Diet and nutrition

Diet is the combination of foods and drinks a person habitually consumes, and nutrition research studies how that intake affects health and lifespan. Poor diet is one of the largest preventable contributors to death worldwide. The Global Burden of Disease Study attributed 11 million deaths and 255 million disability-adjusted life years (a measure combining years lost to early death and years lived with illness) in 2017 to dietary risks, with high sodium intake, low whole-grain intake and low fruit intake the leading factors [1].

Dietary patterns describe whole diets rather than single foods. The Mediterranean diet is the only pattern tested against heart attack, stroke and cardiovascular death in a large randomised trial (a study that assigns participants to groups by chance): among 7,447 Spanish adults at high risk of heart disease and stroke, a Mediterranean diet supplemented with extra-virgin olive oil or nuts was followed by about 30% fewer of these events than advice to eat a low-fat diet [2]. Observational studies (which track people's existing diets rather than assigning one) of vegetarian, vegan and plant-based diets show that food quality matters as much as the label: in about 209,000 US adults, a plant-based diet built on whole grains, fruit, vegetables, nuts and legumes was associated with 25% lower risk of coronary heart disease (narrowing of the arteries that supply the heart), while one built on refined grains, potatoes, sweets and sugary drinks was associated with 32% higher risk [3]. Dietary fiber, found in legumes, whole grains, vegetables and fruit, is among the best-studied single dietary components: systematic reviews (studies that gather and assess all earlier research on a question) of 185 prospective studies (studies that follow people forward in time) and 58 clinical trials found 15 to 30% lower all-cause and cardiovascular mortality (death from any cause and from heart and blood vessel disease) in the highest fiber consumers, with the largest reductions at 25 to 29 grams a day [4].

Other articles in this section cover when and what people drink. Meal timing research links very late eating to higher risk: among 31,044 US adults, a last meal after midnight was associated with 27% higher all-cause mortality than a last meal between 19:00 and 20:00 [5]. Hydration research suggests chronic low fluid intake may be harmful: in a 25-year study of 15,752 middle-aged adults, serum sodium (the concentration of sodium in the blood) above 142 mmol/L, a marker of habitually low fluid intake, was associated with 39% higher risk of chronic disease [6]. Coffee, tea and energy drinks are the main sources of caffeine; among 402,260 US adults aged 50 to 71, drinking four to five cups of coffee a day was associated with 12% lower mortality in men and 16% lower in women than drinking none [7].

Most of this evidence is observational, drawn from questionnaires about habitual diet, and people with healthier diets differ from others in many ways that studies cannot fully measure. Related subjects are covered under alcohol, body weight, metabolic health and type 2 diabetes, cardiovascular disease, colon health and dementia risk factors.

Articles

  • Dietary patterns · Dietary patterns are the overall combinations of foods people habitually eat, studied for their links to heart disease, cancer and lifespan.
  • Dietary fiber · Dietary fiber is the part of plant foods that human digestive enzymes cannot break down; higher intakes are linked to lower heart disease and death rates.
  • Meal timing · Meal timing is the clock time and daily regularity of eating; very late and irregular meals are linked to higher cardiovascular and mortality risk.
  • Hydration · Hydration is the body's water balance; chronic low fluid intake is linked to chronic disease, and heavy drinking in endurance events can cause hyponatremia.
  • Coffee, tea and energy drinks · Coffee, tea and energy drinks are the main sources of caffeine; coffee and tea are linked to lower death rates, energy drinks to short-term heart effects.

