Association of changes in diet quality with total and cause-specific mortality
Open accessAbstract
BACKGROUND: Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. METHODS: 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. RESULTS: 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. CONCLUSIONS: Improved diet quality over 12 years was consistently associated with a decreased risk of death. (Funded by the National Institutes of Health.).
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A core component of collaborative care models is the involvement of several health care professionals working together, typically including a physician, a case manager, and a mental health clinician.
“A core component of CC models is the involvement of several health care professionals working together; with CC teams typically including a physician, a case manager, and a mental health clinician.357,358”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [357]
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“Sotos-Prieto et al 33 reported an 8% to 17% reduction in total mortality and a 7% to 15% reduction in cardiovascular mortality per 20-percentile increase in diet quality, over a 12-year period, in the NHS (Nurses’ Health Study) and the HPFS (Health Professionals Follow-Up Study).”
INTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES"
Dedov, I. I., Shestakova, M. V., Mel'nichenko, G. A., Mazurina, N. V., Andreeva, E. N., Bondarenko, I. Z., Руслановна, Г. З., Dzgoeva, F. K., Елисеев, М. С., Ershova, E. V., et al. (2021) · Obesity and metabolism · doi:10.14341/omet12714 · Cited by 162 · see citing works
Higher diet quality relates to decelerated epigenetic aging
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Chinese Guideline on the Primary Prevention of Cardiovascular Diseases
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The Deficit of Nutrition Education of Physicians
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Extending Methods in Dietary Patterns Research
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“• Status: Tools such as food frequency questionnaires (FFQs) have been used at repeated time points to assess the effect of change and the potential for change [9]; however, FFQs do not capture short-term within person variation to allow for investigation of diurnal variation or timing, and the inherent structure cann…”
BackgroundBurden of cancer attributable to obesity, type 2 diabetes and associated risk factors
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“The characteristics of other MD indexes, such as the aMED [40,44,45,47,49,51], the mMED [50], and the rMED [39,42], are described in the original studies [30,63] and elsewhere [64].”
BackgroundMethodMartínez‐González, M. Á., Sayón-Orea, C., Bullón‐Vela, V., Bes‐Rastrollo, M., Rodríguez‐Artalejo, F., Yusta-Boyo, M. J., & García‐Solano, M. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.10.001 · Cited by 103 · see citing works
Dietary Patterns and Cardiovascular Disease Risk in People with Type 2 Diabetes
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Overall Dietary Quality Relates to Gut Microbiota Diversity and Abundance
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“well as total cholesterol and LDL-C (26,27) and has been associated with a lower risk of cardiovascular disease (28–30), type 2 diabetes (31,32), and mortality (33,34).”
BackgroundGil, Á., & Anta, R. M. O. (2019) · Advances in Nutrition · doi:10.1093/advances/nmz020 · Cited by 93 · see citing works
“Improving food habits, both at the societal and individual level, is essential to achieving a healthy diet and requires a population-based, multisectoral, multidisciplinary, and culturally relevant approach (4, 5).”
BackgroundAdawi, M., Damiani, G. B., Bragazzi, N. L., Bridgewood, C., Pacifico, A., Conic, R. R. Z., Morrone, A., Malagoli, P., Pigatto, P. D. M., Amital, H., et al. (2019) · Nutrients · doi:10.3390/nu11030601 · Cited by 89 · see citing works
“Dietary habits have been found to have a significant impact on human health, affecting the risk for hypertension and cardiovascular diseases, as well as influencing the risk of developing malignant conditions and impacting on mortality [12].”
BackgroundSotos‐Prieto, M., Ortolá, R., Ruiz‐Canela, M., García‐Esquinas, E., Martínez‐Gómez, D., López‐García, E., Martínez‐González, M. Á., & Rodríguez‐Artalejo, F. (2021) · Cardiovascular Diabetology · doi:10.1186/s12933-020-01195-1 · Cited by 89 · see citing works
Dietary and Lifestyle-Centered Approach in Gout Care and Prevention
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Metabolic syndrome and cancer: “The common soil hypothesis”
Bellastella, G., Scappaticcio, L., Esposito, K., Giugliano, D., & Maiorino, M. I. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.05.024 · Cited by 83 · see citing works
Evaluation of the Validity and Reliability of the Chinese Healthy Eating Index
Yuan, Y., Li, F., Wu, H., Wang, Y.-C., Chen, J., He, G., Li, S., & Chen, B. (2018) · Nutrients · doi:10.3390/nu10020114 · Cited by 81 · see citing works
“Studies have proved that high-quality diets are associated with a reduction in the risk of various health outcomes, including cardiovascular diseases, cancer, type 2 diabetes mellitus, and all-cause mortality [3,4].”
