3 [95% UI 1.6 to 3.0]), and nuts (females: 1.7 [95% UI 1.5 to 2.0]; males: 2.0 [95% UI 1.7 to 2.3]), and less red meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]) and processed meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]). Changing from a typical diet to the optimized diet at age 60 years would increase LE by 8.0 (95% UI 6.2 to 9.3) years for women and 8.8 (95% UI 6.8 to 10.0) years for men, and 80-year-olds would gain 3.4 years (95% UI females: 2.6 to 3.8/males: 2.7 to 3.9). Change from typical to feasibility approach diet would increase LE by 6.2 (95% UI 3.5 to 8.1) years for 20-year-old women from the United States and 7.3 (95% UI 4.7 to 9.5) years for men. Using NutriGrade, the overall quality of evidence was assessed as moderate. The methodology provides population estimates under given assumptions and is not meant as individualized forecasting, with study limitations that include uncertainty for time to achieve full effects, the effect of eggs, white meat, and oils, individual variation in protective and risk factors, uncertainties for future development of medical treatments; and changes in lifestyle.

Conclusions: A sustained dietary change may give substantial health gains for people of all ages both for optimized and feasible changes. Gains are predicted to be larger the earlier the dietary changes are initiated in life. The Food4HealthyLife calculator that we provide online could be useful for clinicians, policy makers, and laypeople to understand the health impact of dietary choices.

Expanded question: What are the worst foods and beverages to consume that are detrimental to health span and longevity? Please rank them from the worst to the least detrimental effect on health span and longevity.

Answered on December 3, 2024
The worst foods and beverages to consume that are detrimental to health span and longevity, ranked from the worst to the least detrimental effect, are:
1. Ultra-Processed Foods (UPFs): High consumption of UPFs is associated with increased all-cause mortality and acceleration of biological aging. These foods often contain high levels of sugar, unhealthy fats, and additives, which contribute to chronic diseases and premature death.[1-3]
2. Sugar-Sweetened Beverages (SSBs): SSBs are linked to higher all-cause mortality, cardiovascular disease (CVD) incidence, and CVD mortality. They contribute to obesity, type 2 diabetes, and metabolic syndrome, which are significant risk factors for reduced longevity.[1][4]
3. Processed Meats: High intake of processed meats is associated with increased mortality from heart disease, stroke, and type 2 diabetes. These meats often contain high levels of sodium, nitrates, and unhealthy fats, which contribute to chronic diseases.[1][5-6]
4. Artificially Sweetened Beverages (ASBs): Although slightly less detrimental than SSBs, ASBs are still associated with increased all-cause mortality. The long-term health effects of artificial sweeteners remain a concern.[1][4]
5. Red Meat: High consumption of red meat, particularly unprocessed red meat, is associated with increased mortality from heart disease and other chronic conditions. Red meat contains saturated fats and heme iron, which can contribute to inflammation and oxidative stress.[5-6]
6. High Sodium Foods: Excessive sodium intake is linked to hypertension and increased risk of cardiovascular diseases, which can reduce life expectancy. High sodium foods include processed snacks, canned soups, and fast foods.[5][7]
7. Full-Fat Dairy Products: Full-fat dairy products, such as whole milk and cheese, are associated with higher all-cause mortality due to their high saturated fat content, which can contribute to cardiovascular diseases.[4]
These rankings are based on the current understanding of the impact of these foods and beverages on health span and longevity, as supported by the medical literature. Reducing the intake of these items and replacing them with healthier alternatives can significantly improve health outcomes and longevity.

1.
Association Between Ultra-Processed Food Intake and All-Cause Mortality: A Systematic Review and Meta-Analysis.

Taneri PE, Wehrli F, Roa-Díaz ZM, et al.

American Journal of Epidemiology. 2022;191(7):1323-1335. doi:10.1093/aje/kwac039.

