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This report is written by MaltSci based on the latest literature and research findings

How does diet affect chronic diseases? ​

Abstract ​

The relationship between diet and chronic diseases has become increasingly significant in light of the growing prevalence of conditions such as obesity, diabetes, and cardiovascular diseases. This review synthesizes current research on how dietary choices impact the development and management of these diseases. It emphasizes the importance of dietary patterns over individual nutrients, highlighting the protective effects of plant-based diets, such as the Mediterranean diet, which is rich in fruits, vegetables, and healthy fats. Conversely, the Western diet, characterized by high levels of processed foods and sugars, is associated with elevated chronic disease risk. The review also explores the role of macronutrients, micronutrients, and phytochemicals in disease prevention, while acknowledging the influence of lifestyle factors, including physical activity and socioeconomic status, on dietary habits. Practical dietary recommendations are provided, focusing on the promotion of nutrient-dense foods and strategies for dietary change. Ultimately, this review underscores the urgent need for public health initiatives aimed at improving dietary patterns to mitigate the burden of chronic diseases and enhance overall health outcomes.

Outline ​

This report will discuss the following questions.

  • 1 Introduction
  • 2 The Role of Macronutrients in Chronic Disease
    • 2.1 Carbohydrates and Glycemic Index
    • 2.2 Proteins and Muscle Health
    • 2.3 Fats: Saturated, Unsaturated, and Trans Fats
  • 3 Micronutrients and Their Impact on Health
    • 3.1 Vitamins and Antioxidants
    • 3.2 Minerals and Bone Health
    • 3.3 Phytochemicals and Disease Prevention
  • 4 Dietary Patterns and Chronic Disease Risk
    • 4.1 Mediterranean Diet
    • 4.2 Plant-Based Diets
    • 4.3 Western Diet and Its Implications
  • 5 Lifestyle Factors Influencing Dietary Impact
    • 5.1 Physical Activity and Metabolism
    • 5.2 Socioeconomic Status and Access to Healthy Foods
    • 5.3 Psychological Factors and Eating Behaviors
  • 6 Practical Dietary Recommendations
    • 6.1 Guidelines for Healthy Eating
    • 6.2 Strategies for Dietary Change
    • 6.3 Public Health Initiatives
  • 7 Conclusion

1 Introduction ​

The relationship between diet and chronic diseases has garnered significant attention in recent years, primarily due to the alarming rise in the prevalence of conditions such as obesity, diabetes, cardiovascular diseases, and certain cancers. Chronic diseases represent a substantial public health challenge, particularly as populations age and dietary habits shift towards more processed and less nutritious options. As the global burden of diet-related chronic diseases continues to escalate, understanding the intricate connections between dietary patterns and health outcomes becomes increasingly vital. This review aims to explore these connections, highlighting how dietary choices can influence the development, progression, and management of chronic diseases.

Research indicates that diet plays a critical role in the etiology of chronic diseases, with various dietary components—including macronutrients and micronutrients—affecting health outcomes. For instance, a study assessing the Dietary Inflammatory Index (DII) found that higher DII scores were associated with increased odds of chronic diseases such as cardiovascular disease and diabetes in older adults[1]. Similarly, a holistic approach to understanding diet-related diseases has identified that obesity and diabetes are central to the development of other chronic conditions, necessitating a focus on dietary strategies that prioritize the prevention of these diseases[2].

Current research emphasizes the importance of dietary patterns over individual nutrients. Observational and clinical studies have increasingly demonstrated that plant-based dietary patterns—rich in fruits, vegetables, and whole grains—are beneficial in preventing various chronic diseases, while diets high in red and processed meats and refined sugars are associated with increased risks[3]. This review will delve into specific dietary patterns, such as the Mediterranean diet, vegetarianism, and the Standard American Diet, examining their respective impacts on chronic disease risk.

Moreover, lifestyle factors, including physical activity and socioeconomic status, play a crucial role in modulating the relationship between diet and chronic diseases. Physical inactivity has been linked to the rising incidence of chronic diseases, underscoring the need for comprehensive lifestyle interventions that incorporate both dietary modifications and increased physical activity[4]. Additionally, socioeconomic factors can influence access to healthy foods, further complicating dietary choices and health outcomes[5].

This review will be organized as follows:

  1. The Role of Macronutrients in Chronic Disease: This section will explore the impact of carbohydrates, proteins, and fats on health, with a particular focus on the glycemic index, muscle health, and the effects of saturated, unsaturated, and trans fats.

  2. Micronutrients and Their Impact on Health: Here, we will examine the roles of vitamins, minerals, and phytochemicals in disease prevention and health promotion.

