How to eat to maximize longevity
- Live longer by eating these every day:
- Whole grains: 3 servings
- Vegetables (excluding potatoes): 3 servings
- Fruit: 3 servings
- Nuts: 1 serving
- Olive oil: 2 tbsp
- These also promote longevity:
- As supplemental foods, these pose no risk:
- Refined grains
- Sweets in solid form (not sugary beverages)
- Avoid these foods for a longer life:
- Processed meats (containing nitrates/nitrites)
- Red meat (beef and pork)
- Fried foods (including fried fish and fried potatoes)
- Sugar sweetened beverages
How foods affect mortality risk
Foods that lower mortality risk
- Whole grains:
- -25% (3 servings/day, optimal)
- -17% (3 servings/day, optimal)
- -17% (high vs low intake)
- -16% (high vs low intake)
- -12% (daily vs/ non-daily intake)
- -32% (3+ servings/day vs low)
- -25% (6 servings/day, optimal)
- -25% (3 servings/day, optimal)
- -16% (high vs low intake)
- -11% (3 servings/day, optimal)
- -4% per serving
- Olive Oil:
- -26% (high vs low consumption)
- -23% (2 tbsp per day vs none)
- -22% (1 serving/day, optimal)
- -17% (1 serving/day, optimal)
- -19% (6 servings/day, optimal)
- -17% (3 servings/day, optimal)
- -16% (3 servings/day, optimal)
- -10% (2.5 servings/day, optimal)
- -16% (3 servings/day, optimal)
- -10% (high vs low intake)
- -11% (at 2+ servings/week)
- -10% (at 2 servings/day)
- -8% (high vs low intake)
- -5% (one serving/day)
- 0% (high vs low intake)
Foods that do not affect mortality risk
- -2% (1 serving/day, optimal)
- 0% (1 serving/day)
- 0% (<4 servings)
- +15% (4+ servings)
- 0% (high vs low intake)
- 0% (one serving/day)
- Milk: 0%
- +1% (each tablespoon per day)
- 0% (< 2,645mg or > 4,945mg/day detrimental)
- 0% (high vs low intake)
- 0% (high vs low intake)
- 0% (optimal intake is >5% of calories but <20%)
- sugar-sweetened solid foods reduce mortality risk but sugar-sweetened beverages increase risk
- Refined grains:
- -22% (high vs low intake)
- 0% (high vs low intake)
- 0% (high vs low intake)
- 0% (high vs low intake, large study)
- -7% (each daily serving)
Foods that increase mortality risk
- Sugar sweetened beverages:
- +7% (each daily serving)
- +19% (high vs low intake)
- Fried food:
- +7% (fried fish, 1+ serving week)
- +8% (each daily serving)
- +27 (fried potatoes, high vs low intake)
- +126% (fried potatoes, >2 times a week)
- Red meat:
- +10% (each daily serving)
- +14% (2 servings/day vs 0.25)
- +14% (high vs low intake)
- +26% (high vs low intake)
- +29% (high vs low intake)
- 0% (high vs low intake)
- +8% (each 1/2 egg per day)
- +15% (each daily serving)
- +23% (>6 eggs per week)
- Processed meat:
- +23% (high vs low intake)
- +23% (each daily serving)
- +44% (2 servings/day vs 0.25)
Specific vegetables and mortality risk
- Non-potato vegetables: -16% (each daily serving)
- Raw vegetables:
- -16% (high vs low intake)
- -12% (high vs low intake)
- Cruciferous vegetables: -13% (high vs low intake)
- Salad: -13% (each daily serving)
- Green leafy vegetables: -8% (high vs low intake)
- Cooked vegetables:
- -7% (high vs low intake)
Specific fruits and mortality risk
- Fresh fruit:
- -21% (daily vs non-daily)
- -4% (each daily serving)
- Apples/pears: -20% (high vs low intake)
- Citrus: -10% (high vs low intake)
- Berries: -8% (high vs low intake)
- Canned fruit:
- +13% (high vs low intake)
- +17% (each daily serving)
Specific grains and mortality risk
- All bread: -23% (high vs low intake)
- Whole grain breakfast cereal: -21% (high vs low intake)
- Whole grain bread: -19% (high vs low intake)
- All breakfast cereal:
- -15% (high vs no intake)
- -13% (high vs low intake)
Specific nuts and mortality risk
- Tree nuts: -20% (high vs low intake)
- Peanuts: -15% (high vs low intake)
- Peanut butter: -11% (high vs low intake)
General diets and mortality
Optimal diet reduces mortality risk by 56%; poor diet increases risk by 50% (meta-analysis)
The aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups, including whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages, with risk of all-cause mortality. Results: With increasing intake (for each daily serving) of whole grains (RR risk ratio: 0.92), vegetables (RR: 0.96), fruits (RR: 0.94), nuts (RR: 0.76), and fish (RR: 0.93), the risk of all-cause mortality decreased; higher intake of red meat (RR: 1.10) and processed meat (RR: 1.23) was associated with an increased risk of all-cause mortality in a linear dose-response meta-analysis. Optimal consumption of risk-decreasing foods results in a 56% reduction of all-cause mortality, whereas consumption of risk-increasing foods is associated with a 2-fold increased risk of all-cause mortality.
