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Cited by 203Nutritional Studies and DietNutrition, Health, and Society StudiesAgriculture Sustainability and Environmental Impact

Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review

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English, Laural K., Ard, Jamy D., Bailey, Regan L., Bates, Marlana, Bazzano, Lydia A., Boushey, Carol J., Brown, Clarissa, Butera, Gisela, Callahan, Emily H., de Jesus, Janet, Mattes, Richard D., Mayer-Davis, Elizabeth J., Novotny, Rachel, Obbagy, Julie E., Rahavi, Elizabeth B., Sabate, Joan, Snetselaar, Linda G., Stoody, Eve E., Van Horn, Linda V., Venkatramanan, Sudha, Heymsfield, Steven B.·2021·JAMA Network Open
DOI 10.1001/jamanetworkopen.2021.22277PMC PMC8408672
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Abstract

Importance: The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)? Objective: To ascertain the association between dietary patterns consumed and ACM. Evidence Review: Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements. Findings: A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings. Conclusions and Relevance: In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.

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Crossref · 10.1001/jamanetworkopen.2021.22277

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  • The acceptable macronutrient distribution range (AMDR) for carbohydrates for healthy adults is 45% to 65% of energy intake, corresponding to approximately 135 to 245 g/day for a 1200-to 1500-kcal/day diet or 170 to 290 g/day for a 1500-to 1800-kcal/day diet.

    “The acceptable macronutrient distribution range (AMDR) for carbohydrates for healthy adults is 45% to 65% of energy intake [42,56], which corresponds to approximately 135 to 245 g/day for a 1200-to 1500-kcal/day diet or 170 to 290 g/day for a 1500-to 1800-kcal/day diet.”

    From Nutritional considerations with antiobesity medications (2024) · cites this paper as [56]

  • The Recommended Dietary Allowance for protein for healthy adults of normal weight is 0.8 g/kg body weight/day, and USDA guidelines suggest a minimum goal of 46 g/day for healthy women and 56 g/day for healthy men.

    “The Recommended Dietary Allowance for protein for healthy adults of normal weight is 0.8 g/kg body weight/day, and USDA guidelines suggest a minimum goal of 46 g/day for healthy women and 56 g/day for healthy men [42,56].”

    From Nutritional considerations with antiobesity medications (2024) · cites this paper as [56]

    The Methods passage gives an acceptable macronutrient distribution range for protein as a percentage of energy, not a Recommended Dietary Allowance in g/kg/day. Searches for 0.8 g/kg/day and the 46 g/day and 56 g/day goals found no passage in our copy stating those figures; page numbers were not available. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • The Adequate Intake level for fluids is 2.2 L/day for women and 3.0 L/day for men.

    “The Adequate Intake level for fluids is 2.2 L/day for women and 3.0 L/day for men, and fluid requirements can increase further with physical activity or hot climates [56].”

    From Nutritional considerations with antiobesity medications (2024) · cites this paper as [56]

    The Methods passage (page not provided) discusses macronutrient intake ranges, not fluid intake. Searches for the stated Adequate Intake values and for hydration needs during activity or hot weather found no passage in our copy addressing either point. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Older adults may have a greater risk of dehydration than younger individuals due to aging-associated changes in thirst and decreased urinary concentrating capacity.

    “In addition, older adults may have a greater risk of dehydration than younger individuals due to multiple factors, including aging-associated changes in thirst and decreased urinary concentrating capacity [56,89].”

    From Nutritional considerations with antiobesity medications (2024) · cites this paper as [56]

    The Conclusions discuss dietary patterns and all-cause mortality in adults and older adults, not dehydration risk. Searches for dehydration, thirst, and urinary concentrating capacity found no passage in our copy addressing the claimed age-related mechanisms. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Fluid requirements can increase further with physical activity or hot climates.

    “The Adequate Intake level for fluids is 2.2 L/day for women and 3.0 L/day for men, and fluid requirements can increase further with physical activity or hot climates [56].”

    From Nutritional considerations with antiobesity medications (2024) · cites this paper as [56]

    The Results (Evidence Synthesis) discuss physical activity in relation to dietary patterns and mortality, not fluid requirements. The Methods discuss macronutrient intake ranges, but give no fluid Adequate Intake levels. Searches for increased fluid needs during activity or heat and for the stated intake levels found no supporting passage in our copy; page numbers were unavailable. (LLM, conf=0.76)

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Authors
English, L. K., Ard, J. D., Bailey, R. L., Bates, M., Bazzano, L. A., Boushey, C. J., Brown, C., Butera, G., Callahan, E. H., de Jesus, J., Mattes, R. D., Mayer-Davis, E. J., Novotny, R., Obbagy, J. E., Rahavi, E. B., Sabate, J., Snetselaar, L. G., Stoody, E. E., Van Horn, L. V., Venkatramanan, S., & Heymsfield, S. B.
Affiliations
  • United States Department of Agriculture (US)
  • Wake Forest University Health Sciences (US)
  • Purdue University West Lafayette (US)
  • Tulane University (US)
  • University of Hawaii Cancer Center (US)
  • Center for Nutrition Policy and Promotion (US)
  • Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
  • Departments of Nutrition and Medicine, The University of North Carolina at Chapel Hill, Chapel Hill
  • University of Hawaiʻi at Mānoa (US)
  • Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California
  • University of Iowa (US)
  • Nutrition Division, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • Pennington Biomedical Research Center (US)
Corresponding author
Heymsfield, Steven B.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2021-08-31
Volume
4
Issue
8
Pages
e2122277
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2021.22277
PMC
PMC8408672
OpenAlex
W3197253811
Cited by
203
References
11
Citations by year
2026: 21 · 2025: 53 · 2024: 56 · 2023: 31 · 2022: 37 · 2021: 5
FWCI
5.74
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
  • Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
Keywords
dietary habits, all-cause mortality, Dietary Guidelines for Americans, healthy eating, fruit and vegetable intake, legumes and nuts, whole grains, fish consumption, red and processed meat, high-fat dairy, refined carbohydrates, alcohol consumption, nutrient-dense diet, older adults
MeSH terms
Diet, Healthy, Cause of Death, Diet, Humans, United States, Nutrition Policy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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