  3. Dietary Patterns and Chronic Disease Risk: This section will analyze various dietary patterns, including the Mediterranean diet, plant-based diets, and the implications of the Western diet.

  4. Lifestyle Factors Influencing Dietary Impact: We will discuss how physical activity, socioeconomic status, and psychological factors interact with dietary habits to influence chronic disease risk.

  5. Practical Dietary Recommendations: This section will provide actionable guidelines for healthy eating, strategies for dietary change, and insights into public health initiatives aimed at improving population health.

  6. Conclusion: We will summarize the key findings and emphasize the importance of dietary choices in mitigating the risk of chronic diseases.

In conclusion, this review seeks to synthesize current research findings to provide a comprehensive overview of how dietary choices can be optimized to enhance health outcomes and reduce the burden of chronic diseases. By promoting awareness of the critical role of nutrition in chronic disease prevention and management, we aim to contribute to public health strategies that foster healthier dietary patterns and improve overall population health.

2 The Role of Macronutrients in Chronic Disease ​

2.1 Carbohydrates and Glycemic Index ​

Diet plays a crucial role in the management and prevention of chronic diseases, particularly through the modulation of macronutrient intake and the glycemic index (GI) of foods consumed. Carbohydrates, as a significant macronutrient, have garnered considerable attention due to their varying effects on metabolic health, especially in relation to chronic conditions such as diabetes, cardiovascular disease, and obesity.

The glycemic index is a ranking of carbohydrates in foods according to how they affect blood glucose levels. Foods with a high GI lead to rapid spikes in blood glucose and insulin levels, while low GI foods result in a slower, more gradual increase. This distinction is vital as hyperinsulinemia and insulin resistance, often driven by high-GI diets, are implicated in the etiology of several chronic diseases, including diabetes and coronary heart disease (Augustin et al., 2002) [6].

Research indicates that diets characterized by high glycemic index and high glycemic load are associated with an increased risk of diabetes. For instance, prospective cohort studies have shown that these dietary patterns contribute to long-term weight gain and negatively affect glucose homeostasis (Blaak, 2016) [7]. Conversely, low glycemic index foods, which are often rich in fiber and complex carbohydrates, have been associated with beneficial effects on glucose control, insulin sensitivity, and lipid profiles (Augustin et al., 2002) [6].

Furthermore, recent findings suggest that a higher dietary glycemic index and load may be linked to slower disease progression in specific conditions, such as amyotrophic lateral sclerosis (ALS). In a study involving participants with ALS, those with higher glycemic index diets exhibited less decline in functional scores and a trend towards longer survival without tracheostomy (Lee et al., 2024) [8]. This underscores the potential impact of dietary carbohydrate quality on disease outcomes.

The interaction between macronutrients and chronic disease is complex. While energy restriction remains a primary factor in weight management, the quality of carbohydrates consumed also plays a significant role. A Mediterranean diet, which emphasizes low glycemic index foods and healthy fats, has been shown to reduce the incidence of cardiovascular events in high-risk individuals (Blaak, 2016) [7].

In summary, dietary carbohydrates, particularly their glycemic index, are pivotal in influencing chronic disease risk and progression. Low glycemic index diets may provide protective benefits against metabolic disorders, while high glycemic index diets are associated with adverse health outcomes. As such, dietary interventions focusing on the quality of carbohydrate intake are critical for the prevention and management of chronic diseases.

2.2 Proteins and Muscle Health ​

Diet plays a significant role in the development and management of chronic diseases, particularly through the influence of macronutrients such as proteins, carbohydrates, and fats on overall health and specific conditions. In the context of muscle health, which is crucial for maintaining functionality and independence, especially in older adults, the dietary intake of proteins has been highlighted as a critical factor.

Research indicates that muscle health is vital for the functionality and independence of older adults. Specific nutrients and dietary patterns have been shown to provide protective effects against declines in strength and function associated with aging. Notably, randomized controlled trials suggest that dietary intake of protein is essential in preventing sarcopenia—a condition characterized by loss of muscle mass and strength—although the optimal dose and type of protein remain unclear [9].

In a recent study, the interplay between macronutrients and micronutrients was examined in relation to musculoskeletal health among adults aged 50 to 80 years. The findings revealed that an increase in mixed macronutrient intake was associated with significant improvements in bone mineral density (BMD) and grip strength. Specifically, a one-quartile increase in mixed macronutrient intake resulted in a 0.009 unit increase in BMD and a 0.670 unit increase in grip strength. Similarly, mixed micronutrient intake was linked to a 0.007 unit increase in BMD and a 0.442 unit increase in grip strength. This underscores the importance of a balanced dietary approach in promoting musculoskeletal health and overall well-being in the elderly [10].