High consumption of fruit/vegetables, low consumption of meat reduce mortality (meta-analysis)
Regarding Mediterranean diet components, relatively stronger and statistically significant inverse associations were highlighted for moderate/none-excessive alcohol consumption (0·86) and for above/below-the-median consumptions of fruit (0·88) and vegetables (0·94), whereas a positive association was apparent for above/below-the-median intake of meat (1·07). Our meta-analyses confirm the inverse association of Mediterranean diet with mortality and highlight the dietary components that influence mostly this association.
Replacing carbs with meat increases mortality risk by 18%; Replacing carbs with plants decreases it by 18% (n=432,179)
In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%) and mortality: a percentage of 50-55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432,179 participants), both low carbohydrate consumption (<40%) and high carbohydrate consumption (>70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1.20 for low carbohydrate consumption; 1.23 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1.18) and mortality decreased when the substitutions were plant-based (0.82).
Vegan and vegetarian diets do not decrease overall mortality risk (meta-analysis)
Aim of this study was to clarify the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence, and mortality from cardio-cerebrovascular diseases, total cancer and specific type of cancer, through meta-analysis. Results: Eighty-six cross-sectional and 10 cohort prospective studies were included. The analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75) and incidence of total cancer (RR 0.92) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer. The analysis conducted among vegans reported significant association with the risk of incidence from total cancer (RR 0.85), despite obtained only in a limited number of studies.
Vegetarian diets only associated with longevity among seventh day adventists (meta-analysis)
We searched for comparative studies that evaluated clinical outcomes associated with vegetarian diet as compared to non-vegetarian controls or the general population. Eight studies met the inclusion criteria with 183,321 participants (n=183,321). In all instances, we found that seventh day adventist studies showed greater effect size as compared to non-seventh day adventist studies: death (RR 0.68 vs RR 1.04 (not significant)), ischaemic heart disease (RR 0.60 vs RR 0.84). Sex specific analyses showed that heart disease was significantly reduced in both genders but risk of death and cerebrovascular disease was only significantly reduced in men. Conclusions: Data from observational studies indicates that there is modest cardiovascular benefit, but no clear reduction in overall mortality associated with a vegetarian diet. This evidence of benefit is driven mainly by studies in seventh day adventists, whereas the effect of vegetarian diet in other cohorts remains unproven.
Among health conscious individuals, vegetarians do not live longer (n=10771)
Results: 2064 (19%) subjects smoked, 4627 (43%) were vegetarian, 6699 (62%) ate wholemeal bread daily, 2948 (27%) ate bran cereals daily, 4091 (38%) ate nuts or dried fruit daily, 8304 (77%) ate fresh fruit daily, and 4105 (38%) ate raw salad daily. After a mean of 16.8 years follow up there were 1343 deaths before age 80. Overall the cohort had a mortality about half that of the general population. Within the cohort, daily consumption of fresh fruit was associated with significantly reduced mortality from all causes combined (0.79). Conclusions: In this cohort of health conscious individuals, daily consumption of fresh fruit is associated with a reduced mortality from all causes combined.
Milk, cheese, and butter do not increase mortality risk; meat does (meta-analysis)
We identified 26 publications with individual dietary data and all-cause, total cancer, or cardiovascular mortality as endpoints. Pooled relative risk estimates demonstrated that high intakes of milk, cheese, yogurt, and butter were not associated with a significantly increased risk of mortality compared with low intakes. High intakes of meat and processed meat were significantly associated with an increased risk of mortality.
