5MinuteConsult Journal Club

Healthy Living by Healthy Eating

Reference

JAMA Intern Med. doi:10.1001/jamainternmed.2022.6117

Study Summary

This is a prospective cohort study of initially healthy women from the Nurses’ Health Study (NHS; 1984-2020) and men from the Health Professionals Follow-up Study (HPFS; 1986-2020) where repeated measures of dietary habits were correlated with mortality outcomes.

Dietary scores for 4 healthy dietary patterns, including the Healthy Eating Index 2015 (HEI-2015) (a measure for assessing whether a set of foods aligns with the Dietary Guidelines for Americans (DGA)., Alternate Mediterranean Diet (AMED) score, Healthful Plant-based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI). These dietary assessments have similar components: high consumption of plant-based foods like vegetables, fruits, legumes, monounsaturated fats, and nuts, as well as the low consumption of processed meats and saturated fats.

Study participants were queried using food-frequency questionnaire every 2 – 4 years and followed for over 30 years.

Outcomes

Foods correlating with improved outcomes included high intake of whole grains, fruits, vegetables, nuts, and legumes. Using multivariable analysis, HRs of total mortality were 0.81 (95%CI, 0.79-0.84) for HEI-2015, 0.82 (95%CI, 0.79-0.84) for AMED score, 0.86 (95%CI, 0.83-0.89) for HPDI, and 0.80 (95%CI, 0.77-0.82) for AHEI (P < .001 for trend for all).

All dietary scoring methods found a significantly inversed association with death from cardiovascular disease, cancer, and respiratory disease. Additionally, the AMED score and AHEI were inversely associated with mortality from neurodegenerative disease. These findings occurred across all racial and ethnic groups.

Conclusions

Diets high in fruits, vegetables, legumes, and nuts and limiting processed meats lowered risks for CV and all-cause mortality.

Discussion

This updated review from the Harvard School of Public Health research team tells us a recurrent story. How we eat can influence our mortality risks. While this study made national headlines, will it alter how Americans eat?

YES: if we EFFECTIVELY share the message. While a constant skeptic of the USDA, these resources (https://www.dietaryguidelines.gov/professional-resources); may provide you with handouts for the office and signs for your exam rooms.

Competing with “$3.99” convenience store foods is no easy matter. It will take work far beyond our reach to change how the US (and world) farming and food industries are subsidized.

But one on one, helping patients make better food choices will improve their health outcomes and lower our work. My NNT to help patients lose weight is under 4.

It can be done, if we focus on dietary counseling (using motivational interviewing) rather than A1c or cholesterol numbers. A wonderful dietician friend encourages patients to “Eat More!” Eat more of the good stuff and make the less good a unique occasion rather than a daily intake.

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