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. 2021 Aug 2;4(8):e2122277.
doi: 10.1001/jamanetworkopen.2021.22277.

Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review

Laural K English  1   2 , Jamy D Ard  3 , Regan L Bailey  4 , Marlana Bates  1   2 , Lydia A Bazzano  5 , Carol J Boushey  6 , Clarissa Brown  7 , Gisela Butera  1   2 , Emily H Callahan  1 , Janet de Jesus  8 , Richard D Mattes  4 , Elizabeth J Mayer-Davis  9 , Rachel Novotny  10 , Julie E Obbagy  1 , Elizabeth B Rahavi  7 , Joan Sabate  11 , Linda G Snetselaar  12 , Eve E Stoody  7 , Linda V Van Horn  13 , Sudha Venkatramanan  1   2 , Steven B Heymsfield  14
Affiliations

Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review

Laural K English et al. JAMA Netw Open. .

Abstract

Importance: 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)?

Objective: To ascertain the association between dietary patterns consumed and ACM.

Evidence review: 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.

Findings: 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.

Conclusions and relevance: In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ard reported receiving personal fees from Nestlé Healthcare Nutrition outside the submitted work. Dr Bailey reported serving as a former consultant to the National Institutes of Health (NIH) Office of Dietary Supplements, Nestlé/Gerber, General Mills Bell Institute, RTI International, and Nutrition Impact; serving as a trustee for the International Food Information Council; and receiving travel support in the past to present her research on dietary supplements outside the submitted work. Dr Sabate reported receiving grants that were paid to Loma Linda University from Hass Avocado Board outside the submitted work. Dr Heymsfield reported receiving personal fees from Medifast Corporation Medical Advisory Board outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Analytic Framework for the Systematic Review Question
This analytic framework visually represents the overall scope of the systematic review question and depicts the contributing elements that were examined and evaluated, including the target population, exposure, comparison, outcomes, and key confounders. Reproduced from the 2020 Dietary Guidelines Advisory Committee and Nutrition Evidence Systematic Review Team.
Figure 2.
Figure 2.. Literature Search and Screening Flowchart
The literature search yielded 11 547 studies after the removal of duplicate articles. Dual screening resulted in the exclusion of 400 full-text articles or at least 1 reason, which may not reflect all possible reasons. The body of evidence included 153 articles.
See this image and copyright information in PMC

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