BackgroundTrijsburg, L. E., Talsma, E. F., Crispim, S. P., Garrett, J., Kennedy, G., de Vries, J. H. M., & Brouwer, I. D. (2020) · Nutrients · doi:10.3390/nu13010093 · Cited by 81 · see citing works
“Another approach, which is used for many national food based dietary guidelines (FBDG) often take into account the current dietary pattern and recognize that even small deviations towards a healthy dietary pattern can lead to positive health outcomes [28,29].”
BackgroundDietary patterns, dietary nutrients and cardiovascular disease
Nestel, P. J., & Mori, T. A. (2022) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2301017 · Cited by 85 · see citing works
“The US Nurses’ Health Study (47,994 women) and the Health Professionals Follow-up Study (25,745 men) reported significantly lower CVD event rates over 12-years [17].”
BackgroundOverweight, Obesity, and CVD Risk: a Focus on Visceral/Ectopic Fat
Chartrand, D. J., Murphy-Després, A., Alméras, N., Lemieux, I., Larose, É., & Després, J. (2022) · Current Atherosclerosis Reports · doi:10.1007/s11883-022-00996-x · Cited by 84 · see citing works
Effects of Diet and Sodium Reduction on Cardiac Injury, Strain, and Inflammation
Juraschek, S. P., Kovell, L. C., Appel, L. J., Miller, E. R., Sacks, F. M., Chang, A. R., Christenson, R. H., Rebuck, H., & Mukamal, K. J. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.03.320 · Cited by 76 · see citing works
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Health Center–Based Community-Supported Agriculture: An RCT
Berkowitz, S. A., O’Neill, J., Sayer, E., Shahid, N. N., Petrie, M., Schouboe, S., Saraceno, M., & Bellin, R. (2019) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2019.07.015 · Cited by 74 · see citing works
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“Higher diet quality has been reported to be associated with better health status and lower mortality rate (15).”
BackgroundBlackstone, N. T., & Conrad, Z. (2020) · Current Developments in Nutrition · doi:10.1093/cdn/nzaa015 · Cited by 71 · see citing works
“The “small changes” approach (15–17) recognizes that even moderate dietary shifts can lead to positive health outcomes (18), so individuals should strive to make incremental dietary improvements that can be more easily adopted and sustained, rather than making more extensive changes all at once (15–17).”
BackgroundGut Microbiota and Salivary Diagnostics: The Mouth Is Salivating to Tell Us Something
Kodukula, K., Faller, D. V., Harpp, D. N., Kanara, I., Pernokas, J., Pernokas, M., Powers, W. R., Soukos, N. S., Steliou, K., & Moos, W. H. (2017) · BioResearch open access · doi:10.1089/biores.2017.0020 · Cited by 69 · see citing works
LeBlanc, K. E., Baer-Sinnott, S., Lancaster, K. J., Campos, H., Lau, K., Tucker, K. L., Kushi, L., & Willett, W. C. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100221 · Cited by 54 · see citing works
“These scores predict mortality and a wide variety of other health outcomes across different cultures [84,85], although studies among populations of Asia, Africa, and Latin America remain limited.”
Gaye, B., Tajeu, G. S., Vasan, R. S., Lassale, C. M., Allen, N. B., Singh‐Manoux, A., & Jouven, X. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.017458 · Cited by 66 · see citing works
Fenton, S., Burrows, T. L., Skinner, J. A., & Duncan, M. J. (2020) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12813 · Cited by 68 · see citing works
Chiu, Y., Chavarro, J. E., Dickerman, B. A., Manson, J. E., Mukamal, K. J., Rexrode, K. M., Rimm, E. B., & Hernán, M. Á. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab100 · Cited by 67 · see citing works
Owen, A., Tran, T. D., Hammarberg, K., Kirkman, M., & Fisher, J. (2020) · Public Health Nutrition · doi:10.1017/s1368980020003833 · Cited by 63 · see citing works
Diet quality trends among adults with diabetes by socioeconomic status in the U.S.: 1999–2014
Orr, C. J., Keyserling, T. C., Ammerman, A. S., & Berkowitz, S. A. (2019) · BMC Endocrine Disorders · doi:10.1186/s12902-019-0382-3 · Cited by 64 · see citing works
“The HEI 2010 has been validated in previous research [14] and shown to be associated with diabetes prevalence [15], glycemic control [7], and with risk for a variety of other common chronic diseases [15, 16].”
MethodGuo, R., Li, N., Yang, R., Liao, X.-Y., Zhang, Y., Zhu, B.-F., Zhao, Q., Chen, L., Zhang, Y.-G., & Lei, Y. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.725020 · Cited by 62 · see citing works
“Exclusion criteria were as follows: (1) study design: case reports, case series, observational studies, and animal research; (2) participants: individuals <18 years of age, pregnant women, and acute patients; (3) comparison: other different routes of modified DASH diet; (4) outcomes: outcomes with insufficient data, s…”
BackgroundMethodHu, F. B., Drescher, G., Trichopoulou, A., Willett, W. C., & Martínez‐González, M. Á. (2025) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.04.036 · Cited by 62 · see citing works
“with an 8 – 17% lower risk of mortality for every 20-percentile increase in diet quality scores [28].”
