Association of Diet Quality With Longevity and Successful Aging in Israeli Adults 65 Years or Older

Abstract

To our knowledge, the role of overall diet quality in successful aging has not been conclusively demonstrated. To prospectively examine the association between diet quality and longevity and successful aging in a population-based cohort of older adults. Participants in "Mabat Zahav" (the Israeli National Health and Nutrition Survey of Older Adults), an older adult cohort (aged ≥65 years) consisting of a random sample of 1770 individuals, were recruited from July 2005 to December 2006 (time 1 [T1]). Survivors of T1 were again contacted and asked to participate in a second interview. From May 2017 to June 2019 (time 2 [T2]), an extensive face-to-face interview and a functional assessment were conducted in each participant's home in a subsample of 604 participants from T1, representing 72.7% of 820 surviving individuals who were able to complete interviews and assessments. A 24-hour dietary recall, assessed at T1, was used to calculate scores from the 2015 version of the Healthy Eating Index (HEI-2015) (scores range from 0 [worst diet] to 100 [best diet]). Time to death, with follow-up lasting through June 2019, and successful aging. The latter, based on T2 assessment, was defined as (objectively measured) preserved physical and cognitive function and (subjective) mental well-being and favorable self-rated health. Inverse probability weighting was used in the analysis to minimize attrition bias. At T1, the study included 1770 participants (mean [SD] age, 74.6 [6.2] years; 943 women [53%]). On average, participants with higher HEI-2015 scores had healthier lifestyles and higher socioeconomic status at T1. During a median follow-up duration of 12.6 years (IQR, 7.6-13.2 years), 893 deaths occurred. Among the 596 T2 participants analyzed (mean [SD] age, 84.1 [4.4] years; 334 [56%] women), 242 (40%) met successful aging criteria. After adjustment for sociodemographic and lifestyle risk factors, a higher HEI-2015 score was inversely associated with mortality (hazard ratios, 0.85; 95% CI, 0.72-0.99 in the upper tertile and 0.83; 95% CI, 0.71-0.98 in the middle tertile vs the lower tertile; P = .04 for trend) and was positively associated with successful aging (odds ratios, 1.73; 95% CI, 1.10-2.72 in the upper tertile and 1.30; 95% CI, 0.83-2.03 in the middle tertile vs the lower tertile; P = .03 for trend). In this cohort study of older adults in Israel, improved diet quality was associated with increased longevity and successful aging in a dose-dependent manner. These data contribute to the body of literature that suggests diet quality is associated with aging in the older age group.