Consumption of ultra-processed foods (UPF) has increased worldwide during the last decades because they are hyperpalatable, cheap, and ready-to-consume products. However, uncertainty exists about their impact on health. We conducted a systematic review and meta-analysis evaluating the association of UPF consumption with all-cause mortality risk. Five bibliographic databases were searched for relevant studies. Random effects models were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). Of 6,951 unique citations, 40 unique prospective cohort studies comprising 5,750,133 individuals were included; publication dates ranged from 1984 to 2021. Compared with low consumption, highest consumption of UPF (RR = 1.29, 95%

Ci: 1.17, 1.42), sugar-sweetened beverages (RR = 1.11, 95% CI, 1.04, 1.18), artificially sweetened beverages (RR = 1.14, 95% CI, 1.05, 1.22), and processed meat/red meat (RR = 1.15, 95% CI, 1.10, 1.21) were significantly associated with increased risk of mortality. However, breakfast cereals were associated with a lower mortality risk (RR = 0.85, 95% CI, 0.79, 0.92). This meta-analysis suggests that high consumption of UPF, sugar-sweetened beverages, artificially sweetened beverages, processed meat, and processed red meat might increase all-cause mortality, while breakfast cereals might decrease it. Future studies are needed to address lack of standardized methods in UPF categorization.

2.
Association of Ultra-Processed Food Consumption With All Cause and Cause Specific Mortality: Population Based Cohort Study.

Fang Z, Rossato SL, Hang D, et al.

BMJ (Clinical Research Ed.). 2024;385:e078476. doi:10.1136/bmj-2023-078476.

Leading Journal
New Research

Objective: To examine the association of ultra-processed food consumption with all cause mortality and cause specific mortality.

Design: Population based cohort study.

Setting: Female registered nurses from 11 US states in the Nurses' Health Study (1984-2018) and male health professionals from all 50 US states in the Health Professionals Follow-up Study (1986-2018).

Participants: 74 563 women and 39 501 men with no history of cancer, cardiovascular diseases, or diabetes at baseline.

Main Outcome Measures: Multivariable Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for the association of ultra-processed food intake measured by semiquantitative food frequency questionnaire every four years with all cause mortality and cause specific mortality due to cancer, cardiovascular, and other causes (including respiratory and neurodegenerative causes).

Results: 30 188 deaths of women and 18 005 deaths of men were documented during a median of 34 and 31 years of follow-up, respectively. Compared with those in the lowest quarter of ultra-processed food consumption, participants in the highest quarter had a 4% higher all cause mortality (hazard ratio 1.04, 95% confidence interval 1.01 to 1.07) and 9% higher mortality from causes other than cancer or cardiovascular diseases (1.09, 1.05 to 1.13). The all cause mortality rate among participants in the lowest and highest quarter was 1472 and 1536 per 100 000 person years, respectively. No associations were found for cancer or cardiovascular mortality. Meat/poultry/seafood based ready-to-eat products (for example, processed meat) consistently showed strong associations with mortality outcomes (hazard ratios ranged from 1.06 to 1.43). Sugar sweetened and artificially sweetened beverages (1.09, 1.07 to 1.12), dairy based desserts (1.07, 1.04 to 1.10), and ultra-processed breakfast food (1.04, 1.02 to 1.07) were also associated with higher all cause mortality. No consistent associations between ultra-processed foods and mortality were observed within each quarter of dietary quality assessed by the Alternative Healthy Eating Index-2010 score, whereas better dietary quality showed an inverse association with mortality within each quarter of ultra-processed foods.

Conclusions: This study found that a higher intake of ultra-processed foods was associated with slightly higher all cause mortality, driven by causes other than cancer and cardiovascular diseases. The associations varied across subgroups of ultra-processed foods, with meat/poultry/seafood based ready-to-eat products showing particularly strong associations with mortality.

3.
Ultra-Processed Food Consumption Is Associated With the Acceleration of Biological Aging in the Moli-Sani Study.

Esposito S, Gialluisi A, Di Castelnuovo A, et al.

The American Journal of Clinical Nutrition. 2024;:S0002-9165(24)00813-X. doi:10.1016/j.ajcnut.2024.10.006.

New Research

Background: Healthy diets have been inversely associated with biological aging. However, the nutritional content is only one aspect of the overall food health potential, and more recently, increasing attention has been paid to nonnutrient food characteristics, such as food processing.

Objectives: To examine the association of ultra-processed food (UPF) consumption with biological aging measured by circulating blood biomarkers.

