Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Improved Diet Quality & Mortality Risks

N Engl J Med; 2017 Jul 13; Sotos-Prieto, et al

Over a 12-year period, improving diet quality was consistently associated with a decreased risk of death, a recent study found. The study calculated adjusted hazard ratios (HRs) for total and cause-specific mortality among 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Researchers found:

  • Pooled HRs for all-cause mortality among participants who had the greatest improvement in diet quality as compared to those who had a relatively stable diet quality during the study period were as follows:
    • 0.91 according to changes in the Alternate Healthy Eating Index score;
    • 0.84 according to changes in the Alternate Mediterranean Diet score;
    • 0.89 according to changes in the Dietary Approaches to Stop Hypertension (DASH) score.
  • A 20-percentile increase in diet scores was significantly associated with a reduction in total mortality of 8 to 17% with the use of the 3 diet indexes and a 7 to 15% reduction in the risk of death from CVD with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet.
  • Participants who maintained a high-quality diet over a 12-year period showed a significantly lower risk of death from any cause.


Sotos-Prieto M, Bhupathiraju SN, Mattei J, et al. Association of changes in diet quality with total and cause-specific mortality. N Engl J Med. 2017;377:143-153. doi:10.1056/NEJMoa1613502.


Previous studies have shown that healthy diets are associated with a reduction of approximately 15% in total mortality, a 20% reduction in cardiovascular mortality, and a 15% reduction in cancer mortality.1,2 This study adds to our body of knowledge, demonstrating that sustaining a change in dietary habits over time can yield an important benefit of decreasing the risk of disease and death over the subsequent 12 years. In other words, we can tell our patients with confidence that it is not just the diet they have been eating over the past decade, but rather the diet they decide that they will continue eating going forward that can make a big difference in their health. This evidence is similar to the evidence we have seen that improvement in exercise level leads to a decrease in the development of hypertension, hyperlipidemia, metabolic syndrome, and mortality.3 The lesson here is that it is never too late to begin to focus on fundamentals—diet and exercise—and by so doing improve our health and lengthen our lives. —Neil Skolnik, MD

  1. Reedy J, Krebs-Smith SM, Miller PE, et al. Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults. J Nutr. 2014;144:881-9. doi:10.3945/jn.113.189407.
  2. Blair SN, Kohl HW 3rd, Barlow CE, Paffenbarger RS Jr, Gibbons LW, Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273(14):1093-1098.
  3. Lee DC, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors: Hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol. 2012;59(7):665-72. doi:10.1016/j.jacc.2011.11.013.