As people get older, the type of care they need inevitably changes. For older Americans, this often means managing a chronic condition, as it is estimated that at least 80 percent of older adults have at least one chronic condition. While some are relatively benign, others can diminish quality of life and contribute to premature mortality.

Chronic conditions are far from inevitable. While genetics plays a role, there are environmental and behavioral factors that can increase patients’ risk of developing conditions such as diabetes mellitus, cardiovascular disease, or even psychiatric disorders like depression. Among behavioral factors, diet is of critical importance because it is central to our daily lives, and it can be difficult to reverse the detrimental effects following years or even decades of consuming calorie-rich, nutrient-deficient foods while avoiding nutrient-dense foods. As the Global Burden of Disease Study 2017 showed, poor diet is a leading behavioral risk factor contributing to the mortality burden and noncommunicable diseases globally, and it may be responsible for as many as 11 million deaths annually. If you do the math, that is a death every three seconds.

Though diet can negatively impact health and increase the risk of chronic disease, the opposite is also true. An individual’s diet can also promote healthy aging, and a recent analysis of data from the Nurses’ Health Study (1986-2016) and the Health Professionals Follow-Up Study (1986-2016) shows that long-term adherence to certain dietary patterns and the avoidance of ultraprocessed foods can diminish the risk of developing chronic conditions.

Healthy Diets and Healthy Aging

The analysis, which was published in Nature Medicine and conducted by Tessier and colleagues, examined up to 30 years of follow-up among 105,015 participants. The team’s definition of healthy aging was based on the construct of “successful aging” described by Rowe and Kahn, which entails “surviving to the age of 70 years without the presence of 11 major chronic diseases and no impairment in cognitive function, physical function, or mental health.” Of all 105,015 participants, 9,771 (9.3 percent) achieved healthy aging.

Eight dietary patterns were examined in the study, including:

• Alternative healthy eating index (AHEI)
• Alternative Mediterranean index (aMED)
• Dietary approaches to stop hypertension (DASH)
• Mediterranean-DASH intervention for neurodegenerative delay (MIND)
• Healthful plant-based diet (hPDI)
• Planetary health diet index (PHDI)
• Empirically inflammatory dietary pattern (EDIP)
• Empirical dietary index for hyperinsulinemia (EDIH)

Individuals who followed the guidelines for these diets had better outcomes when compared with individuals who ate what is considered a typical American diet, which is low in whole fruits, vegetables, nuts, and legumes, but high in red meat, alcohol, and ultraprocessed foods. This remained true even when the threshold for healthy aging increased to 75 years.

The AHEI was created by researchers at the Harvard T.H. Chan School of Public Health and assigns ratings to certain foods and nutrients and then grades an individual’s diet based on how often that individual consumes those foods and nutrients. The AHEI discourages ultraprocessed foods and prioritizes whole foods over processed alternatives (e.g., whole fruits as opposed to juices). To receive a higher grade on the AHEI, individuals should strive to eat:

• Vegetables: Five servings per day, particularly those of the green leafy variety.
• Fruit: Four servings per day.
• Whole grains: Up to five to six servings per day.
• Nuts, legumes, and vegetable proteins: At least one serving per day.
• Fish: Regular consumption of fish throughout the week provides healthy fatty acids.
• Healthy fats: Use olive oil or avocado oil instead of margarine.

Meanwhile, the AHEI advises individuals to minimize the consumption of red meat, processed meats, refined grains, and artificially sweetened beverages.

An optimized menu for AHEI might look like the following:

• Breakfast: Oatmeal with mixed fruit and black coffee
• Mid-morning snack: Unsweetened dried berries and nuts
• Lunch: Roast vegetable sandwich with hummus on whole wheat bread and a cucumber and tomato salad in a red wine vinaigrette
• Mid-afternoon snack: Banana
• Dinner: Baked salmon filet with steamed broccoli, brown rice, and a spinach salad with roast beets and walnuts dressed in olive oil and balsamic vinegar

Better adherence to diet plans was associated with greater odds of healthy aging. It should be noted that among study participants, those who were graded in the highest quintile for adherence were more likely to have a higher socioeconomic status, take multivitamins, have a lower body mass index, and engage in more physical activity than participants from the lowest quintile. Participants within the highest quintile were also less likely to have a history of depression.

Are Specific Foods Associated With Healthy Aging?

Tessier and colleagues’ analysis also found that some foods were more associated with healthy aging than others. At the top of the list were:

• Fruits
• Whole grains
• Vegetables
• Leafy-green vegetables
• Nuts

Adding unsaturated fats (e.g., olive oil, avocado oil, fatty fish) and consuming a higher ratio of mono-unsaturated fatty acids to saturated fatty acids were also associated with healthy aging.

The items with the lowest association with healthy aging were:

• Trans fats
• Total meats
• Sodium
• Red and processed meats
• Margarine

The analysis aligns with other recent findings, including those of Assmann and colleagues, which also found an association between healthy aging and a higher intake of fruits and vegetables, as well as an unfavorable association between healthy aging and meat and alcohol.

Playing the Long Game

Your diet is something over which you have an enormous amount of control, and doing a little every day can lead to notable changes down the road. It is not simply about weight or preventing metabolic conditions like hypertension or hyperlipidemia. Diet is deeply connected to every system in the body, and it can impact how you think, how you sleep, and even how you feel. We should all be eating like our mental health depends on it—because it does.

For patients who want to prioritize healthy aging and maintaining mental health into their golden years, it is never too early to start considering how dietary decisions can impact overall health. After all, healthy aging is a marathon. It’s not a sprint.