Furthermore, in the context of chronic obstructive pulmonary disease (COPD), a common condition that leads to reduced muscle strength and function, dietary interventions have shown promise. A study demonstrated that the ingestion of protein and carbohydrates after strength training could enhance strength recovery in individuals with COPD. The findings suggested that a meal rich in these macronutrients led to significant increases in strength measures, indicating the potential of dietary strategies to improve physical capacity in patients with chronic conditions [11].

The cumulative evidence from various studies emphasizes the critical role of dietary proteins in maintaining muscle health and function, particularly in older adults and individuals with chronic diseases. It highlights the need for further research to establish specific dietary recommendations and interventions that can effectively address muscle-related health issues and improve the quality of life for affected populations [12][13].

In summary, the relationship between diet—especially macronutrient intake—and chronic diseases, particularly regarding muscle health, is complex and multifaceted. Adequate protein intake, alongside a balanced diet rich in other macronutrients and micronutrients, is essential for preserving muscle mass and strength, thereby reducing the risk of sarcopenia and improving overall health outcomes in aging populations and those with chronic diseases.

2.3 Fats: Saturated, Unsaturated, and Trans Fats ​

Diet plays a crucial role in the development and management of chronic diseases, particularly through the influence of macronutrients, including fats. The composition and type of dietary fats—saturated, unsaturated, and trans fats—have significant implications for health outcomes and the risk of chronic conditions.

Saturated fats, commonly found in animal products and certain plant oils, have been linked to adverse health effects. A study by Hydes et al. (2021) highlights that saturated fat intake is associated with increased intrahepatic triglycerides (IHTG), insulin resistance, and harmful ceramides, which contribute to the risk of developing conditions such as non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes. The detrimental effects of saturated fats are contrasted with those of unsaturated fats, which have been shown to have protective effects on liver health and metabolic function [14].

Trans fats, often found in processed foods and partially hydrogenated oils, are particularly harmful. They not only raise low-density lipoprotein (LDL) cholesterol but also lower high-density lipoprotein (HDL) cholesterol, thereby increasing the risk of cardiovascular disease. The consumption of trans fats is associated with inflammation and an increased risk of developing chronic diseases, including heart disease and diabetes [15].

On the other hand, unsaturated fats, particularly polyunsaturated fatty acids (PUFAs) such as omega-3 fatty acids, have been shown to exert beneficial effects on health. These fats are involved in anti-inflammatory processes and may improve insulin sensitivity. The Mediterranean diet, which is rich in monounsaturated and polyunsaturated fats, has been associated with lower rates of chronic diseases, including cardiovascular diseases [16].

Moreover, the interplay between dietary fats and other macronutrients, such as carbohydrates, further complicates the relationship between diet and chronic disease. Excessive carbohydrate intake, especially from refined sugars, can promote de novo lipogenesis, leading to increased liver fat accumulation and insulin resistance [14]. Thus, the type of carbohydrate consumed, along with the type of fat, plays a critical role in determining health outcomes.

In summary, the type and quality of dietary fats are significant factors influencing the risk of chronic diseases. Reducing saturated and trans fat intake while promoting unsaturated fats can contribute to better metabolic health and lower the risk of chronic conditions. Adopting a balanced diet that emphasizes whole, nutrient-dense foods is essential for preventing the onset and progression of chronic diseases [17][18].

3 Micronutrients and Their Impact on Health ​

3.1 Vitamins and Antioxidants ​

Diet plays a crucial role in the prevention and management of chronic diseases, particularly through the intake of micronutrients such as vitamins and antioxidants. Recent literature emphasizes the significant impact of these dietary components on various health outcomes.

Micronutrients, including vitamins and trace elements, are essential for maintaining cellular functions and overall health. A deficiency in these nutrients can lead to various chronic conditions, including cardiovascular diseases, neurodegenerative disorders, and metabolic syndromes. For instance, research indicates that inadequate intake of micronutrients is prevalent among the elderly, affecting nearly 44% of otherwise healthy individuals in developed countries. This malnutrition can exacerbate cardiovascular diseases and impact longevity (Visioli & Hagen, 2007) [19].

Antioxidant vitamins, such as vitamins C and E, selenium, and zinc, have been shown to mitigate oxidative damage, which is linked to the pathogenesis of chronic diseases. Antioxidants help neutralize free radicals, thereby protecting cellular integrity and reducing inflammation. In critically ill patients, supplementation with these antioxidants has resulted in decreased organ failure and lower rates of infectious complications (Berger, 2005) [20]. Additionally, a balanced intake of these micronutrients can enhance immune function, which is particularly vital for older adults who are at increased risk of infections and chronic diseases (Bhaskaram, 2002) [21].

