American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Dietary Patterns and Long-Term Survival: A Retrospective Study of Healthy Primary Care Patients


Dietary patterns are related to mortality in selected populations with comorbidities. We studied whether dietary patterns are associated with long-term survival in a middle-aged, healthy population.


In this observational cohort study at the Cooper Clinic preventive medicine center (Dallas, Tex), a volunteer sample of 11,376 men and women with no history of myocardial infarction or stroke completed a baseline dietary assessment between 1987 and 1999 and were observed for an average of 18 years. Proportional hazard regressions, including a tree-augmented model, were used to assess the association of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, Mediterranean dietary pattern, and individual dietary components with mortality. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality.


Mean baseline age was 47 years. Each quintile increase in the DASH diet score was associated with a 6% lower adjusted risk for all-cause mortality (P < .02). The Mediterranean diet was not independently associated with all-cause or cardiovascular mortality. Solid fats and added sugars were the most predictive of mortality. Individuals who consumed >34% of their daily calories as solid fats had the highest risk for all-cause mortality.


The DASH dietary pattern was associated with significantly lower all-cause mortality over approximately 2 decades of follow-up in a middle-aged, generally healthy population. Added solid fat and added sugar intake were the most predictive of all-cause mortality. These results suggest that promotion of a healthy dietary pattern should begin in middle age, before the development of comorbid risk factors.



Dietary pattern is a known modifiable risk factor for chronic diseases, including cardiovascular disease1 and cancer.2 Dietary patterns have also been linked to chronic disease risk factors, such as lipids,1 blood pressure,3diabetes,4 body mass index (BMI),5 and atherosclerosis and inflammation.1 However, the relationship between dietary pattern and mortality outcomes has been inconsistent.16

The Dietary Approaches to Stop Hypertension (DASH) diet, originally designed to reduce hypertension,3 has been shown to reduce overall mortality in select populations, such as adults with hypertension7 and women with heart failure8 over approximately 5 to 8 years of follow-up. Also, the DASH diet was associated with an approximately 17% decrease in the risk for all-cause and cardiovascular disease mortality in adults aged more than 60 years.9 The Mediterranean dietary pattern has shown an inconsistent relationship with mortality.8101112Individual foods and food groups, for example, fruits,131415 vegetables,131415 dairy,1316 sugars,1718 and fats,192021 have similarly demonstrated an inconsistent association with mortality outcomes. In a population of generally healthy, middle-aged individuals, we sought to assess the relationship of dietary patterns and food group intake at midlife with the long-term risk of all-cause and cardiovascular disease mortality.

Materials and Methods

Design and Participants

The Cooper Center Longitudinal Study is a prospective study of predominantly non-Hispanic white patients at the Cooper Clinic in Dallas, Texas.22 The current study included men and women aged 20 years or older who completed a 3-day dietary record from 1987 to 1999 (n = 15,517). Participants were excluded if they were missing data on covariates (n = 3507), they reported prevalent cardiovascular disease (n = 466), their discretionary fat intake was recorded greater than total fat intake (n = 107), their total daily calorie intake was less than 500 kcal (n = 5) or greater than 5000 kcal (n = 31), or their physical activity exceeded 140 metabolic equivalent of task hours/week (n = 25). After exclusions, 11,376 individuals remained for primary analysis.

The Cooper Center Longitudinal Study is reviewed annually by the Institutional Review Board at the Cooper Institute, and the present analysis was determined not to require review by the Stanford University Institutional Review Board.

To read this article in its entirety please visit our website.

-Nilay S. Shah, MD, MPH, David Leonard, PhD, Carrie E. Finley, MS, Fatima Rodriguez, MD, MPH, Ashish Sarraju, MD, Carolyn E. Barlow, PhD, Laura F. DeFina, MD, Benjamin L. Willis, MD, MPH, William L. Haskell, PhD, David J. Maron, MD

To watch a related video from our Editor in Chief Dr. Joseph Alpert follow this link.

This article originally appeared in the January 2018 issue of The American Journal of Medicine.

Comments are closed.