Methods: Cross-sectional analyses were conducted on 22,495 participants enrolled in the Moli-sani Study (2005-2010, Italy). Food intake was assessed by a 188-item food frequency questionnaire. UPF was defined according to the Nova classification and calculated as the ratio (weight ratio; %) between UPF (g/d) and total food eaten (g/d). Diet quality was assessed by the Mediterranean Diet Score (MDS; ranging 0-9). A deep neural network approach based on 36 circulating biomarkers was used to compute biological age (BA), and the resulting difference (Δage = BA - chronological age)-an index of biological aging-was tested as dependent variable in multivariable linear regression analyses including known risk factors.

Results: The mean Δage in this population was -0.70 (standard deviation ±7.70) years. In multivariable-adjusted analyses, higher intake of UPF was associated with accelerated Δage [β = 0.34 years; 95% confidence interval (CI): 0.08, 0.61 for the last fifth compared with the first). This association was not linear (P value for overall association <0.001; P value for nonlinearity = 0.049). Inclusion of the MDS into the model slightly attenuated this association by 9.1% (β = 0.31 years; 95%

Ci: 0.04, 0.59).

Conclusions: A diet rich in UPF was associated with an acceleration of biological aging in a large sample of Italian adults. The poor nutritional composition of highly processed foods weakly accounted for this association, suggesting that biological aging could be adversely influenced by nonnutrient characteristics of these foods.

4.
Beverage Consumption and Mortality Among Adults With Type 2 Diabetes: Prospective Cohort Study.

Ma L, Hu Y, Alperet DJ, et al.

BMJ (Clinical Research Ed.). 2023;381:e073406. doi:10.1136/bmj-2022-073406.

Leading Journal

Objective: To investigate the intake of specific types of beverages in relation to mortality and cardiovascular disease (CVD) outcomes among adults with type 2 diabetes.

Design: Prospective cohort study.

Setting: Health professionals in the United States.

Participants: 15 486 men and women with a diagnosis of type 2 diabetes at baseline and during follow-up (Nurses' Health Study: 1980-2018; and Health Professionals Follow-Up Study: 1986-2018). Beverage consumption was assessed using a validated food frequency questionnaire and updated every two to four years.

Main Outcome Measures: The main outcome was all cause mortality. Secondary outcomes were CVD incidence and mortality.

Results: During an average of 18.5 years of follow-up, 3447 (22.3%) participants with incident CVD and 7638 (49.3%) deaths were documented. After multivariable adjustment, when comparing the categories of lowest intake of beverages with the highest intake, the pooled hazard ratios for all cause mortality were 1.20 (95% confidence interval 1.04 to 1.37) for sugar sweetened beverages (SSBs), 0.96 (0.86 to 1.07) for artificially sweetened beverages (ASBs), 0.98 (0.90 to 1.06) for fruit juice, 0.74 (0.63 to 0.86) for coffee, 0.79 (0.71 to 0.89) for tea, 0.77 (0.70 to 0.85) for plain water, 0.88 (0.80 to 0.96) for low fat milk, and 1.20 (0.99 to 1.44) for full fat milk. Similar associations were observed between the individual beverages and CVD incidence and mortality. In particular, SSB intake was associated with a higher risk of incident CVD (hazard ratio 1.25, 95% confidence interval 1.03 to 1.51) and CVD mortality (1.29, 1.02 to 1.63), whereas significant inverse associations were observed between intake of coffee and low fat milk and CVD incidence. Additionally, compared with those who did not change their consumption of coffee in the period after a diabetes diagnosis, a lower all cause mortality was observed in those who increased their consumption of coffee. A similar pattern of association with all cause mortality was also observed for tea, and low fat milk. Replacing SSBs with ABSs was significantly associated with lower all cause mortality and CVD mortality, and replacing SSBs, ASBs, fruit juice, or full fat milk with coffee, tea, or plain water was consistently associated with lower all cause mortality.

Conclusions: Individual beverages showed divergent associations with all cause mortality and CVD outcomes among adults with type 2 diabetes. Higher intake of SSBs was associated with higher all cause mortality and CVD incidence and mortality, whereas intakes of coffee, tea, plain water, and low fat milk were inversely associated with all cause mortality. These findings emphasize the potential role of healthy choices of beverages in managing the risk of CVD and premature death overall in adults with type 2 diabetes.

5.
Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States.

Micha R, Peñalvo JL, Cudhea F, et al.

JAMA logoJama. 2017;317(9):912-924. doi:10.1001/jama.2017.0947.

