J. Manson

Post-Diagnosis Healthy Dietary Patterns in Relation to All-Cause and Cause-Specific Mortality and Life Expectancy among Adults with Type 2 Diabetes: Evidence from Cohort Studies.

BACKGROUND Type 2 diabetes (T2D) is associated with an increased risk of premature death. Diet may influence long-term health outcomes among individuals with T2D, but prospective evidence on dietary patterns and mortality remains limited. OBJECTIVES To prospectively examine associations of eleven pre-defined or empirically-developed dietary patterns with all-cause and cause-specific mortality (e.g., cardiovascular disease [CVD] and cancer) among U.S. individuals with T2D. METHODS We included 7,795 participants with incident T2D in the Nurses' Health Study (1984-2016) and Health Professionals Follow-Up Study (1986-2020), who were free of CVD and cancer at diagnosis. Diet was assessed using a validated food frequency questionnaire and updated every four years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS Over 24 years of follow-up, 3,509 deaths were confirmed, including 1,079 from CVD and 649 from cancer. Adherence to healthy dietary patterns after diagnosis (comparing the 90th with the 10th percentile of dietary pattern scores) was consistently associated with lower all-cause mortality, with multivariable-adjusted HRs ranging from 0.78 (95% CI: 0.71, 0.85) for the Planetary Health Diet to 0.92 (95% CI: 0.84, 1.01) for the Dietary Approaches to Stop Hypertension. Furthermore, greater improvements in dietary pattern adherence from pre- to post-diagnosis (comparing the 90th with the 10th percentile of change scores) were also associated with lower all-cause mortality, with HRs (95% CI) ranging from 0.63 (0.58, 0.70) to 0.92 (0.85, 1.01). A similar pattern of inverse associations with CVD mortality was also observed for these dietary scores. Additionally, the reversed Empirical Dietary Index for Hyperinsulinemia was specifically associated with lower cancer mortality. CONCLUSIONS Adherence to healthy dietary patterns is universally associated with better survival in individuals with T2D. These findings suggest the importance of consuming high-quality diets in the prevention of premature deaths among individuals with T2D.

Association of adherence to various dietary patterns with mortality among survivors of myocardial infarction: a prospective cohort study

Background: Current dietary guidelines are largely based on evidence from the general population, and data on dietary patterns and survival after myocardial infarction (MI) remain limited. We evaluated post-MI adherence to multiple healthy dietary patterns, as well as changes in adherence from before to after MI diagnosis, in relation to mortality among MI survivors. Methods: We included 3,277 women from the Nurses’ Health Study and 2,618 men from the Health Professionals Follow-up Study who survived a non-fatal MI. The mean age at MI diagnosis was 68.2 (standard deviation, 10.2) years. Diet was assessed using validated food frequency questionnaires and updated every two to four years. We calculated post-MI adherence scores for eight healthy patterns: the Alternate Healthy Eating Index (AHEI), the Healthy Eating Index-2015 (HEI-2015), the Alternate Mediterranean Diet Score (AMED), the Dietary Approaches to Stop Hypertension (DASH), the healthful Plant-Based Diet Index (hPDI), the reversed empirical dietary inflammatory pattern (rEDIP), the reversed empirical dietary index for hyperinsulinemia (rEDIH), and the reversed empirical dietary index for insulin resistance (rEDIR). The main outcome was total mortality, with cardiovascular disease (CVD) mortality and recurrent non-fatal MI as secondary outcomes. Results: During 15.7 years of follow-up after MI, 3,858 deaths (65.4%) were documented, including 1,639 CVD deaths (42.5% of deaths). Comparing the highest with the lowest quintile, higher post-MI dietary scores were consistently associated with lower total mortality, with the hazard ratio (HR) of 0.67 (95% confidence interval [CI]: 0.60–0.74) for AHEI, 0.73 (0.65–0.81) for HEI-2015, 0.66 (0.59–0.75) for AMED, 0.77 (0.69–0.86) for DASH, 0.74 (0.66–0.83) for hPDI, 0.77 (0.68–0.86) for rEDIP, 0.73 (0.65–0.83) for rEDIR, and 0.71 (0.64–0.80) for rEDIH. Similar inverse associations were observed for CVD mortality and recurrent non-fatal MI. Improved AHEI adherence from before to after MI was associated with lower mortality (HR: 0.86; 95% CI: 0.76–0.97), whereas decreased adherence to most patterns was associated with higher mortality. Conclusions: Among individuals who survived MI, adherence to post-MI dietary patterns emphasizing higher diet quality was associated with better long-term survival. These findings support dietary guidance focusing on overall diet quality for the secondary prevention of deaths among MI survivors.

Coffee Intake is Associated with Improved Insulin Sensitivity and Lower Visceral Adiposity: Evidence from Biomarker and Genetic Analysis