Han, T., Gao, J., Wang, L., Li, C., Qi, L., Sun, C., & Li, Y. (2020) · Diabetes Care · doi:10.2337/dc19-2289 · Cited by 61 · see citing works
“The most important finding of this study was that higher intake of energy at dinner than breakfast was significantly associated with diabetes and CVD mortality, and this association was independent of a series of traditional dietary risk factors, in particular, breakfast skipping anddiet quality (27,28).”
BackgroundKorat, A. V. A., Shea, M. K., Jacques, P. F., Paola Sebastiani, B., Wang, M., Eliassen, A. H., Willett, W. C., & Sun, Q. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2023.11.010 · Cited by 64 · see citing works
“Diet is an important modi fi able factor of several chronic diseases [3,4], frailty [5], premature death [6], and successful or healthy aging [7,8], which are relevant to this vulnerable population.”
BackgroundLim, S., Hill, B., Pirotta, S., O’Reilly, S., & Moran, L. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9010237 · Cited by 58 · see citing works
“However, improved diet quality independent of weight changes could improve total and cause-specific mortality [53], and considering the high risk of weight gain in this population [54], a modest energy restriction to prevent further weight gain could support chronic diseases prevention [55].”
BackgroundMatsuyama, S., Zhang, S., Tomata, Y., Abe, S., Tanji, F., Sugawara, Y., & Tsuji, I. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.10.008 · Cited by 57 · see citing works
Liu, D., Zhang, X., Li, Z., Zhang, Y., Lv, Y., Wang, Z., Shen, D., Chen, P., Zhong, W.-F., Huang, Q., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.04.012 · Cited by 57 · see citing works
Livingstone, K. M., Abbott, G., Ward, J., & Bowe, S. J. (2021) · Nutrients · doi:10.3390/nu13124283 · Cited by 59 · see citing works
Livingstone, K. M., Abbott, G., Bowe, S. J., Ward, J., Milte, C. M., & McNaughton, S. A. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045362 · Cited by 55 · see citing works
Thorndike, A. N., Gelsomin, E. D., McCurley, J. L., & Levy, D. E. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.6789 · Cited by 56 · see citing works
A Coaching Program to Improve Dietary Intake of Patients with CKD
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Huitink, M., Poelman, M. P., van den Eynde, E., Seidell, J. C., & Dijkstra, S. C. (2020) · Appetite · doi:10.1016/j.appet.2020.104655 · Cited by 56 · see citing works
Association between dietary carbohydrate quality and the prevalence of obesity and hypertension
Kim, D.-Y., Kim, S. H., & Lim, H. (2018) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12559 · Cited by 55 · see citing works
“A 12-year follow-up study suggested that an improved diet was associated with a decreased risk of death from cardiovascular disease related to metabolic disorders ((4)).”
Gu, X., Wang, D. D., Sampson, L., Barnett, J. B., Rimm, E. B., Stampfer, M. J., Djoussé, L., ROSNER, B. A., & Willett, W. C. (2023) · American Journal of Epidemiology · doi:10.1093/aje/kwad170 · Cited by 52 · see citing works
Impact of Genes and Environment on Obesity and Cardiovascular Disease
Heianza, Y., & Qi, L. (2018) · Endocrinology · doi:10.1210/en.2018-00591 · Cited by 54 · see citing works
Álvarez‐Álvarez, I., de Rojas, J. P., Fernández‐Montero, A., Zazpe, I., Ruiz‐Canela, M., Hidalgo-Santamaría, M., Bes‐Rastrollo, M., & Martínez‐González, M. Á. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318783263 · Cited by 51 · see citing works
Weber, B., Bersch-Ferreira, Â. C., Torreglosa, C. R., Marcadenti, A., Lara, E. S., da Silva, J. T., Costa, R. P., Santos, R. H. N., Berwanger, O. B., Bosquetti, R., et al. (2019) · American Heart Journal · doi:10.1016/j.ahj.2019.06.010 · Cited by 53 · see citing works
Lagström, H., Stenholm, S., Akbaraly, T. N., Pentti, J., Vahtera, J., Mika Kivimaki, B., & Head, J. A. (2019) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqz329 · Cited by 57 · see citing works
Sun, Y., Bao, W., Liu, B., Caan, B. J., Lane, D. S., Millen, A. E., Simon, M. S., Thomson, C. A., Tinker, L. F., Horn, L. V., et al. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.03.017 · Cited by 49 · see citing works
Lifestyle management to prevent atherosclerotic cardiovascular disease: evidence and challenges
Trier, T. J. V., Mohammadnia, N., Snaterse, M., Peters, R. J. G., Jorstad, H. T., & Bax, W. A. (2021) · Netherlands Heart Journal · doi:10.1007/s12471-021-01642-y · Cited by 52 · see citing works
“On the other hand, in a recent large prospective study, adherence to a DASH-style diet was significantly associated only with all-cause mortality but not cardiovascular mortality [43].”