Foods

  • Nuts · Nuts are energy-dense seeds such as almonds, walnuts and peanuts; each extra 28 g a day is linked to 22% lower all-cause mortality across 15 studies.
  • Leafy greens · Leafy greens are vegetables eaten mainly for their leaves, such as spinach, kale and lettuce; higher intake is linked to 22% lower all-cause mortality.
  • Coffee · Coffee is a brewed drink made from roasted coffee beans; strong evidence links moderate intake with lower all-cause mortality.
  • Olive oil · Olive oil is the fat pressed from olives; strong evidence links higher intake with lower all-cause and cardiovascular mortality.
  • Chili peppers · Chili peppers are hot peppers whose heat comes from capsaicin; across 4 cohorts, eating them regularly was linked to 12% lower all-cause mortality.
  • Cruciferous vegetables · Cruciferous vegetables are the cabbage family, including broccoli, cabbage and kale; higher intake is linked to 10% lower all-cause mortality.
  • Tea · Tea is a drink brewed from the leaves of the tea plant; moderate evidence links higher intake with lower all-cause mortality.
  • Fish · Fish is the flesh of finned water animals eaten as food; higher intake, especially of fatty fish, is linked to somewhat lower death rates.
  • Soy foods · Soy foods are made from soybeans, such as tofu, soy milk and edamame; the highest intake was linked to 8% lower all-cause mortality than the lowest.
  • Berries · Berries are small, soft fruits such as strawberries, blueberries and cranberries; one US study linked eating any berries with 21% lower all-cause mortality.
  • Yogurt · Yogurt is milk fermented by bacteria; the highest intakes are linked to modestly lower death rates, with no extra benefit above about half a serving a day.
  • Fruit · Fruit is the sweet, seed-bearing part of flowering plants; each extra daily serving of fruit is linked to 6% lower all-cause mortality.
  • Whole grains · Whole grains keep the bran, germ and endosperm of the cereal kernel; strong evidence links higher intake with lower all-cause mortality.
  • Legumes · Legumes are beans, lentils, chickpeas and peas; across 27 studies the highest intake was linked to 6% lower all-cause mortality than the lowest.
  • Mushrooms · Mushrooms are the edible fruiting bodies of fungi; pooled cohorts of 601,893 people linked eating them with 6% lower all-cause mortality.
  • Cheese · Cheese is a food made by curdling and ageing milk; the highest intakes are linked to slightly lower death rates in an umbrella review.
  • Vegetables · Vegetables are the edible leaves, stems, roots and other parts of plants; each extra daily serving is linked to 4% lower all-cause mortality.
  • Poultry · Poultry is the meat of farmed birds such as chicken and turkey; the highest intakes are linked to slightly lower death rates, with low-certainty evidence.
  • Chocolate · Chocolate is a food made from roasted cacao beans, usually with sugar; limited evidence links moderate intake with slightly lower mortality.
  • Butter · Butter is a dairy fat made by churning cream; evidence on mortality is mixed, with a small or neutral link in pooled studies.
  • Dairy overall · Dairy covers milk and foods made from it, such as cheese, yogurt and butter; reviews find no clear overall link between total dairy and death from any cause.
  • Eggs · Eggs are the shelled eggs of hens and other birds; the highest intakes show no clear link with death from any cause, with small risks reported at high amounts.
  • Fried foods · Fried foods are foods cooked in hot oil or fat; they show no clear link with death from any cause in pooled data but are linked to heart disease.
  • Fruit juice · Fruit juice is the liquid pressed from fruit; evidence on mortality is mixed, and no pooled all-cause mortality figure was found.
  • Milk · Milk is the liquid produced by cows and other mammals for drinking; extra milk shows no clear link with death from any cause, though whole milk may differ.
  • Potatoes · Potatoes are starchy tubers eaten boiled, baked, mashed or fried; pooled studies show no clear link between potatoes and all-cause mortality.
  • Sweets and added sugar · Sweets and added sugar include candy, desserts and sugar added to foods; evidence on mortality is mixed, and no pooled figure was found for added sugar.
  • White rice · White rice is rice milled to remove the bran and germ; evidence on mortality is mixed, with no clear link in pooled studies.
  • Avocado · Avocado is a creamy fruit rich in unsaturated fat; no all-cause mortality figure was found, but two US cohorts linked it with lower cardiovascular disease.
  • Citrus fruit · Citrus fruit includes oranges, lemons, limes and grapefruit; a large review linked citrus with lower all-cause mortality, but no pooled figure was found.
  • Diet drinks · Diet drinks are beverages sweetened with low- or no-calorie sweeteners; evidence on mortality is mixed and likely distorted by who chooses them.
  • Sugary drinks · Sugary drinks are soft drinks and other beverages sweetened with added sugar; moderate evidence links each extra daily serving with higher all-cause mortality.
  • Refined grains · Refined grains are milled to remove the bran and germ; evidence on mortality is mixed, with one large multi-country study finding higher risk at very high intake.
  • Salt added at the table · Salt added at the table is salt sprinkled on food after cooking; in one large UK study, always adding it was linked to higher risk of premature death.
  • Red meat · Red meat is the meat of mammals such as cattle, pigs and sheep; higher intake is linked to modestly higher death rates, with low-certainty evidence.
  • Ultra-processed foods · Ultra-processed foods are industrial products made mostly from refined ingredients and additives; greater intake is linked to higher death rates.
  • Processed meat · Processed meat is meat preserved by curing, salting or smoking, such as bacon, ham and sausages; higher intake is consistently linked to higher death rates.

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