healthy diet

Epidemiology

• 46% of U.S. adults still consume poor-quality diets

Complications

• suboptimal intake of dietary factors (fruits, vegetables, whole grains, sodium, nuts & seeds, processed meats) accounted for 45.4% of U.S. cardiovascular mortality in 2012
  • diet low in fruits & vegetables*
  • high sodium intake (9.5%)
  • low consumption of nuts and seeds (8.5%)
  • high intake of processed meats (8.2%)
• encouraging adolescents to diet is counterproductive
  • as adults, they are more likely to have unhealthy weight control behaviors & to encourage their own children to diet, thus perpetuating the cycle into the next generation
• marginal increase in serum insulin, serum glucose & blood pressure in hispanics who ate dinner late
• diets with wide variety of foods not necessarily healthiest
  • may increase calorie consumption & weight gain in adults

Management

adherence to a healthy diet

• a healthy diet is linked to slower biological aging & reduced risk of dementia
• dietary diversity is a component of a healthy diet
• replacing highly processed foods with copious salt, sugar & other additives with fruits, vegetables, nuts, beans, lentils, seafood & whole grains has health benefits at any age
• a healthy diet consists of more fish, fruits, vegetables, whole grains
• a healthy diet may reduce risk of chronic disease
  • cardiovascular disease
  • cancer (see cancer prevention)
  • diabetes mellitus type 2
  • chronic obstructive pulmonary disease (COPD)
• greater adherence to 4 healthy eating patterns (Healthy Eating Index 2015, Alternate Mediterranean Diet, Healthful Plant-Based Diet Index, Alternate Healthy Eating Index) can reduce risk of death 20%
  • consuming more whole grains, fruits, vegetables, nuts & legumes can reduce death from cancer, cardiovascular illness, respiratory disease & neurodegenerative disease
• Lancet's 'Planetary Health Diet' & Frances Moore Lappe's 'Diet for a Small Planet' integrate the concepts of a healthy diet with enviromental impact of dietary choices
• improved diet quality over 12 years decreases mortality
• more frequent family dinners tied to healthier diets in young people
• a diet rich in fruits and vegetables, whole grains, low-fat dairy, seafood, legumes, & nuts & low in red or processed meats, sugar-sweetened foods & beverages, & refined grains (see Mediterranean diet)
• high intake of vegetables, fruit, whole grains, nuts, dairy, & fish with low intake of sugar-containing beverages is associated with larger brain volume, gray matter volume, white matter volume, & hippocampal volume
  • not associated with white matter lesions or lacunar infarcts
• improved intakes of polyunsaturated fats & nuts & seeds & lower intake of sugar-sweetened beverages reduced diet-related cardiovascular mortality in the U.S. by 25% from 2002-2012
• consumption of spicy food at least 3X/week associated with 14% lower mortality
  • reduction in mortality due to cancer, ischemic heart disease, respiratory disease
  • chili peppers most commonly used spice
• limit daily consumption of added sugars (<10% of calories), saturated fat (<10% of calories), & dietary sodium (<2300 mg)
• restriction of red meat & processed meat consumption may diminish cancer-related mortality, cardiovascular mortality & overall mortality
• reduce total fat intake to < 30% of calories
  • restrict saturated fats to less than 10% of calories
  • trans-fatty acids may have simliar effects to saturated fat
  • dietary fat from plants may be associated with lower cardiovascular & overall mortality than animal fats including eggs & dairy
• increasing intake of omega-3 fatty acids may improve outcomes
• consume < 300 mg of dietary cholesterol daily
  • U.S. guidelines that limit dietary cholesterol to 300 mg/day will be lifted
• high carbohydrate diet associated with increased mortality relative to high fat diet
• moderate carbohydrate intake (50-55% of calories) associated with lowest mortality
  • mortality highest with lowest-carbohydrate diet followed by highest carbohydrate diet
  • low carbohydrate diets high in animal protein or fat associated with increased mortality
  • low carbohydrate diets high in plant protein or fat associated with decreased mortality
• limit daily sodium consumption to less than 2300 mg
  • high-risk groups (> 50 years, black, hypertension, diabetes, or chronic kidney diseases) should consume less than 1500 mg
  • see DASH diet
• >= all grain intake should come from whole grains
  • replace refined grains with whole grains
• restrict consumption of solid fats & added sugars
• eat a variety of fruits & vegetables & more of them
  • >= 3 servings/day of fruits/vegetable decreased
    • all-cause mortality (RR=0.74 for 5 servings/day)
    • cardiovascular mortality
    • cancer-related mortality
      • no decrease in cancer-related mortality
• higher fruit, vegetable, & legume consumption associated with lower risk of non-cardiovascular, & total mortality
  • fruit intake associated with lower risk of cardiovascular, non-cardiovascular, & total mortality
  • legume intake associated with lower risk of non-cardiovascular mortality & total mortality
  • raw vegetable intake strongly associated with lower risk of total mortality
  • cooked vegetables associated with modest benefit on mortality
• replace some meat & poultry with seafood
• nutrients with favorable effects on cognitive function & brain health from the Mediterranean Diet include fatty acids, antioxidants, carotenoids & vitamins
• dietary patterns associated with diminished mortality have charactertics of Mediterranean diet & DASH diet
  • higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish
  • low in red meat, processed meat, high-fat dairy, & refined carbohydrates or sweets
  • intake of alcoholic beverages in moderation
• Mediterranean diet & DASH diet rated best diets
• combination of a Mediterranean diet with a DASH diet is called a MIND diet
• Mediterranean diet rated best overall diet & easiest to follow
• healthy living diet in association with intermittent fasting appears to provide benefits in insulin resistance & brain aging

alcohol, coffee, calorie restriction, fasting

• calorie restriction may improve overall health
• intermittent fasting independent of calorie intake may improve overall health
• limit alcohol to one drink per day for women & two for men
• up to 5 cups of coffee daily is not associated with adverse effects in most adults

World Health Organization, Food & Agriculture Organization of the United Nations

• principles of a healthy diet
  • adequate
    • providing enough essential nutrients to prevent deficiencies & promote health without excess
  • balanced
    • in energy intake, & energy sources (fats, carbohydrates & proteins) to promote healthy weight, growth* & disease prevention
    • the inclusion of growth would suggest that pinciple is applicable to children
  • moderate
    • in consumption of foods, nutrients or other compounds associated with detrimental health effects
    • unclear why consumption of foods, nutrients or other compounds associated with detrimental health effects is part of a healthy diet
  • diverse
    • including a wide variety of nutritious foods within & across food groups to favor nutritional adequacy & consumption of other health promoting substances

More specific terms

• anti-inflammatory diet
• Dietary Approaches to Stop Hypertension (DASH) diet
• healthy living diet
• Mediterranean diet
• Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet
• National Cholesterol Education Program (NCEP) step 1 diet
• National Cholesterol Education Program (NCEP) step 2 diet
• pescovegetarian diet
• plant-based diet
• portfolio diet
• vegetarian diet

Additional terms

• healthy (successful) aging; sustained independence