Diet and Cancer
Objectives : The 2015 Dietary Guidelines for Americans (DGA) recommend a healthy eating pattern for chronic disease prevention. This study aimed to prospectively evaluate diet quality by adherence to the 2015 DGA in association with mortality outcomes among a representative sample of US adults.
Methods : Using dietary data collected by 24-hour diet recalls among 29,098 US adults aged 20+ years from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2010, we estimated adherence to the 2015 DGA using the Healthy Eating Index-2015 (HEI-2015). Mortality from all cause, cardiovascular diseases (CVD), and cancer were obtained from linkage to the National Death Index Mortality data. Cox proportional-hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after multivariable adjustments.
Results : The mean (SE) of total HEI-2015 was 50.1 (0.2). During a median follow-up of 6.2 years, 2,861 total deaths occurred, including 726 CVD and 671 cancer deaths. Compared to individuals in the lowest quartile of HEI-2015, those in the highest quartile had a 16% lower risk of all-cause mortality (Q4 vs. Q1: HR=0.84; 95% CI: 0.72-0.90; p-trend=0.04) and a 31% lower risk of cancer mortality (Q4 vs. Q1: HR=0.69; 95% CI: 0.50-0.95; p-trend=0.06). The lower all-cause and cancer mortality among those with higher HEI-2015 scores was confined to individuals with comorbidity conditions at baseline (all-cause mortality: Q4 vs. Q1: HR=0.79; 95% CI: 0.67-0.94; p-trend=0.005; cancer mortality: Q4 vs. Q1: HR=0.46; 95% CI: 0.30-0.69; p-trend=0.001), former smokers (all-cause mortality: Q4 vs. Q1: HR=0.65; 95% CI: 0.49-0.88; p-trend=0.006; cancer mortality: Q4 vs. Q1: HR=0.47; 95% CI: 0.29-0.74; p-trend=0.005), and those with a body mass index of 18.5-25kg/m2 (all-cause mortality: Q4 vs. Q1: HR=0.60; 95% CI: 0.46-0.79; p-trend< 0.001; cancer mortality: Q4 vs. Q1: HR=0.40; 95% CI: 0.22-0.70; p-trend=0.001). Similar associations were found between men and women. No significant associations were observed between HEI-2015 and CVD mortality.
Better adherence to the 2015 Dietary Guidelines of Americans is associated with lower all-cause and cancer mortality among US adults.
Funding Sources : National Institute of Health/ National Institute of Minority Health and Health Disparities