长期健康饮食可能减少死亡风险
此前，很少有研究评估饮食质量随时间变化与死亡风险之间的相关性。
2017年7月13日，美国麻省（马萨诸塞州）医学会《新英格兰医学杂志》正式发表哈佛大学陈曾熙公共卫生学院、布莱根女子医院、哈佛大学医学院、西蒙斯学院、俄亥俄大学、华中科技大学同济医学院的研究报告，发现长期健康饮食可以减少死亡风险。
该队列研究使用Cox比例风险模型计算了1998～2010年73739位医务人员（护士健康研究47994位女性、医生随访研究25745位男性）的全部原因和特定原因所致死亡校正风险比，使用替代健康饮食指数评分、替代地中海式饮食评分、饮食法停止高血压饮食评分，对过去12年（1986～1998年）饮食质量变化进行评定。该研究由美国国家卫生研究院资助。
在上述三种饮食评分中：
最有提高饮食质量作用的食物组合通常包括全谷物、蔬菜、水果、坚果、豆类、鱼类或多不饱和脂肪酸。
最有降低饮食质量作用的食物组合通常包括精细粮、红肉或加工肉类、反式脂肪酸、饱和脂肪酸、酒精。
结果发现，饮食质量提高最大（提高13%～33%）与饮食质量相对不变（提高0～3%）的参与者相比，12年全部原因所致死亡合并风险比：
0.91（95%置信区间：0.85～0.97，根据替代健康饮食指数评分变化）
0.84（95%置信区间：0.78～0.91，根据替代地中海式饮食评分变化）
0.89（95%置信区间：0.84～0.95，根据饮食法停止高血压评分变化）
饮食评分每增加20%（表明饮食质量提高）：
与全部原因所致死亡风险减少8～17%有显著相关性（根据上述三种饮食评分）
与心血管病所致死亡风险减少7～15%有显著相关性（根据替代健康饮食指数评分、替代地中海式饮食评分）
12年保持高质量饮食与保持低质量饮食的参与者相比，任何原因所致死亡风险显著减少：
14%（95%置信区间：8～19，根据替代健康饮食指数评分评定）
11%（95%置信区间：5～18，根据替代地中海式饮食评分评定）
9%（95%置信区间：2～15，根据饮食法停止高血压评分评定）
因此，12年保持饮食质量提高与死亡风险减少有相关性。
相关阅读
N Engl J Med. 2017 Jul 13;377(2):143-153.
Association of Changes in Diet Quality with Total and Cause-Specific Mortality.
Sotos-Prieto M, Bhupathiraju SN, Mattei J, Fung TT, Li Y, Pan A, Willett WC, Rimm EB, Hu FB.
Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Simmons College, Boston; Ohio University, Athens; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BACKGROUND: Few studies have evaluated the relationship between changes in diet quality over time and the risk of death.
METHODS: We used Cox proportional-hazards models to calculate adjusted hazard ratios 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. Changes in diet quality over the preceding 12 years (1986-1998) were assessed with the use of the Alternate Healthy Eating Index-2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score.
RESULTS: The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower - by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score - than the risk among participants with consistently low diet scores over time.
CONCLUSIONS: Improved diet quality over 12 years was consistently associated with a decreased risk of death. (Funded by the National Institutes of Health.).
PMID: 28700845
DOI: 10.1056/NEJMoa1613502