Foods common in Mediterranean diet reduce risk of mortality (n=23349)
Controlling for potential confounders, higher adherence to a Mediterranean diet was associated with a statistically significant reduction in total mortality. The contributions of the individual components of the Mediterranean diet to this association were moderate ethanol consumption 23.5%, low consumption of meat and meat products 16.6%, high vegetable consumption 16.2%, high fruit and nut consumption 11.2%, high monounsaturated to saturated lipid ratio 10.6%, and high legume consumption 9.7%. The contributions of high cereal consumption and low dairy consumption were minimal, whereas high fish and seafood consumption was associated with a non-significant increase in mortality ratio.
Fish and olive oil may reduce mortality risk while meat increases risk (n=8937)
The risk of death was significantly lower among subjects with the highest fruit and vegetable consumption (at least one fruit and one vegetable, cooked or raw, per day versus less than one fruit and one vegetable, cooked or raw, per day (hazard ratio 0·90) and with regular fish consumption (more than twice a week versus less than twice per week) (hazard ratio 0·89). The benefit of olive oil use was found only in women (moderate olive oil use: hazard ratio 0·80; intensive use: hazard ratio 0·72). Conversely, daily meat (including poulty) consumption increased the mortality risk (HR 1·12). No association was found between risk of death and diet diversity and use of various fats. These findings suggest that fruits/vegetables, olive oil and regular fish consumptions have a beneficial effect on the risk of death, independently of the socio-demographic features and the number of medical conditions.
Fruits and veggies
Benefits to fruits and veggies maxes out at 5 servings combined, lowering mortality risk 26% (meta-analysis)
Sixteen prospective cohort studies were eligible in this meta-analysis. During follow-up periods ranging from 4.6 to 26 years there were 56,423 deaths among 833,234 participants. Higher consumption of fruit and vegetables was significantly associated with a lower risk of all cause mortality. Pooled hazard ratios of all cause mortality were 0.95 for an increment of one serving a day of fruit and vegetables, 0.94 for fruit, and 0.95 for vegetables. There was a threshold around five servings of fruit and vegetables a day, after which the risk of all cause mortality did not reduce further. Compared with people who had no daily consumption of fruit and vegetables, the estimated hazard ratios of all cause mortality were 0.92 for one serving/day of fruit and vegetables, 0.85 for two servings/day, 0.79 for three servings/day, 0.76 for four servings/day, 0.74 for five servings/day, and 0.74 for six or more servings/day. A lower risk of all cause mortality was observed in association with higher fruit consumption at about two servings a day (hazard ratio 0.83) and vegetable consumption at about three servings a day (0.75).
Eating a combined 8 servings per day of fruits and vegetables reduces mortality risk 31% (meta-analysis)
95 studies were included. For fruits and vegetables combined, the summary risk ratio per 200 g/day was 0.90 for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day. Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality. The summary risk ratio was 0.85 for fruits, and 0.87 for vegetables. There was evidence of nonlinearity for fruits and vegetables, fruits, and vegetables, respectively, with stronger reductions in risk at lower levels of intake. There were 31%, 19% and 25% reductions in the relative risk with intakes of 800 g/day for fruits and vegetables combined, and at 600 g/day for fruits, and for vegetables, respectively.
Combined fruit/veggie intake of 3 to 4 servings reduces mortality risk 22%; no benefit to more servings (n=135335)
Overall, combined mean fruit, vegetable and legume intake was 3.91 (SD 2.77) servings per day. The hazard ratio for total mortality was lowest for three to four servings per day (0.78) compared with the reference group, with no further apparent decrease in hazard ratio with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality.
Vegetables better for longevity than fruit (n=65226)
Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted hazard ratio for 7+ portions 0.67, reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58). Fruit and vegetable consumption was associated with reduced cancer (0.75) and cardiovascular mortality (0.69). Vegetables may have a stronger association with mortality than fruit (hazard ratio for 2 to 3 portions 0.81 and 0.90, respectively). In the fully adjusted model, there appeared to be a threshold for increasing survival with consumption of three to less than four portions of fruit daily (HR 0.84). The effect of vegetable consumption was greater, HR for three+ portions daily 0.68. Consumption of vegetables (0.85 per portion) or salad (0.87 per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 per portion). Conclusions: A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily.