Leading Journal

Importance: In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established. Objective: To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults. Design, Setting, and Participants: A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n = 8104; 2009-2012: n = 8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-specific national mortality from the National Center for Health Statistics. Exposures: Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium. Main Outcomes and Measures: Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated. Results: In 2012, 702 308 cardiometabolic deaths occurred in US adults, including 506 100 from heart disease (371 266 coronary heart disease, 35 019 hypertensive heart disease, and 99 815 other cardiovascular disease), 128 294 from stroke (16 125 ischemic, 32 591 hemorrhagic, and 79 578 other), and 67 914 from type 2 diabetes. Of these, an estimated 318 656 (95% uncertainty interval [UI], 306 064-329 755; 45.4%) cardiometabolic deaths per year were associated with suboptimal intakes-48.6% (95% UI, 46.2%-50.9%) of cardiometabolic deaths in men and 41.8% (95% UI, 39.3%-44.2%) in women; 64.2% (95% UI, 60.6%-67.9%) at younger ages (25-34 years) and 35.7% (95% UI, 33.1%-38.1%) at older ages (≥75 years); 53.1% (95% UI, 51.6%-54.8%) among blacks, 50.0% (95% UI, 48.2%-51.8%) among Hispanics, and 42.8% (95% UI, 40.9%-44.5%) among whites; and 46.8% (95% UI, 44.9%-48.7%) among lower-, 45.7% (95% UI, 44.2%-47.4%) among medium-, and 39.1% (95% UI, 37.2%-41.2%) among higher-educated individuals. The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (66 508 deaths in 2012; 9.5% of all cardiometabolic deaths), low nuts/seeds (59 374; 8.5%), high processed meats (57 766; 8.2%), low seafood omega-3 fats (54 626; 7.8%), low vegetables (53 410; 7.6%), low fruits (52 547; 7.5%), and high SSBs (51 694; 7.4%). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%. The greatest decline was associated with insufficient polyunsaturated fats (-20.8% relative change [95% UI, -18.5% to -22.8%]), nuts/seeds (-18.0% [95% UI, -14.6% to -21.0%]), and excess SSBs (-14.5% [95% UI, -12.0% to -16.9%]). The greatest increase was associated with unprocessed red meats (+14.4% [95% UI, 9.1%-19.5%]). Conclusions and Relevance: Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.

6.
Influence of Alcohol and Red Meat Consumption on Life Expectancy: Results of 164 Countries From 1992 to 2013.

Ranabhat CL, Park MB, Kim CB.

Nutrients. 2020;12(2):E459. doi:10.3390/nu12020459.

Background: High consumption of red meat, which is carcinogenic to humans, and misuse or abuse of alcohol drinking increase premature death and shortened life expectancy. The aim of this study was to examine the association of alcohol and red meat consumption with life expectancy (LE) by analyzing data from 164 countries using an ecological approach.

Design: This was a longitudinal ecological study using data from the United Nation's (UN) Food and Agriculture Organization (FAO) for 164 countries over the period 1992-2013. In regression analysis, the relationship of alcohol and red meat consumption with LE was estimated using a pooled ordinary least squares regression model. Alcohol and red meat consumption were measured every 5 years.

Results: The consumption of alcohol and red meat in high-income countries (HIC) was about 4 times (36.8-143.0 kcal/capita/day) and 5 times (11.2-51.9 kcal/capita/day) higher than that in low-income countries (LIC). Red meat and alcohol consumption had a negative estimated effect on LE in HIC (b = -1.616 = <0.001 and b = -0.615, = 0.003). Alcohol consumption was negatively associated with LE for all income groups, while positive relationships were found for all estimates associated with gross national income (GNI).

Conclusions: Red meat and alcohol consumption appeared to have a negative impact on LE in high-income countries (HIC) and upper-middle-income countries (UMIC), although it had no significant association with LE in low-income countries (LIC) or lower-middle-income countries (LMIC). This study suggests reviewing the policies on the gradual reduction of alcohol abuse and the high consumption of red meat, particularly HIC and UMIC.

7.
Health Effects of Dietary Risks in 195 Countries, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study 2017.

Lancet (London, England). 2019;393(10184):1958-1972. doi:10.1016/S0140-6736(19)30041-8.

Leading Journal

Background: Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity.

Methods: By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of disease-specific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome.

Findings: In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.

Interpretation: This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.

Funding: Bill & Melinda Gates Foundation.