The role of dietary patterns in chronic disease management is also noteworthy. Diets rich in antioxidants and anti-inflammatory components, such as those found in fruits, vegetables, nuts, and fish, are associated with reduced risks of cognitive decline and neurodegenerative diseases (Melzer et al., 2021) [22]. Furthermore, specific dietary interventions, such as the Mediterranean diet, have been linked to lower mortality rates and improved health outcomes in aging populations (Hu, 2024) [17].

Moreover, there is evidence suggesting that adequate micronutrient intake can enhance DNA repair mechanisms, which is critical in aging and the prevention of age-related diseases. Vitamins and trace elements play a pivotal role in maintaining genomic stability and reducing the risk of carcinogenesis (Kaźmierczak-Barańska et al., 2020) [23].

In summary, the interplay between diet, particularly the intake of vitamins and antioxidants, and chronic diseases is profound. Ensuring adequate micronutrient levels through a balanced diet can significantly influence health outcomes, reduce the incidence of chronic diseases, and promote healthy aging. Further research is essential to fully elucidate the mechanisms through which these nutrients exert their protective effects and to develop tailored dietary recommendations that cater to individual health needs, particularly in vulnerable populations.

3.2 Minerals and Bone Health ​

Diet plays a critical role in the prevention and management of chronic diseases, particularly concerning bone health, where micronutrients are essential. Osteoporosis, characterized by decreased bone mineral density (BMD) and increased risk of fragility fractures, highlights the importance of adequate nutrition in maintaining skeletal integrity. The interplay of various dietary components, including minerals and vitamins, significantly influences bone metabolism and health.

Calcium and phosphorus are vital minerals for bone structure, comprising approximately 80-90% of bone mineral content. A deficiency in these minerals can lead to impaired bone formation and increased fragility, making them essential for preventing osteoporosis [24]. Additionally, other micronutrients such as magnesium, zinc, copper, and vitamins D, C, and K are crucial for normal bone metabolism and health [25].

Recent studies emphasize the impact of dietary patterns on bone health. For instance, adequate intake of fruits, vegetables, and protein-rich foods has been positively associated with bone health, while high caloric diets and excessive alcohol consumption correlate with lower bone mass and higher fracture rates [26]. The role of dietary fat and sugar is complex; high-fat diets can negatively affect bone structure, yet some studies suggest that certain fats may contribute to achieving peak bone mass [27].

Moreover, maternal nutrition during pregnancy can influence fetal bone development, linking early dietary exposures to later chronic disease risk [28]. The importance of a balanced diet, rich in essential nutrients, cannot be overstated as it not only supports bone health but also mitigates the risk of chronic diseases such as type 2 diabetes and cardiovascular diseases [29].

The relationship between diet and chronic diseases extends beyond individual nutrients; it involves understanding dietary patterns and their cumulative effects on health. For example, vegetarian and vegan diets, while often associated with various health benefits, have been linked to lower BMD and higher fracture risks, potentially due to insufficient intake of calcium, vitamin D, and protein [30].

In conclusion, micronutrients, particularly minerals like calcium and phosphorus, along with a balanced diet rich in diverse nutrients, are integral to maintaining bone health and preventing chronic diseases. A comprehensive understanding of these dietary influences can inform strategies for improving health outcomes and reducing the risk of osteoporosis and related conditions.

3.3 Phytochemicals and Disease Prevention ​

Diet plays a critical role in the prevention and management of chronic diseases, with a particular emphasis on the consumption of micronutrients and phytochemicals. Research has shown that unhealthy diets contribute significantly to the burden of chronic, non-communicable diseases, such as obesity, type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease (CVD), cancer, neurodegenerative diseases, and chronic kidney disease (CKD) [31]. In contrast, diets rich in fruits and vegetables are associated with a reduced risk of these chronic diseases, primarily due to the presence of bioactive compounds such as vitamins, phytochemicals, and dietary fibers [31].

Phytochemicals, which include polyphenols, carotenoids, and other bioactive compounds, have garnered attention for their potential health benefits. These compounds have been shown to exert protective effects against various chronic diseases. For instance, polyphenols are known for their anti-inflammatory properties, which can modulate both pro- and anti-inflammatory mediators in conditions like arthritis [32]. Additionally, specific phytochemicals play a role in maintaining intestinal barrier function, balancing gut microbiota, and supporting immune and metabolic resilience during critical developmental windows, such as early life [33].

