Our results are consistent with those of recent meta-analyses showing that higher diet-quality scores measured with the Alternate Healthy Eating Index, Alternate Mediterranean Diet, DASH, and the Healthy Eating Index–2010 were associated with a 17 to 26% reduction in the risk of death from any cause. We found a dose-dependent relationship between changes in diet quality over 12 years and total mortality. These results underscore the concept that moderate improvements in diet quality over time could meaningfully decrease the risk of death, and conversely, worsening diet quality may increase the risk. The change in the risk of death was more pronounced when longer-term (16 years) rather than shorter-term (8 years) changes in diet quality were considered.


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