Abstract Body: Background: Human nutrition is tightly linked to health and disease and, as such, to longevity. Consequently, high adherence to a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH), has repeatedly been associated with a reduced mortality risk. However, the contribution of individual score components driving this association is incompletely understood.
Objectives: We assessed the association of adherence to the DASH score as well as its individual components to all-cause mortality in the largest German population-based study, the German National Cohort (NAKO).
Methods: We included n=131,486 individuals from the NAKO baseline examination (51.3% women, mean age 49.6 (±12.6) years). Dietary intake was assessed with a multiple source method combining up to four 24h dietary recalls with a self-administered, validated Food Frequency Questionnaire. DASH score was derived based on quintiles of consumption scoring fruits, vegetables, legumes/nuts, wholegrains, and low-fat dairy products positively, while scoring red/processed meat, soft drink, and sodium intake negatively. Cox proportional hazards regression models, adjusted for age, sex, body mass index, smoking, socioeconomic status, physical activity, alcohol, and total daily energy intake, were used to relate DASH adherence to all-cause mortality. Furthermore, we related individual components of DASH (per 1-portion increment) to all-cause mortality.
Results: Over a mean follow-up time of 6 (±2) years, n=2,058 participants died. In multivariable-adjusted models, better adherence to DASH was associated with a reduced risk of all-cause mortality (HR: 0.88 [95% CI: 0.84; 0.91] per 5-point increment). When relating individual score components to all-cause mortality, we particularly observed a reduced mortality risk associated with the positively-scored food groups ‘vegetables’ (HR: 0.83 [95% CI: 0.74; 0.93] per 100g increment) and ‘legumes/nuts’ (HR: 0.85 [95% CI: 0.73; 0.92] per 25g increment), while the negatively-scored food groups ‘red/processed meat’ (HR: 1.57 [95% CI: 1.29; 1.92] per 100 g increment) and ‘sodium’ (HR: 1.57 [95% CI: 1.36; 1.83]) were associated with an increased mortality risk.
Conclusion: Better adherence to DASH is associated with a reduced risk of all-cause mortality in a large sample from the German general population, with higher intake of vegetables, legumes, and nuts and lower intake of red/processed meat and sodium possibly having a particularly protective effect.