Background Sustainable dietary patterns that incorporate multiple dimensions may have benefits for both human health and the environment. We examined the association between sustainable dietary patterns assessed by using the Sustainable Diet Index-US (SDI-US) and mortality in US adults. Methods This study used data from the National Health and Nutrition Examination Survey 2007–18 (N = 22 414 aged ≥20 years). The SDI-US (range: 4–20) was composed of four sub-indices representing nutritional, environmental, economic and sociocultural dimensions, and was computed using 24-h dietary recalls, food expenditures and food preparation habits. A higher score indicates a more sustainable dietary pattern. All-cause mortality from baseline until 31 December 2019 was obtained through linkage to the National Death Index. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional-hazards models, adjusting for covariates. Results During 150 386 person-years of follow-up, 2100 total deaths occurred and the median SDI-US was 9.8 in Quintile 1 (Q1) and 16.3 in Quintile 5 (Q5). In a multivariable-adjusted model, the highest SDI-US quintile was associated with a 36% reduction in mortality risk (Q5 vs Q1, HR 0.64, 95% CI 0.49–0.84, P = 0.002) compared with the lowest quintile. When stratified by age (P interaction = 0.002), an inverse association between SDI-US and mortality was observed in younger adults (<65 years, HR 0.41, 95% CI 0.25–0.68, P = 0.001) but not in older adults (≥65 years, HR 0.91, 95% CI 0.71–1.16, P = 0.15). Conclusions A higher SDI-US score was associated with lower mortality risk among US adults, particularly in younger adults.

中文翻译：

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美国成年人的可持续饮食模式和全因死亡率

背景 包含多个维度的可持续饮食模式可能对人类健康和环境都有好处。我们研究了使用美国可持续饮食指数 (SDI-US) 评估的可持续饮食模式与美国成年人死亡率之间的关联。方法 本研究使用 2007-18 年全国健康和营养检查调查的数据（N = 22 414 岁≥20 岁）。SDI-US（范围：4-20）由代表营养、环境、经济和社会文化维度的四个子指数组成，并根据 24 小时饮食回忆、食品支出和食品准备习惯进行计算。分数越高表明饮食模式越可持续。从基线到 2019 年 12 月 31 日的全因死亡率是通过与国家死亡指数联系获得的。使用 Cox 比例风险模型估计 95% CI 的风险比 (HR)，并调整协变量。结果 在 150 386 人年的随访期间，总共发生了 2100 例死亡，五分位数 1 (Q1) 的 SDI-US 中位数为 9.8，五分位数 5 (Q5) 的中位数为 16.3。在多变量调整模型中，与最低五分位数相比，最高 SDI-US 五分位数与死亡风险降低 36% 相关（Q5 与 Q1，HR 0.64，95% CI 0.49–0.84，P = 0.002）。按年龄分层时（P 交互作用 = 0.002），在年轻人中观察到 SDI-US 与死亡率之间呈负相关（<65 岁，HR 0.41，95% CI 0.25–0.68，P = 0.001），但在老年人中则不然（≥65 岁，HR 0.91，95% CI 0.71–1.16，P = 0.15）。结论 较高的 SDI-US 评分与美国成年人（尤其是年轻人）较低的死亡风险相关。