As the global population continues to age, identifying dietary patterns that promote not just the absence of disease, but also comprehensive overall health and functional wellbeing in later life is paramount. Addressing this need, a recent study published in Nature Medicine provides critical new evidence. Conducted by Tessier et al. (2025), this research is distinguished by its unprecedented scale and duration – a comprehensive longitudinal follow-up of over 100,000 participants across 30 years.
The study uniquely investigated the long-term association between adherence to eight diverse dietary patterns and a multidimensional definition of healthy ageing, which encompasses maintaining cognitive function, physical capabilities, and mental wellbeing alongside freedom from major chronic diseases. By moving beyond a disease-centric approach to a holistic view of healthy ageing, this study offers particularly valuable insights for future dietary recommendations and public health strategies.
Background
Healthy ageing encompasses multiple dimensions beyond simply avoiding disease, including maintaining cognitive function, physical capabilities, and mental wellbeing.
The World Health Organisation (WHO) has recently shifted focus from a disease-centric approach to one that prioritises the preservation of functional ability and prevention of capacity decline as central to healthy ageing models.
While several studies have examined associations between diet and specific health outcomes, such as cardiovascular disease, type 2 diabetes, and mortality, fewer have considered diet in relation to a multidimensional model of healthy ageing.
Methodology
Tessier and colleagues (2025) utilised data from two large prospective cohorts: the Nurses’ Health Study (NHS) with 70,091 women and the Health Professionals Follow-Up Study (HPFS) with 34,924 men.
Participants were excluded if they had baseline chronic diseases, implausible dietary data, or missing information on healthy ageing phenotype.
Dietary intake was assessed using validated food frequency questionnaires (FFQs) administered every four years from 1986 onwards.
Eight diets for healthy ageing
The researchers calculated adherence to eight diets for healthy ageing, as outlined below.
- Alternative Healthy Eating Index (AHEI): evaluates intake of 11 components known to influence disease risk, including fruits, vegetables, nuts, whole grains, and healthy fats, while limiting red/processed meats, sodium, and trans fats. This pattern showed the strongest association with overall healthy ageing.
- Alternative Mediterranean Diet Index (aMED): characterised by high consumption of olive oil, fruits, vegetables, legumes, nuts, and fish; moderate intake of alcohol (particularly wine); and low consumption of red and processed meats. This traditional pattern is associated with cardiovascular benefits.
- Dietary Approaches to Stop Hypertension (DASH): designed to manage blood pressure through high intake of fruits, vegetables, whole grains, and low-fat dairy products, while limiting sodium, sweets, and red meats. This pattern helps control hypertension, a major risk factor for many chronic diseases.
- Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND): combines features of Mediterranean and DASH diets but emphasises foods specifically linked to cognitive health, including berries, green leafy vegetables, and brain-healthy nutrients (i.e. omega-3 fatty acids).
- Healthful Plant-Based Diet Index (hPDI): differentiates between healthy and unhealthy plant foods, allocating positive scores to whole plant foods and negative scores to refined plant foods and animal products. This was the weakest predictor of healthy ageing among patterns studied.
- Planetary Health Diet Index (PHDI): focuses on both human health and environmental sustainability, encouraging plant-based foods with low greenhouse gas emissions while ensuring nutritional adequacy. Strongly linked to cognitive health and longevity.
- Empirical Dietary Inflammatory Pattern (EDIP): developed using biomarkers of inflammation, with higher scores indicating more inflammatory diets. For analysis, this was reversed (rEDIP) to align with other patterns where higher scores indicate healthier diets.
- Empirical Dietary Index for Hyperinsulinemia (EDIH): derived empirically based on foods associated with insulin response. Like EDIP, this was reversed (rEDIH) for analysis and showed particularly strong association with prevention of chronic diseases.
They also examined ultraprocessed food (UPF) consumption.
Healthy ageing, an holistic view
Healthy ageing was defined as reaching at least 70 years of age while maintaining:
- intact cognitive function (assessed via a validated subjective cognitive decline questionnaire);
- physical function (measured using the 36-item Short Form Survey);
- mental health (evaluated using the 15-item Geriatric Depression Scale);
- freedom from 11 major chronic diseases, including cancer, diabetes, cardiovascular conditions, and neurodegenerative disorders.
The researchers used logistic regression models to assess associations between dietary patterns and healthy ageing, adjusting for various potential confounders, including age, body mass index, ancestry, smoking status, physical activity, socioeconomic status, multivitamin use, and family history of various diseases.
Major outcomes
Of the 105,015 participants followed for up to 30 years, only 9,771 (9.3%) achieved healthy ageing. Across all eight dietary patterns, higher adherence was consistently associated with greater odds of healthy ageing. When examining individual components of healthy ageing:
- the Alternative Healthy Eating Index (AHEI) showed the strongest association with maintaining intact physical function and mental health;
- the Planetary Health Diet Index (PHDI) was most strongly associated with maintaining intact cognitive health and surviving to age 70;
- the reversed Empirical Dietary Index for Hyperinsulinemia (rEDIH) showed the strongest association with freedom from chronic diseases.
When an age threshold of 75 years was used, associations were even stronger.
Dietary factors and healthy ageing
Individual dietary factors showed consistent patterns:
- higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy products were linked to greater odds of healthy ageing;
- conversely, higher intakes of trans fats, sodium, sugary beverages, and red or processed meats were inversely associated with healthy ageing;
- ultraprocessed food (UPF) consumption was also inversely associated with healthy ageing, showing a 32% lower likelihood of maintaining intact cognitive and physical function, good mental health, and remaining free of chronic diseases.
Subgroup analyses revealed that dietary patterns were more strongly associated with healthy ageing in women than in men for most dietary patterns. Associations were also stronger in smokers, individuals with higher BMI, and those with lower physical activity levels.
Discussion
This study by Tessier and colleagues (2025) provides robust evidence that long-term adherence to healthy dietary patterns during mid-life is associated with increased likelihood of healthy ageing in later years. Among the eight patterns examined, the AHEI emerged as having the strongest association with overall healthy ageing.
All diets showing positive associations with healthy ageing share common elements: they
- emphasise consumption of plant-based foods (fruits, vegetables, whole grains, nuts, legumes) while limiting intake of animal products, particularly processed meats, and
- reducing trans fats, sodium, added sugars and ultra-processed foods. This suggests that a predominantly plant-based diet with moderate inclusion of healthy animal-based foods may be optimal for promoting healthy ageing.
The strengths of this study include its large sample size, long follow-up period, repeated assessment of dietary patterns and confounding factors, and comprehensive definition of healthy ageing that encompasses multiple domains of health and function. However, limitations include the predominantly health professional population studied, which may limit generalisability, and the use of self-reported measures for cognitive and physical function.
Implications and conclusions
The findings from this study suggest that encouraging adherence to dietary patterns rich in plant-based foods with moderate inclusion of healthy animal-based foods may enhance overall healthy ageing. Specifically, the Alternative Healthy Eating Index (AHEI) showed the strongest association with healthy ageing, suggesting it may be particularly effective for promoting overall health in later life.
These results extend beyond simply preventing chronic diseases to promoting comprehensive health and wellbeing in older adults. They provide evidence-based guidance for public health recommendations and clinical advice aimed at promoting healthy ageing.
Future research should explore these associations in more diverse populations, investigate potential biological mechanisms, and consider how dietary interventions might be optimally implemented to promote healthy ageing across different demographic groups.
Dario Dongo
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Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
