Food biodiversity and mortality in older Mediterranean adults with high cardiovascular risk

The food system is a key determinant of population and planetary health. As the "one planet, one health" approach gains momentum, evaluating "food biodiversity" and its association with mortality in high-risks populations is increasingly important. Hence, we evaluated the associations of food biodiversity with all-cause and cause-specific mortality in a Spanish cohort of older adults at high cardiovascular risks. Food biodiversity was defined using dietary species richness (DSR), the count of unique plants and animal species consumed by an individual. DSR was cumulatively calculated over the PREDIMED study follow-up, using yearly food frequency questionnaire data. The association of food biodiversity with all-cause and cause-specific mortality was assessed using Cox regression, while controlling for confounders. We analyzed data from 7210 participants (58 % women), with a median age of 67 years. DSR in the cohort ranged between 16 and 57 (median: 48). Over a median follow-up of 6 years, 425 deaths were recorded (103 deaths from cardiovascular diseases (CVD), 169 cancer deaths, and 153 deaths due to other-causes). DSR was only moderately correlated with adherence to the Mediterranean diet. On average, when fully adjusted, every additional species over the follow-up period was associated with a Hazard Ratio (HR (95 % Confidence Interval) of 0.91(0.90,0.93) for all-cause mortality, 0.93(0.90,0.96) for CVD mortality, 0.92 (0.89,0.94) for cancer deaths, and a 0.91(0.89,0.94) for deaths from other causes. Dietary recommendations to improve food biodiversity may increase longevity.