The incorporation of diverse plant foods into the diet, such as those found in traditional diets like the Indian thali, can enhance the diversity of gut microbiota and may help prevent or reverse chronic diseases, including colon cancer and T2DM [34]. This dietary variety is essential as it provides not only fiber but also a range of phytochemicals that contribute to health promotion.

Moreover, evidence suggests that the quality of plant-based foods can be improved through plant science, which can help identify and enhance the levels of specific phytonutrients that promote health [35]. This aligns with the understanding that chronic diseases are influenced by dietary patterns that are often discordant with those on which humans evolved, highlighting the importance of consuming more plant-based foods to mitigate health risks [36].

In summary, a diet rich in micronutrients and phytochemicals is fundamental in preventing chronic diseases. The protective effects of these compounds, particularly when consumed through a diverse and balanced diet, can significantly contribute to improved health outcomes and reduced disease incidence. Future dietary recommendations should focus on enhancing the intake of these bioactive compounds to optimize health and prevent chronic conditions.

4 Dietary Patterns and Chronic Disease Risk ​

4.1 Mediterranean Diet ​

The relationship between diet and chronic diseases has been extensively studied, particularly focusing on dietary patterns such as the Mediterranean diet, which has shown significant health benefits. The Mediterranean diet, characterized by high consumption of fruits, vegetables, whole grains, legumes, nuts, and olive oil, along with moderate consumption of fish and poultry, and low intake of red meat and processed foods, is associated with a reduced risk of several chronic diseases, including cardiovascular diseases (CVD), type 2 diabetes, and certain cancers.

Epidemiological studies and clinical trials provide compelling evidence that adherence to the Mediterranean dietary pattern significantly reduces the risk of chronic diseases. For instance, a review by Richter et al. (2014) highlighted that the Mediterranean diet lowers the risk of chronic diseases, particularly CVD, aligning with current dietary guidelines and promoting better long-term adherence to dietary recommendations[37]. Similarly, Bonaccio et al. (2016) emphasized that the traditional Mediterranean diet is linked to lower incidences of major chronic diseases and is associated with the highest life expectancy in Mediterranean populations. However, adherence to this diet has been declining due to socioeconomic factors, which have influenced dietary behaviors and access to healthy foods[38].

The Mediterranean diet also positively impacts metabolic health and inflammation, which are critical factors in the development of chronic diseases. According to Tosti et al. (2018), this dietary pattern has been shown to reduce the risk of cardiovascular disease, type 2 diabetes, and even breast cancer, primarily through mechanisms such as lipid-lowering effects, protection against oxidative stress, and modulation of gut microbiota[39]. Furthermore, Itsiopoulos et al. (2022) noted that adherence to a Mediterranean diet correlates with lower morbidity and mortality from chronic diseases due to its anti-inflammatory properties, which may also affect systemic inflammation and atherosclerosis progression[40].

Additionally, the Mediterranean diet's role in enhancing quality of life and mental health has been increasingly recognized. Studies indicate that individuals following this dietary pattern report better mental health outcomes, which is particularly relevant for aging populations facing chronic health conditions[41]. The synergistic effects of various nutrients in the Mediterranean diet contribute to its overall health benefits, providing a multifaceted approach to preventing chronic diseases[42].

In summary, the Mediterranean diet significantly influences the risk of chronic diseases through its rich composition of plant-based foods, healthy fats, and moderate protein sources. Its anti-inflammatory and metabolic benefits further enhance its protective effects against conditions such as cardiovascular disease, type 2 diabetes, and certain cancers, making it a valuable dietary pattern for promoting long-term health and well-being.

4.2 Plant-Based Diets ​

Dietary patterns significantly influence the risk of chronic diseases, with an increasing body of evidence highlighting the benefits of plant-based diets in this context. Chronic diseases, such as obesity, type 2 diabetes, cardiovascular diseases, and neurodegenerative diseases, are closely linked to dietary habits and lifestyle choices. Investigating dietary patterns provides a more comprehensive understanding of how different food combinations affect health, as individuals typically consume a variety of foods that form distinct dietary patterns.

Research indicates that plant-based dietary patterns, characterized by high consumption of fruits, vegetables, whole grains, legumes, and nuts, are associated with a lower risk of developing chronic diseases. For instance, a systematic review noted that plant-based diets are beneficial in preventing various chronic diseases, while diets high in red and processed meats, refined grains, and added sugars tend to increase disease risk [3]. Furthermore, a longitudinal cohort study revealed that optimal dietary patterns involving plant-based foods can effectively reduce the risk of chronic diseases, including hypertension, stroke, and diabetes [43].