Raw vegetables may promote longevity more than cooked vegetables (n=451,151)
Consumption of fruits and vegetables was inversely associated with all-cause mortality (for the highest quartile, hazard ratio = 0.90). This association was driven mainly by cardiovascular disease mortality (for the highest quartile, hazard ratio = 0.85). Stronger inverse associations were observed for participants with high alcohol consumption or high body mass index and suggested in smokers. When stratifying vegetable consumption by mode of preparation, we observed stronger inverse associations for raw vegetables (in the highest quartile, HR = 0.84) than for cooked vegetables (in the highest quartile, HR = 0.93). These results support the evidence that fruit and vegetable consumption is associated with a lower risk of death.
Nuts reduce mortality risk 19%; peanut butter and tree nuts both effective (meta-analysis)
Twenty studies were included in the meta-analysis. The summary risk ratio for high versus low intake was 0.81. The summary risk ratio was 0.78 per one serving per day. There was evidence of a nonlinear association between nut consumption and all-cause mortality, with a steeper reduction in risk at lower intakes, and no further reduction in risk above 15–20 grams per day. The summary risk ratio for high versus low intake of tree nuts was 0.80, that of peanuts was 0.85, and that of peanut butter was 0.89, and the respective summary risk ratios per 10 grams/day increase in intake were 0.82, 0.77, and 0.94, respectively.
Fish, especially when baked, reduces mortality risk (n=77604)
We observed 6914 deaths among 77,604 participants with dietary data (follow-up time 5.5 years). We investigated associations between mortality with fish and n-3 LCFA intake, adjusting for age, race, sex, kcal/day, body mass index (BMI), smoking, alcohol consumption, physical activity, income, education, chronic disease, insurance coverage, and meat intake. Intakes of fried fish, baked/grilled fish and total fish, but not tuna, were associated with lower mortality among all participants. Analysis of trends in overall mortality by quintiles of intake showed that intakes of fried fish, baked/grilled fish and total fish, but not tuna, were associated with lower risk of total mortality among all participants. When participants with chronic disease were excluded, the observed association remained only between intakes of baked/grilled fish.
High consumption of olive oil reduces mortality risk by 23% (meta-analysis)
Following subgroup analyses, significant associations could only be found between higher intakes of olive oil and reduced risk of all-cause mortality (RR: 0.77), cardiovascular events (RR: 0.72), and stroke (RR: 0.60), respectively. Subgroup analysis for mono-unsaturated fatty acids (of mixed animal and plant origin) did not reveal any significant risk reduction for all-cause mortality.
2 tbsp of olive oil per day reduces mortality risk 26% (n=40622)
A total of 40,622 participants (62% female) aged 29-69 y were recruited from 5 Spanish regions in 1992-1996. The association between olive oil (analyzed as a categorical and continuous variable) and overall and cause-specific mortality (CVD, cancer, and other causes) was analyzed. Results: In comparison with nonconsumers, the highest quartile of olive oil consumption was associated with a 26% reduction in risk of overall mortality and a 44% reduction in CVD mortality. For each increase in olive oil of 10 g · 2000 kcal, there was a 7% decreased risk of overall mortality and a 13% decreased risk of CVD mortality. No significant association was observed between olive oil and cancer mortality.
High intake of whole grains reduces mortality risk 18% (meta-analysis)
45 studies were included. The pooled relative risk for high versus low intake was 0.82. Although steeper reductions in risk were observed at lower intakes, there was a clear dose-response relation, and the lowest risk was observed at 225 g/day. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains.
3 servings of whole grains daily reduces mortality risk 17% (meta-analysis)
Twenty prospective cohort studies were included in the systematic review: 9 studies reported total whole-grain intake and 11 others reported specific whole-grain food intake. A greater intake of both total whole grains and specific whole-grain foods was significantly associated with a lower risk of all-cause mortality in the meta-analysis. The pooled risk ratio for all-cause mortality for an increase of 3 servings total whole grains/d (90 g/d) was 0.83.
Those consuming the most whole grains enjoy 16% lower risk of mortality (meta-analysis)
We included 19 cohort studies, with 1,041,692 participants. We observed an inverse relationship of whole grain intake with risk of total, cardiovascular disease and cancer mortality. The pooled risk ratio was 0.84 for total mortality, 0.83 for CVD mortality and 0.94 for cancer mortality, comparing the highest intake of whole grain with the lowest category. For dose-response analysis, we found a nonlinear relationship of whole grain intake with risk of total, cardiovascular and cancer mortality. Each 28 g/d intake of whole grains was associated with a 9% (pooled risk ratio: 0.91) lower risk for total mortality.