ResultBonaccio, M., Costanzo, S., Castelnuovo, A. F. D., Gialluisi, A., Ruggiero, E., Curtis, A. D., Persichillo, M., Cerletti, C., Donati, M. B., de Gaetano, G., et al. (2022) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2022.12.005 · Cited by 48 · see citing works
Yoo, E. R., Kim, D., Vazquez‐Montesino, L. M., Escober, J. A., Li, A. A., Tighe, S. P., Fernandes, C. T., Cholankeril, G. T., & Ahmed, A. (2020) · Liver International · doi:10.1111/liv.14374 · Cited by 48 · see citing works
Plant‐Centered Diet and Risk of Incident Cardiovascular Disease During Young to Middle Adulthood
Choi, Y., Larson, N., Steffen, L. M., Schreiner, P. J., Gallaher, D. D., Duprez, D. A., Shikany, J. M., Rana, J. S., & Jacobs, D. R. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.020718 · Cited by 46 · see citing works
Zhang, Y., Pan, X., Lu, Q., Wang, Y.-X., Geng, T., Zhou, Y., Liao, L. M., Tu, Z., Chen, J., Xia, P., et al. (2022) · Diabetologia · doi:10.1007/s00125-022-05754-x · Cited by 46 · see citing works
“Such methods were widely used in previous pooling projects [25, 26].”
MethodMediterranean Diet Adherence and Risk of All-Cause Mortality in Women
Ahmad, S., Moorthy, M. V., Lee, I.-M. M., Ridker, P. M., Manson, J. E., Buring, J. E., Demler, O., & Mora, S. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.14322 · Cited by 47 · see citing works
Sleep and Dietary Patterns in Pregnancy: Findings from the GUSTO Cohort
van Lee, L., Chia, A., Loy, S. L., Colega, M., Tham, E. K. H., Cai, S., Yap, F. K. P., Godfrey, K. M., Teoh, O. H., Goh, D. Y. T., et al. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14111409 · Cited by 45 · see citing works
“Furthermore, even moderate changes in diet quality have been shown to decrease the risk of death meaningfully [39].”
BackgroundPala, V. M., Sieri, S., Chiodini, P., Masala, G., Palli, D., Mattiello, A., Panico, S., Tumino, R., Frasca, G., Fasanelli, F., et al. (2019) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqz183 · Cited by 44 · see citing works
“A healthy diet is associated with decreased risk of death (1).”
BackgroundBeydoun, H. A., Huang, S., Beydoun, M. A., Hossain, S. A., & Zonderman, A. B. (2019) · Nutrients · doi:10.3390/nu11102311 · Cited by 44 · see citing works
“Broadly speaking, the DASH dietary pattern has been linked to reductions of 8–22% in all-cause mortality, 19–28% in cardiovascular disease-specific mortality and 11–23% in cancer-specific mortality risks [9].”
BackgroundResult
- Authors
- Sotos-Prieto, M., Bhupathiraju, S. N., Mattei, J., Fung, T. T., Li, Y., Pan, A., Willett, W. C., Rimm, E. B., & Hu, F. B.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-07-13
- Volume
- 377
- Issue
- 2
- Pages
- 143-153
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5589446
- OpenAlex
- W2734661169
- Cited by
- 466
- References
- 37
- Citations by year
- 2026: 27 · 2025: 38 · 2024: 45 · 2023: 55 · 2022: 47 · 2021: 76 · 2020: 66 · 2019: 46 · 2018: 56 · 2017: 10
- FWCI
- 45.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k01hl120951-05)
- National Heart, Lung, and Blood Institute (R01HL060712, K01‐HL120951, R01HL035464, R01HL034594, R01HL088521)
- National Cancer Institute (P01CA087969, P01CA055075, UM1CA186107, UM1CA167552)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK046200)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- diet quality, dietary change over time, all-cause mortality, cause-specific mortality, cardiovascular mortality, Alternative Healthy Eating Index, alternate Mediterranean diet, DASH diet, diet quality index, Nurses' Health Study, Health Professionals Follow-up Study, men and women comparison, diet and longevity, diet and disease prevention, diet and cancer prevention
- MeSH terms
- Diet, Healthy, Adult, Aged, Cause of Death, Diet, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk, Multivariate Analysis, Proportional Hazards Models
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