What dietary principles are associated with the lowest risk of all-cause mortality across all populations?

From the Guidelines

The dietary pattern most consistently associated with the lowest risk of all-cause mortality across populations is a predominantly plant-based diet rich in whole foods, as supported by the most recent and highest quality study 1. This approach emphasizes abundant consumption of:

• Vegetables
• Fruits
• Whole grains
• Legumes
• Nuts
• Seeds while limiting:
• Processed foods
• Refined carbohydrates
• Added sugars Moderate consumption of fish, particularly fatty varieties containing omega-3 fatty acids, appears beneficial, while red and processed meats should be limited 1. Healthy fats from sources like olive oil, avocados, and nuts are preferred over saturated and trans fats 1. This dietary pattern provides essential nutrients, fiber, antioxidants, and anti-inflammatory compounds that support cellular health, reduce oxidative stress, and help maintain healthy weight and metabolic function. The combination of these foods creates synergistic effects that appear to reduce risk factors for major chronic diseases including cardiovascular disease, cancer, and diabetes. Adequate hydration with water as the primary beverage and limited alcohol consumption further supports overall health. This dietary approach is sustainable long-term and adaptable across different cultural food traditions while maintaining its core principles of emphasizing minimally processed plant foods. Key components of this diet include:
• Monounsaturated fat (<20% of daily calories; eg, olive oil)
• Polyunsaturated fat (≤10% of daily calories; eg, salmon)
• Dietary fiber
• Complex carbohydrates
• Lean protein as recommended by the American Heart Association 1.

From the Research

Dietary Principles for Lowest Risk of All-Cause Mortality

The following dietary principles are associated with the lowest risk of all-cause mortality across all populations:

• High consumption of:
  • Whole grains 2, 3, 4, 5
  • Vegetables 2, 3, 6, 4, 5
  • Fruits 2, 3, 6, 4, 5
  • Nuts 2, 3, 4, 5
  • Legumes 3, 4, 5
  • Fish 2, 6, 5
  • Unsaturated vegetable oils 5
  • Lean meat or poultry (when meat is included) 5
• Moderate consumption of:
  • Alcoholic beverages 5
• Low consumption of:
  • Red meat 2, 5
  • Processed meat 2, 5
  • High-fat dairy 5
  • Refined carbohydrates or sweets 5

Optimal Intake Levels

Optimal intake levels for some of these food groups have been suggested:

• Fruits and vegetables: 800 g/d 3
• Whole grains: 225 g/d 3
• Nuts: 15-20 g/d 3

Dietary Patterns

Certain dietary patterns have been associated with a decreased risk of all-cause mortality, including:

• Mediterranean diet 6, 4
• Healthy Eating Index-2010 (HEI-2010) 4
• Alternative Healthy Eating Index-2010 (AHEI-2010) 4
• Alternate Mediterranean Diet (aMED) 4
• Dietary Approaches to Stop Hypertension (DASH) 4