Those consuming highest ratio of whole grains/refined enjoy 17% lower risk of death (n=11040)
After multivariate adjustment in proportional hazards regression, women who consumed on average 1.9 g refined grain fiber/2,000 kcal and 4.7 g whole grain fiber/2,000 kcal had a 17% lower mortality rate (RR=0.83, 95% CI=0.73-0.94) than women who consumed predominantly refined grain fiber: 4.5 g/2,000 kcal, but only 1.3 g whole grain fiber/2,000 kcal.
Cereal reduces mortality risk 15% (n=367442)
Consumption of ready to eat cereal was significantly associated with reduced risk of mortality from all-cause mortality. In multivariate models, compared to nonconsumers of ready to eat cereal, those in the highest intake of ready to eat cereal had a 15% lower risk of all-cause mortality. Within ready to eat consumers, total fiber intakes were associated with reduced risk of mortality from all-cause mortality. Conclusions: Consumption of ready to eat cereal was associated with reduced risk of all-cause mortality. This association may be mediated via greater fiber intake.
Refined grains do not increase mortality risk, whole grains decrease risk (n=15792)
In contrast with the results for whole-grain intake, positive dose-response relations for total mortality and incident CAD were observed across quintiles of refined-grain intake after adjustment for demographic characteristics and energy intake. However, after further adjustment for potential confounding factors, the relations were attenuated. Compared with the subjects in the quintile with a mean intake of 0.5 servings of refined-grain foods/d, those in the quintile with a mean intake of 2 servings/d showed a trend for an increase in risk; however, the linear trend was not significant after adjustment for potential confounding factors.
Total dairy, cheese and yogurt are not associated with mortality risk (meta-analysis)
Random-effect meta-analyses with summarised dose-response data were performed for total (high-fat/low-fat) dairy, milk, fermented dairy, cheese and yogurt. A total of 29 cohort studies were available for meta-analysis, with 938,465 participants and 93,158 mortality, 28,419 CHD and 25,416 CVD cases. No associations were found for total (high-fat/low-fat) dairy, and milk with the health outcomes of mortality, CHD or CVD. Inverse associations were found between total fermented dairy (included sour milk products, cheese or yogurt; per 20 g/day) with mortality (RR 0.98) and CVD risk (RR 0.98). Further analyses of individual fermented dairy of cheese and yogurt showed cheese to have a 2% lower risk of CVD (RR 0.98) per 10 g/day, but not yogurt. All of these marginally inverse associations of totally fermented dairy and cheese were attenuated in sensitivity analyses by removing one large Swedish study. This meta-analysis combining data from 29 prospective cohort studies demonstrated neutral associations between dairy products and cardiovascular and all-cause mortality.
Milk, cheese, and yogurt do not increase mortality risk (meta-analysis)
A total of 8 meta-analyses were finally included after applying the inclusion and exclusion criteria. The risk ratios reported by the meta-analyses ranged from 0.96 to 1.01 per 200 g/d of dairy product consumption (including total, high-fat, low-fat, and fermented dairy products), from 0.99 to 1.01 per 200-244 g/d of milk consumption, and from 0.99 to 1.03 per 10-50 g/d of cheese consumption. The risk ratio per 50 g/d of yogurt consumption was 0.97 (95% CI: 0.85, 1.11). In conclusion, dairy product consumption is not associated with risk of all-cause mortality.
Cheese does not increase risk of mortality (meta-analysis)
The final analysis included nine prospective cohort studies involving 21,365 deaths. The summary risk ratio of all-cause mortality for the highest compared with the lowest cheese consumption was 1.02 (95% CI: 0.97, 1.06 not significant). The association between cheese consumption and risk of all-cause mortality did not significantly differ by study location, sex, age, number of events, study quality score or baseline diseases excluded. There was no dose-response relationship between cheese consumption and risk of all-cause mortality (risk ratio per 43 g/day = 1.03, 95% CI: 0.99-1.07 not significant). No significant publication bias was observed. Our findings suggest that long-term cheese consumption was not associated with an increased risk of all-cause mortality.
