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How You Age May Depend on What You Eat

Overall diet in mid-life may predict future aging phenotypes By Neelum T. Aggarwal, MD

Multiple initiatives from the City of Chicago’s Healthy Chicago programs, to Building a Healthier Chicago’s F.I.T City, to Food Day/Eat Real Chicago, encourage healthy eating and nutrition. Now this message is reinforced by a study that examined the role of diet/nutrition in the overall health of a large group of community-dwelling individuals.

Traditionally, medical literature has focused on analyzing dietary patterns and their potential impact on individual age-related diseases—cognitive decline, dementia, cardiovascular disease, stroke, and metabolic conditions such as diabetes. However, little has been reported on the effect of diet on overall health—considering the incidence of all these conditions simultaneously. A recent paper by Akbaraly and colleagues in the American Journal of Medicine examined diet from a holistic approach, using data from a well-established longitudinal study in the United Kingdom, often referred to as the Whitehall group.

The Whitehall group is a cohort study of people ages 35-55 who worked in 20 civil service departments at the time of baseline evaluation. A screening phase took place between 1985-1988 with over 10,000 people, and was comprised of a clinical examination and self- administered questionnaire. In Phase 3 of the study (between 1991-1993), a nutrition survey was given to participants. For this paper, only those age 60 by the end of 2007-2009 and with no history of stroke, myocardial infarction, or cancer, were included.

The food questionnaire administered during the study consisted of 127 food items and the selected food items/category was converted to daily intake. The groups were then broken into two categories: Western-type diet (fried or processed food, red meat, pies, and high-fat dairy products) or healthy foods (high intake of fruits, vegetables and fish).

Four aging outcomes were considered for this study: (1) ideal aging; (2) non-fatal cardiovascular disease at follow-up; (3) cardiovascular death; and (4) non-cardiovascular death. Criteria for ideal aging (age 60 or older at the last follow-up examination) included: being alive; having no chronic diseases (such as coronary heart disease), stroke, cancer or diabetes; absence of mental health problems; and good cardio-metabolic, respiratory, musculoskeletal, and cognitive functioning.

Over the 16-year-period, 12.7% of the cohort developed non-fatal cardiovascular disease; 2.8% died from cardiovascular disease; and 7.3% died from non-cardiovascular causes. The remaining 73.2% followed a natural aging course. Diet data was examined based on two types of patterns—healthy foods and Western diets. Higher scores on the Western diet were associated with higher odds of cardiovascular and non-cardiovascular mortality (OR= 1.53 and 1.36) in adjusted models. People in the highest tertile of the Western dietary pattern, compared to the lowest tertile, were more likely to have poorer musculoskeletal and cognitive functioning. There was no association noted between the Western diet and indicators of cardio-metabolic and respiratory functioning and mental health.

Interestingly, the healthy food dietary pattern did not demonstrate any significant associations with the four aging outcomes, contrary to the literature, which has demonstrated the protective effect of vegetarian diets or of those low in meat to health outcomes. This result, however, should be interpreted cautiously, since in this cohort there were very few non-meat eaters and the study did not attempt to classify whether participants were vegetarians.

Nevertheless, this study provided a model for examining how multiple aging phenotypes could be analyzed simultaneously in a cohort to inform patterns associated with dietary intake and habits. In addition, the study also reinforced recommendations of other studies, namely, that avoiding a Western diet could improve the chance of reaching old age free of chronic disease in addition to remaining highly functional.

Dr. Aggarwal is the chair of the F.I.T. City Initiative and board member of Building a Healthier Chicago (

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