In individuals with chronic kidney disease (CKD), adherence to healthful plant-based diets was linked to a significantly lower risk of mortality. A study involving CKD patients demonstrated that those with higher adherence to a healthful plant-based diet index had a 34% lower risk of all-cause mortality compared to those with lower adherence [44]. This highlights the importance of not only the quantity but also the quality of plant-based foods consumed.

Moreover, the relationship between plant-based diets and chronic disease risk is supported by mechanisms involving the gut microbiota. Plant-based diets, rich in dietary fiber and fermentable substrates, promote a favorable gut microbial profile, which can reduce risk factors associated with chronic diseases. The fermentation of dietary fibers by gut bacteria produces short-chain fatty acids, which have been shown to have beneficial effects on host health [45].

Specific dietary patterns, such as the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH), emphasize plant-based foods and have been associated with reduced risk of chronic diseases [46]. These diets not only contribute to better health outcomes but are also recognized for their sustainability, suggesting a dual benefit for both individual health and environmental impact [47].

The evidence suggests that transitioning to a more plant-based diet can mitigate the incidence of chronic diseases and improve overall health outcomes. Therefore, dietary guidelines should emphasize the importance of plant-based dietary patterns as a strategic approach to prevent and manage chronic diseases [48]. In summary, the adoption of healthful plant-based diets is a promising strategy for reducing the burden of chronic diseases and enhancing population health.

4.3 Western Diet and Its Implications ​

Diet plays a crucial role in the development and progression of chronic diseases, with specific dietary patterns significantly influencing health outcomes. The Western diet, characterized by high intakes of processed foods, refined grains, red and processed meats, sugars, and low consumption of fruits and vegetables, has been particularly associated with an increased risk of various chronic conditions, including obesity, type 2 diabetes, cardiovascular diseases, and chronic kidney disease (CKD).

The Western dietary pattern is marked by several key characteristics: it typically includes large portion sizes and a high intake of energy-dense foods, which can lead to obesity and metabolic disturbances. For instance, studies have shown that the Western diet contributes to the incidence and progression of CKD by promoting dyslipidemia, oxidative stress, inflammation, and impaired renal hormonal regulation [49].

Research indicates that adherence to the Western diet is linked to a higher risk of CKD. A cross-sectional study involving 2437 participants aged 45-59 in China revealed that individuals in the highest quartile of a Western dietary pattern had 1.83 times greater odds of developing CKD compared to those in the lowest quartile [50]. Conversely, a dietary pattern rich in grains and vegetables was associated with a reduced risk of CKD, with an odds ratio of 0.84 for the highest quartile compared to the lowest [50].

Moreover, the Western diet has been implicated in the rise of cardiovascular diseases. In a prospective cohort study of women, adherence to a prudent dietary pattern (high in fruits, vegetables, whole grains, and lean proteins) was associated with a 28% lower risk of cardiovascular mortality, while a higher adherence to the Western dietary pattern was linked to a 22% increased risk [51]. This relationship underscores the importance of dietary choices in managing health risks associated with chronic diseases.

The implications of the Western diet extend beyond individual health, affecting public health systems globally. The increased prevalence of chronic diseases due to poor dietary habits poses significant challenges, necessitating public health initiatives to promote healthier eating patterns. Such initiatives could include education on the benefits of diets rich in plant-based foods, which have been shown to lower the risk of chronic diseases [3].

In summary, the Western dietary pattern is closely associated with an elevated risk of chronic diseases, including CKD and cardiovascular conditions. Interventions aimed at promoting healthier dietary patterns, such as increased consumption of fruits, vegetables, and whole grains, could mitigate these risks and improve overall public health outcomes.

5 Lifestyle Factors Influencing Dietary Impact ​

5.1 Physical Activity and Metabolism ​

Diet plays a crucial role in the development and management of chronic diseases, particularly in the context of lifestyle factors such as physical activity and metabolism. A comprehensive review of the literature reveals that dietary patterns and specific nutritional components significantly influence the risk of various chronic conditions, including cardiovascular disease (CVD), diabetes, obesity, and certain types of cancer.

The Dietary Inflammatory Index (DII) is one measure that has been linked to chronic diseases. A study involving 16,512 adults aged over 60 years found that higher DII scores, indicative of a more inflammatory diet, were associated with increased odds of chronic diseases. Specifically, individuals in the highest quartile of DII had 28% higher odds of having CVD, 17% higher odds of diabetes, and 19% higher odds of hypertension compared to those in the lowest quartile, even after adjusting for various confounding factors (Patel et al. 2025) [1].