Butter increases mortality risk by 1% (meta-analysis)
We identified 9 publications including 15 country-specific cohorts, together reporting on 636,151 unique participants. Butter consumption was weakly associated with all-cause mortality (per 14g(1 tablespoon)/day: risk ratio = 1.01); was not significantly associated with any cardiovascular disease (risk ratio = 1.00), coronary heart disease (risk ratio = 0.99), or stroke (risk ratio = 1.01), and was inversely associated with incidence of diabetes (risk ratio = 0.96). We did not identify evidence for publication bias. Conclusions: This systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality.
Both low and high sodium diets increase mortality risk (meta-analysis)
Data from 23 cohort studies and 2 follow-up studies of random controlled trials (n = 274,683) showed that the risks of all cause mortality were decreased in usual sodium (between 2,645mg and 4,945mg) vs. low sodium intake (hazard ratio = 0.91) and increased in high sodium vs. usual sodium intake (hazard ratio = 1.16). Conclusions: Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.
No significant increase in overall mortality risk with increased salt intake (meta-analysis)
We included 14 cohort studies. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant. Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24), stroke mortality (1.63), and coronary heart disease mortality (1.32). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60).
No evidence of salt reduction improving mortality risk (meta-analysis)
Eight studies met the inclusion criteria. The risk ratios for all-cause mortality in normotensives were imprecise and showed no evidence of reduction or in hypertensives. There was weak evidence of benefit for cardiovascular events (pooled analysis of six trials (some including hypertensives) RR 0.77, 95% CI 0.63 to 0.95). These findings were driven by one trial among retirement home residents that reduced salt intake in the kitchens of the homes, thereby not requiring individual behaviour change. Health-related quality of life was assessed in one trial in normotensives, which reported significant improvements in well-being but no data were presented.
Sugar sweetened beverages increase mortality risk while sugary snacks do not (n=353,751)
The participants (n = 353,751), aged 50-71 y, were followed for up to 13 y. Results: In fully adjusted models (fifth quartile compared with first quartile), all-cause mortality was positively associated with the intake of total sugars [hazard ratio: 1.13], total fructose [1.10], and added fructose [1.07] in women and total fructose [1.06] in men. In men, a weak inverse association was found between other-cause mortality and dietary added sugars, sucrose, and added sucrose. Investigation of consumption of sugars by source showed that the positive association with mortality risk was confined only to sugars from beverages, whereas the inverse association was confined to sugars from solid foods. Conclusions: In this large prospective study, total fructose intake was weakly positively associated with all-cause mortality in both women and men, whereas added sugar, sucrose, and added sucrose intakes were inversely associated with other-cause mortality in men. In our analyses, intake of added sugars was not associated with an increased risk of mortality.
Sugar sweetened beverages only increase mortality risk in studies from the US (meta-analysis)
Five studies with 81,407 mortality cases were included in the high- compared with the low-intake meta-analysis (overall intake range: 0−930 mL/d). No association between all-cause mortality and sugar sweetened beverages was observed in the analysis of high compared with low intake We observed a positive association in studies conducted in America. The risk of all-cause mortality increased by ∼7% with increasing intake of sugar sweetened beverages up to ∼250 mL/d.
High intake of sugar sweetened drinks increases mortality risk 19% (n=69582)
Higher risk of total mortality was associated with greater intake of fast food intake (hazard ratio=1·16; comparing highest v. lowest quartile) and sugar sweetened drink (hazard ratio=1·19; comparing highest v. lowest quartile). Conclusions: Intake of fast food intake and sugar sweetened drinks has a detrimental effect on future mortality risk.
High sugar intake increases mortality risk, but so does low sugar intake (n=48747)
Higher sugar consumption was associated with a less favorable lifestyle in general. The lowest mortality risk was found with added sugar intakes between 7.5% and 10% of energy intake in both cohorts. Intakes >20% of energy were associated with a 30% increased mortality risk, but increased risks were also found at intakes <5% of energy [23% in the Malmö Diet and Cancer Study and 9% (nonsignificant) in the Northern Swedish Health and Disease Study]. By separately analyzing the different sugar sources, the intake of sugar sweetened beverages was positively associated with mortality, whereas the intake of treats was inversely associated. Conclusions: Our findings indicate that a high sugar intake is associated with an increased mortality risk. However, the risk is also increased among low sugar consumers, although they have a more favorable lifestyle in general. In addition, the associations are dependent on the type of sugar source.
