Adherence to the 2025-2030 dietary guidelines (DGA) and risk of all-cause and cause-specific mortality: A prospective analysis in a middle-aged cohort.

BACKGROUND & AIMS: The 2025-2030 Dietary Guidelines for Americans (DGA) shifted toward a model expanding animal-based proteins and fats, with unknown impacts on long-term survival. This study aimed to evaluate the association between adherence to the 2025-2030 DGA and all-cause and cause-specific mortality, compared with the traditional Mediterranean Diet (MedDiet).

METHODS

Prospective cohort study of university graduates. A total of 17,855 participants [10,928 women (61.2%) and 6927 men; mean age 37.2 years], initially free of chronic diseases, followed-up every two years. At baseline a validated 136-item semi-quantitative food frequency questionnaire was used to build two dietary indices: 1) A score of adherence to the 2025-2030 DGA (theoretical range 0-28 points); and 2) A well-known 9-item Mediterranean Diet Score (MDS) appraising adherence to the traditional MedDiet. The primary outcome was all-cause mortality, verified through the National Death Index. Secondary outcomes included cardiovascular (CVD) and cancer mortality. Multivariable Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) across categories (roughly quartiles: Q1-Q4) of dietary indices.

RESULTS

Over a 14.3-year median follow-up, 525 deaths occurred. Comparing highest (Q4) to lowest (Q1) adherence, the 2025-2030 DGA showed no significant association with all-cause (HR = 0.87; 95%CI:0.67-1.13), CVD (HR = 1.62; 0.86-3.04), or cancer mortality (HR = 0.82; 0.57-1.17). Conversely, high MedDiet adherence (Q4 vs. Q1) was inversely associated with all-cause (HR = 0.68; 0.50-0.92), CVD (HR = 0.39; 0.18-0.85), and cancer mortality (HR = 0.59; 0.40-0.88). Specific plant-based DGA components and limiting processed meats showed independent inverse mortality associations.

CONCLUSIONS

Adherence to the DGA 2025-2030 does not appear to be associated with reduced mortality in this cohort. In contrast, the traditional MedDiet remains strongly associated with lower risks of premature death, including CVD deaths, and cancer deaths. Dietary recommendations should prioritize the MedDiet over the recent DGA 2025-2030 and particularly some features common to both dietary models.

CLINICAL TRIAL REGISTRY: ClinicalTrials.gov NCT02669602.