Additionally, dietary patterns such as the Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension), and plant-based diets have been associated with a reduced risk of chronic diseases. These diets are characterized by high consumption of fruits, vegetables, whole grains, and healthy fats, while limiting red and processed meats, refined sugars, and saturated fats. Research has shown that adherence to these dietary patterns correlates with lower mortality rates and improved health outcomes (Hu 2024) [17].

The mechanisms through which diet influences chronic disease risk are multifaceted. Poor dietary choices can lead to metabolic dysregulation, increased inflammation, and oxidative stress, all of which contribute to the pathogenesis of chronic diseases. For instance, diets high in processed foods and added sugars are linked to obesity and metabolic syndrome, which are precursors to conditions like type 2 diabetes and cardiovascular diseases (Ojo & Adegboye 2023) [52].

Physical activity further compounds the effects of diet on chronic diseases. Regular exercise is known to enhance metabolic health, improve insulin sensitivity, and reduce inflammation. Therefore, combining a balanced diet with adequate physical activity can significantly mitigate the risk of chronic diseases. A study highlighted that lifestyle modifications, including diet and exercise, could extend disease-free life expectancies significantly (Bojang & Manchana 2023) [53].

Moreover, the economic implications of dietary choices are noteworthy. Increased adherence to healthy dietary patterns has been shown to result in substantial healthcare cost savings due to reductions in chronic disease prevalence. For example, a modeling study estimated that improving dietary conformance in the U.S. adult population could lead to cost savings ranging from $16.7 billion to $88.2 billion, depending on the level of adherence achieved (Scrafford et al. 2019) [54].

In conclusion, diet is a pivotal factor influencing chronic disease outcomes. A holistic approach that includes promoting healthy dietary patterns and encouraging physical activity is essential for preventing and managing chronic diseases effectively. This multifaceted strategy not only improves individual health outcomes but also offers significant economic benefits to society.

5.2 Socioeconomic Status and Access to Healthy Foods ​

Diet plays a crucial role in the development and management of chronic diseases, with lifestyle factors and socioeconomic status significantly influencing dietary choices and access to healthy foods.

Chronic diseases, including cardiovascular diseases, diabetes, and certain cancers, are closely linked to dietary patterns and nutritional quality. For instance, studies have shown that a diet rich in fruits, vegetables, whole grains, and low in processed foods is associated with a reduced risk of these diseases. Specifically, adherence to dietary patterns such as the Mediterranean diet, which emphasizes plant-based foods and healthy fats, has been linked to lower mortality rates and better health outcomes (Hu 2024; Medina-Remón et al. 2018).

Socioeconomic status (SES) is a critical determinant of dietary habits and health outcomes. Higher SES often correlates with better access to nutritious foods, enabling individuals to make healthier dietary choices. Conversely, individuals from lower SES backgrounds may face barriers such as limited access to fresh produce, higher prices for healthy options, and less nutritional education, which can lead to poorer dietary habits and increased risk of chronic diseases (Irankhah et al. 2024; Everson et al. 2002). For example, the study conducted in Mashhad revealed that higher SES was negatively associated with the prevalence of chronic diseases, suggesting that economic access plays a significant role in dietary choices and health outcomes (Irankhah et al. 2024).

Moreover, lifestyle factors such as physical activity and food intake significantly interact with dietary choices. The relationship between diet quality and chronic diseases has been emphasized in various studies, indicating that improved dietary quality can mitigate the risk of chronic diseases, even in the presence of other risk factors (Yang et al. 2021). In this context, lifestyle modifications, including increasing physical activity and improving diet quality, are essential for reducing the burden of chronic diseases.

The impact of diet on chronic diseases is further compounded by the built environment, which influences food availability and lifestyle choices. Access to supermarkets and healthy food options is often limited in lower SES neighborhoods, which can perpetuate unhealthy eating patterns and increase the risk of chronic diseases (Irankhah et al. 2024).

In conclusion, the interplay between diet, lifestyle factors, and socioeconomic status is critical in understanding the prevalence of chronic diseases. To mitigate the impact of these diseases, it is essential to promote access to healthy foods, enhance nutritional education, and address the broader socioeconomic factors that influence dietary choices. Public health initiatives must focus on creating supportive environments that facilitate healthy eating and active living, particularly in underserved communities (Cavalli-Sforza et al. 1996; Santos 2022).

5.3 Psychological Factors and Eating Behaviors ​

Diet plays a crucial role in the development and management of chronic diseases, which have become a significant public health challenge, particularly among aging populations. The relationship between dietary habits and chronic diseases is multifaceted, influenced by a variety of lifestyle and psychological factors that shape eating behaviors.