High intake of added sugar does not significantly increase mortality risk (n=31147)
In the fully adjusted model, the hazard ratio for total mortality was 1.28 (95% CI, 0.94-1.75 not statistically significant) in the highest quintile. Detailed analysis between added sugar intake and each component of the healthy eating index suggested that added sugar intake was moderately and negatively correlated with total grain, vegetable, meat, and variety components and moderately and positively correlated with total fat and cholesterol intake. However, hazard ratios remained largely unchanged after adjusting each component of the healthy eating index.
Potatoes do not increase mortality risk, unless they are fried (n=566407)
Eating baked, boiled, or mashed potatoes, French fries or potato salad seven or more times per week was associated with higher risk of overall mortality. These results were attenuated in fully adjusted models (hazard ratio category 4 vs category 1 = 1.02, 95%CI = 0.97, 1.06 not significant). The only statistically significant association was that for French fry consumption with cancer-related mortality (HR C4 vs C1 = 1.27), a finding for which uncontrolled confounding could not be ruled out. Conclusion: We find little evidence that potato consumption is associated with all-cause or cause-specific mortality.
Potatoes do not increase mortality risk (n=2442)
The 2,442 eligible participants were aged a mean of 64.3 years. After adjusting for 12 potential baseline confounders, and taking those with the lowest consumption of potatoes as the reference group, participants with the highest consumption of potatoes did not have an increased overall mortality risk (HR=0.75; 95%CI: 0.53-1.07 not significant). Conclusion: Overall potato consumption was not associated with higher risk of death in older people living in a Mediterranean area.
Red meat and processed meat increases risk of mortality by 14% and 22%; no effect of white meat (meta-analysis)
In the meta-analysis combining the risk estimates for the highest v. the lowest consumption category, the consumption of processed meat but not of total, red and white meats was found to be positively associated with all-cause mortality (risk ratio 1.22). For red meat consumption, the heterogeneity remained when each study was excluded one by one, and a positive association was confirmed (risk ratio 1.14) when an Asian study was excluded. For white meat consumption, between-study heterogeneity decreased when a large American study was excluded, but no association with all-cause mortality was observed.
The dose–response analysis showed that the risk ratio for a 50 g/d increase in processed meat intake was 1.25. A positive association was found between red meat consumption and mortality risk in both men (risk ratio 1.21) and women (risk ratio 1.14).
Red meat and processed meat increase mortality risk, poultry does not (review)
The risk of death within 10 years was 16% higher in men with the highest compared to the lowest consumption (highest versus lowest quintile) of red meat (hazard ratio 1.31) and of processed meat (hazard ratio 1.16), respectively, after adjustment to 13 covariates associated with mortality. The corresponding data for women was a hazard ratio of 1.36 for red meat and 1.25 for processed meat when the highest and the lowest quintiles of consumption were compared. Lowest vs. highest quintiles of consumption in g per 1000 kcal were: 9.3 vs. 68.1 for men and 9.1 vs. 65.9 for women (red meat), and 5.1 vs. 19.4 for men and 3.8 vs. 16.0 for women (processed meat).
The overall mortality during the course of follow-up over 22 and 28 years in the two studies indicated an almost linear increase in the hazard ratio of mortality with increasing consumption of red meat. In men, the increase in risk was more pronounced than in women (hazard ratio 1.37 vs. 1.24) when comparing the highest quintile of consumption with the lowest (median: 174 g total red meat per day vs. 21 g in men, and 182 g vs. 43 g in women, respectively).
In 2013 the results of a large European study (EPIC) of the relationship between meat consumption and mortality in 448,568 men and women from 10 countries was published. An increased consumption of red meat (>160 g vs. 10–19.9 g per day) was associated with a mean increase of 14 % mortality during a mean follow-up of 13 years. The consumption of processed meat was associated with an even more pronounced 44% increase in mortality (>160 g compared to 10–19.9 g per day). The consumption of poultry showed no association with mortality.
