Estimating impact of food choices on life expectancy: A modeling study

Abstract

Background: Interpreting and utilizing the findings of nutritional research can be challenging to clinicians, policy makers, and even researchers. To make better decisions about diet, innovative methods that integrate best evidence are needed. We have developed a decision support model that predicts how dietary choices affect life expectancy (LE).

Methods and findings: Based on meta-analyses and data from the Global Burden of Disease study (2019), we used life table methodology to estimate how LE changes with sustained changes in the intake of fruits, vegetables, whole grains, refined grains, nuts, legumes, fish, eggs, milk/dairy, red meat, processed meat, and sugar-sweetened beverages. We present estimates (with 95% uncertainty intervals [95% UIs]) for an optimized diet and a feasibility approach diet. An optimal diet had substantially higher intake than a typical diet of whole grains, legumes, fish, fruits, vegetables, and included a handful of nuts, while reducing red and processed meats, sugar-sweetened beverages, and refined grains. A feasibility approach diet was a midpoint between an optimal and a typical Western diet. A sustained change from a typical Western diet to the optimal diet from age 20 years would increase LE by more than a decade for women from the United States (10.7 [95% UI 8.4 to 12.3] years) and men (13.0 [95% UI 9.4 to 14.3] years). The largest gains would be made by eating more legumes (females: 2.2 [95% UI 1.1 to 3.4]; males: 2.5 [95% UI 1.1 to 3.9]), whole grains (females: 2.0 [95% UI 1.3 to 2.7]; males: 2.3 [95% UI 1.6 to 3.0]), and nuts (females: 1.7 [95% UI 1.5 to 2.0]; males: 2.0 [95% UI 1.7 to 2.3]), and less red meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]) and processed meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]). Changing from a typical diet to the optimized diet at age 60 years would increase LE by 8.0 (95% UI 6.2 to 9.3) years for women and 8.8 (95% UI 6.8 to 10.0) years for men, and 80-year-olds would gain 3.4 years (95% UI females: 2.6 to 3.8/males: 2.7 to 3.9). Change from typical to feasibility approach diet would increase LE by 6.2 (95% UI 3.5 to 8.1) years for 20-year-old women from the United States and 7.3 (95% UI 4.7 to 9.5) years for men. Using NutriGrade, the overall quality of evidence was assessed as moderate. The methodology provides population estimates under given assumptions and is not meant as individualized forecasting, with study limitations that include uncertainty for time to achieve full effects, the effect of eggs, white meat, and oils, individual variation in protective and risk factors, uncertainties for future development of medical treatments; and changes in lifestyle.

Conclusions: A sustained dietary change may give substantial health gains for people of all ages both for optimized and feasible changes. Gains are predicted to be larger the earlier the dietary changes are initiated in life. The Food4HealthyLife calculator that we provide online could be useful for clinicians, policy makers, and laypeople to understand the health impact of dietary choices.

Fig 1. Expected life years gained for 20-year-old female adults (left forest plot) and males (right forest plot) from the United States who change from a typical Western diet to an optimized or feasible approach diet with changes indicated in grams per day.

Estimates per food groups and total change in LE is presented with uncertainty intervals (UI). *The meta-evidence is high for whole grains; moderate for fish, nuts, legumes, processed and red meat, and sugar-sweetened beverages; and low for and very low for white meat. LE, life expectancy; 95% UI, 95% uncertainty interval.

Fig 2. Expected life years gained for 60-year-old female adults (left forest plot) and males (right forest plot) from the United States who change from a typical Western diet to an optimized or feasible approach diet with changes indicated in grams per day.

Estimates per food groups and total change in LE is presented with uncertainty intervals (UI). *The meta-evidence is high for whole grains; moderate for fish, nuts, legumes, processed and red meat, and sugar-sweetened beverages; and low for and very low for white meat. LE, life expectancy; 95% UI, 95% uncertainty interval.

Fig 3. Expected increase in LE for optimizing different food groups with diet changes initiating from various ages between 20 and 80 years of age (left plot).

Right plot presents similar estimates with a feasible approach* diet (time to full effect: 10 years). *For the optimal diet and feasibility approach diet, the following intakes were used: 225 g and 137.5 g whole grains (fresh weight), 400 g and 325 g vegetables, 400 g and/ 300 g fruits, 25 g and 12.5 g nuts, 200 g and/ 100 g legumes, 200 g and 100 g fish, 25 g and 37.5 g eggs, 200 g and 250 g milk/dairy, 50 g and 100 g refined grains, 0 g and 50 g red meat, 0 g and 25 g processed meat, 50 g and 62.5 g white meat, 0 g and 250 g sugar-sweetened beverages, and 25 g and 25 g added plant oils. Note that lines for LE for red and processed meat changes are overlapping and similarly also for white meat and added oils. LE, life expectancy.