Adherence to the healthy and sustainable dietary recommendations for the Spanish population and all-cause mortality

Introduction and objectives: The healthy and sustainable dietary recommendations for the Spanish population have recently been launched. We aimed to develop a food-based dietary index to measure adherence to these guidelines and assess its association with all-cause mortality.

Methods: Data were drawn from 11 904 individuals, representative of the Spanish population aged 18 and older, recruited between 2008 and 2010, and followed-up until 2022. The healthy and sustainable dietary recommendations for the Spanish population index (HS-DRSI) includes 20 food components, scored dichotomously to reflect adherence to the recommendations. The association between the HS-DRSI and all-cause mortality was examined using Cox proportional hazard models adjusted for sociodemographic, lifestyle, and morbidity factors, within a retrospective cohort design.

Results: The mean±SE age of participants was 46.9±0.3 years and 50.5% were female. After a median follow-up of 12.9 years, 939 all-cause deaths were recorded. Compared with participants in the lowest quartile of adherence (HS-DRSI range: 1-5), those in the highest quartile (HS-DRSI range: 9-17) had a lower risk of mortality (HR, 0.76; 95%CI, 0.60-0.96; P for trend=.02). A 2-point increase in the HS-DRSI was associated with a 7% lower risk of mortality (HR, 0.93; 95%CI, 0.86-1.00; P=.04). This protective association was also observed among participants without chronic diseases at baseline (HR per 2-point increment: HR, 0.80; 95%CI, 0.70-0.92; P=.002). Results were robust in sensitivity analyses.

Conclusions: Higher adherence to the healthy and sustainable dietary recommendations for the Spanish population was associated with lower all-cause mortality.