Red meat and processed meat increase mortality risk, fish and poultry do not (n=536969)
Participants: 536,969 AARP members aged 50-71 at baseline. Results: An increased risk of all cause mortality (hazard ratio for highest versus lowest fifth 1.26) with red meat intake was observed. Both processed and unprocessed red meat intakes were associated with all cause and cause specific mortality. Heme iron and processed meat nitrate/nitrite were independently associated with increased risk of all cause and cause specific mortality. When the total meat intake was constant, the highest fifth of white meat intake was associated with a 25% reduction in risk of all cause mortality compared with the lowest intake level. When we analyzed the sources of white meat separately, the results were similar; the hazard ratio for all cause mortality was 0.93 for each 20 g/1000 kcal increase in daily intake of poultry and 0.95 for fish intake.
Red meat and processed meat increase mortality, white meat does not (n=500000)
The study population included the National Institutes of Health-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study cohort of half a million people aged 50 to 71 years at baseline. Men and women in the highest vs lowest quintile of red (hazard ratio, 1.31, and hazard ratio, 1.36, respectively) and processed meat (hazard ratio, 1.16, and hazard ratio, 1.25, respectively) intakes had elevated risks for overall mortality. When comparing the highest with the lowest quintile of white meat intake, there was an inverse association for total mortality and cancer mortality, as well as all other deaths for both men and women.
Red meat and processed meat increase mortality risk (meta-analysis)
The summary relative risks of all-cause mortality for the highest versus the lowest category of consumption were 1.23 for processed meat, and 1.29 for total red meat. In a dose-response meta-analysis, consumption of processed meat and total red meat was statistically significantly positively associated with all-cause mortality in a nonlinear fashion. These results indicate that high consumption of red meat, especially processed meat, may increase all-cause mortality.
Each 1/2 egg per day increases mortality risk by 8% (meta-analysis)
Among 29, 615 adults pooled from 6 prospective cohort studies in the United States with a median follow-up of 17.5 years, each additional 300 mg of dietary cholesterol consumed per day was significantly associated with higher risk of all-cause mortality (adjusted hazard ratio, 1.18), and each additional half an egg consumed per day was significantly associated with higher risk of all-cause mortality (adjusted hazard ratio, 1.08). Meaning: Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of all-cause mortality in a dose-response manner.
Eggs increase risk of mortality (n=27530)
All-cause mortality showed a significant negative association with green salad consumption and a significant positive association with consumption of eggs and meat. For green salad and eggs, the association was stronger for women; for meat, the association was stronger for men. All the observed associations were adjusted for age, sex, smoking history, history of major chronic disease.
Eating 7+ servings of eggs per week increases mortality risk 23% (n=21327)
Adjusted hazard ratios for mortality were 1.0 (reference), 1.23 for the consumption of <1, and ≥7 eggs/wk, respectively. Conclusions: Egg consumption was positively related to mortality.
Eggs do not significantly increase mortality risk (n=9263)
Dose-response relations of egg consumption to total cholesterol and age-adjusted total cholesterol concentrations were noted in the women, and all-cause mortality was affected by egg consumption. However, no such relations were noted in the men. Sources other than eggs may contribute to total cholesterol intake in men. These results suggest that limiting egg consumption may have some health benefits, at least in women in geographic areas where egg consumption makes a relatively large contribution to total dietary cholesterol intake.
Fried food increases mortality risk 8% through heart disease, not cancer (n=106,966)
For total fried food consumption, when comparing at least one serving per day with no consumption, the multivariable adjusted hazard ratio was 1.08 for all cause mortality. When comparing at least one serving per week of fried chicken with no consumption, the hazard ratio was 1.13 for all cause mortality and 1.12 for cardiovascular mortality. For fried fish/shellfish, the corresponding hazard ratios were 1.07 for all cause mortality and 1.13 for cardiovascular mortality. Total or individual fried food consumption was not generally associated with cancer mortality.
Fried potatoes increase mortality risk 126%; unfried white potatoes do not increase risk (n=4400)
Of the 4400 participants, 2551 (57.9%) were women with a mean ± SD age of 61.3 ± 9.2 y. During the 8-y follow-up, 236 participants died. After adjustment for 14 potential baseline confounders, and taking those with the lowest consumption of potatoes as the reference group, participants with the highest consumption of potatoes did not show an increased risk of overall mortality. However, subgroup analyses indicated that participants who consumed fried potatoes 2-3 times/wk (HR: 1.95) and ≥3 times/wk (HR: 2.26) were at an increased risk of mortality. The consumption of unfried white potatoes was not associated with an increased mortality risk.