Abstract
The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)? To ascertain the association between dietary patterns consumed and ACM. Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements. A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings. In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.
Highlights
Every 5 years, the US Department of Agriculture and Department of Health and Human Services convene the Dietary Guidelines Advisory Committee to review existing evidence on diet and health to inform the Dietary Guidelines for Americans
In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes
The systematic review question was, “what is the relationship between dietary patterns consumed and all-cause mortality (ACM)?” It addressed the topic of diets on the basis of macronutrient distribution
Summary
Dietary patterns are the quantities, proportions, variety, or combination of different foods, beverages, and nutrients in diets as well as the frequency with which they are habitually consumed.[3,4] Different approaches can be used to study dietary patterns. A priori methods are based on scientific consensus or evidence-based approaches and use scores that reflect the degree of adherence.[5,6,7] A posteriori methods identify which factors explain the variation in patterns or aggregate individuals into groups with nonoverlapping patterns.[8] Other approaches can include hybrid methods, clinical trials that assign consumption to a specific pattern, and/or observational studies on food avoidance (eg, vegetarian diets)
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