Diet-Quality Scores and Mortality: What the Cohorts Report
Adherence to validated diet-quality indices is associated with lower all-cause mortality across large cohorts (English 2021; Jankovic 2014), with cardiovascular findings varying by index and region (Jankovic 2015; Struijk 2014), and greater adherence to any of several healthy eating patterns was associated with lower cardiovascular risk (Shan 2020).
Not for clinical populations without professional guidance
- Signs of disordered eating (food/weight preoccupation, restriction, bingeing, purging, compulsive exercise): see a qualified eating-disorder professional
- Diagnosed medical condition (diabetes, chronic kidney disease, heart failure, GI disease): see a registered dietitian or physician
- Pregnancy or breastfeeding: see a prenatal provider or registered dietitian
- Unintentional weight loss, difficulty swallowing, or persistent GI symptoms: seek medical evaluation
What the evidence says
The sources on this entry are a systematic review, two pooled cohort analyses and five large cohort studies of diet-quality indices and mortality or chronic disease. English 2021 (systematic review of 153 studies, 6,550,664 participants) reports that dietary patterns characterised by vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish and lean meat or poultry were associated with decreased risk of all-cause mortality. Jankovic 2014 (pooled analysis of cohorts, 396,391 participants) reports each 10-point increase in the WHO Healthy Diet Indicator associated with a hazard ratio of 0.90 for all-cause mortality in elderly men and women; Jankovic 2015 (pooled analysis of 10 cohorts) reports the same increase not significantly associated with cardiovascular mortality overall (HR 0.94) but inversely associated in southern European (HR 0.87) and US (HR 0.85) cohorts. Shan 2020 (cohort, 23,366 cardiovascular cases) reports a pooled hazard ratio of 0.83 for the highest versus lowest quintile of both HEI-2015 and the alternate Mediterranean score, and concludes that greater adherence to any of several healthy eating patterns is associated with lower cardiovascular risk; Hu 2019 (cohort) reports the highest HEI-2015 quintile with 16% lower incident cardiovascular disease and 32% lower cardiovascular mortality, concluding that adherence may reduce risk; George 2020 (cohort) reports women with higher HEI-2015 scores having 18% lower all-cause and 21% lower cancer mortality with no association for cardiovascular or dementia mortality; Chiuve 2012 (cohort) reports highest-quintile relative risks of 0.84 for HEI-2005 and 0.81 for AHEI-2010 for major chronic disease, with AHEI-2010 the stronger predictor. Struijk 2014 (cohort) reports no association of the WHO or Dutch indices with cardiovascular disease while DASH adherence was associated with lower cardiovascular, coronary and stroke risk. These are associations from observational cohorts, not demonstrations of cause.
- 'There's a single right diet index.' Shan 2020 reports the same pooled hazard ratio (0.83) for the highest quintile of HEI-2015 and the alternate Mediterranean score, and concludes that greater adherence to any of several healthy eating patterns is associated with lower cardiovascular risk.
- MYTH: One nutrient determines your health. CORRECTION: What these cohorts measure is adherence to a whole dietary pattern, and that is what tracks with lower mortality.
- 'A high score guarantees good health.' It lowers risk on average, not with certainty.
- Do not claim any food, diet, or supplement cures, treats, or protects against any disease
- Do not diagnose nutrient deficiencies or medical conditions
- Do not promise specific weight-loss amounts or timelines
- Do not deliver individualized medical nutrition therapy or replace clinical care
- Agreement
- Direction recorded for 0 of 8 sources; not yet recorded for the rest.
- The claim's outcome
- Outcome not yet recorded
- Certainty
- No source states a certainty rating.
- Authors
- Sources share authors: N. Jankovic (first author of 2 sources); E. Feskens (senior author of 2 sources).
- How the sources were read
- Some sources are based on abstracts, not full texts.
What each source measured and concluded (8)
- What it measured
- All-cause mortality (ACM).
- How it measured it
- A priori and a posteriori methods (e.g., index or score analysis, factor or cluster analysis).
- How it was read
- read in full text
- What the review says it includes
- Systematic review of 1 RCT and 152 observational studies
- Studies and participants, as stated
- N=6,550,664 participants across 153 studies
- What it measured
- Mortality from CVD, coronary artery disease, and stroke
- How it was read
- based on the abstract, not the full text
- What the review says it includes
- Pooled analysis of prospective cohort studies (meta-analysis)
- Studies and participants, as stated
- N=281,874 across 10 cohorts
- What it measured
- Association between HEI-2015 scores and all-cause, CVD, cancer, and Alzheimer's/dementia mortality
- How it was read
- screened only, not extracted
- What it measured
- Association of adherence to WHO (HDI), Dutch (DHD-index) and DASH dietary guidelines with CVD, CHD and stroke risk
- How it was read
- screened only, not extracted
- What it measured
- Association between WHO Healthy Diet Indicator and all-cause mortality
- How it was read
- screened only, not extracted
- What the review says it includes
- Pooled analysis of prospective cohort studies (meta-analysis)
- Studies and participants, as stated
- 396,391
- What it measured
- Association of HEI-2005 and AHEI-2010 with major chronic disease risk
- How it was read
- screened only, not extracted
- What it measured
- Association of 4 healthy eating pattern scores with incident CVD
- How it was read
- screened only, not extracted
- What it measured
- Incident CVD, CVD mortality, all-cause mortality
- How it was read
- screened only, not extracted
Every source below is shown with its study design and links to the original study. This is the audit trail.
“Abstract only” means the review read that paper’s abstract, not its full text; “screened only” means it was included at re-screening and not extracted. Both stay in the trail with their DOI, because how a source was read is part of the audit.