Chronic diseases such as cardiovascular disease (CVD), diabetes, and obesity are closely linked to dietary patterns. Research indicates that higher scores on the Dietary Inflammatory Index (DII), which assesses the inflammatory potential of diet, are associated with increased odds of developing these conditions. For instance, a study involving 16,512 adults aged over 60 found that individuals in the highest quartile of DII had 28% higher odds of CVD, 17% higher odds of diabetes, and 19% higher odds of hypertension compared to those in the lowest quartile, even after adjusting for various confounding factors (Patel et al., 2025) [1].

Moreover, the composition of the diet—specifically the balance of macronutrients and the inclusion of whole, nutrient-dense foods—plays a pivotal role in influencing chronic disease risk. Diets rich in fruits, vegetables, whole grains, and healthy fats, such as those found in the Mediterranean diet, have been associated with lower risks of chronic diseases, while diets high in red and processed meats, refined grains, and added sugars have been linked to increased disease prevalence (Bojang & Manchana, 2023) [53].

Psychological factors also significantly impact dietary choices and eating behaviors. Emotional states, stress levels, and cognitive patterns can influence food selection and consumption. For instance, individuals may resort to comfort foods that are high in sugars and fats during periods of stress, which can exacerbate the risk of chronic diseases (Ojo & Adegboye, 2023) [52]. Furthermore, the concept of "Food Is Medicine" emphasizes the need for healthy food resources to prevent and manage chronic conditions, suggesting that dietary interventions can be a critical component of health care strategies (Volpp et al., 2023) [55].

The interplay between diet and chronic diseases is further complicated by social and environmental factors. Access to healthy foods, socioeconomic status, and cultural norms can dictate dietary patterns and ultimately influence health outcomes. For instance, populations in lower socioeconomic brackets may have limited access to fresh produce and whole foods, leading to higher consumption of processed foods that are often less nutritious (Neufeld et al., 2023) [56].

In conclusion, the impact of diet on chronic diseases is significant and multifactorial, involving an intricate relationship between dietary patterns, psychological influences, and lifestyle factors. Addressing these elements through targeted dietary recommendations and public health strategies can help mitigate the burden of chronic diseases and promote healthier aging.

6 Practical Dietary Recommendations ​

6.1 Guidelines for Healthy Eating ​

Diet plays a crucial role in the development and management of chronic diseases, influencing factors such as inflammation, weight management, and overall health. The literature emphasizes the importance of adhering to healthy dietary patterns to mitigate the risk of various chronic conditions, including cardiovascular diseases, diabetes, and certain cancers.

A significant body of evidence indicates that diets high in fruits, vegetables, whole grains, and lean proteins while low in saturated fats, trans fats, sodium, and added sugars are effective in reducing the risk of major diet-related chronic diseases. Specifically, healthy dietary patterns have been associated with lower mortality rates and enhanced longevity. For instance, the Mediterranean diet, characterized by high consumption of plant-based foods and moderate intake of fish and dairy, has been shown to have anti-inflammatory and antioxidant properties that contribute to better health outcomes and a reduction in chronic disease risk [17][57][58].

The dietary components are equally significant; the type of fats, proteins, and carbohydrates consumed can have more impact on chronic disease risk than their quantities. Diets rich in nutrient-dense foods such as vegetables, fruits, nuts, and legumes are linked to improved health, whereas diets high in processed foods, added sugars, and saturated fats are associated with increased risks of chronic diseases [17][59].

In terms of practical dietary recommendations, the Academy of Nutrition and Dietetics advocates for children and adults to achieve optimal physical and cognitive development through appropriate eating habits. This includes promoting regular physical activity and making healthier food choices to prevent obesity and chronic diseases [58]. Furthermore, the adoption of culturally tailored, person-centered dietary interventions is crucial for effective public health strategies, especially in diverse populations [60].

To summarize, a diet rich in whole, nutrient-dense foods while limiting processed and energy-dense options is vital for preventing chronic diseases. Public health initiatives should focus on creating environments that facilitate access to healthy food choices, thereby promoting healthier eating habits across different populations. The integration of personalized nutrition strategies into clinical practice is also recommended to enhance individual health outcomes and address the broader social and economic challenges associated with chronic diseases [61][62].

6.2 Strategies for Dietary Change ​

Diet plays a critical role in the development and management of chronic diseases. Various studies emphasize that dietary patterns significantly influence health outcomes, with specific recommendations and strategies emerging from the research.

Public health entities advocate for healthy diets and physical activity as key lifestyle factors that affect the development of chronic diseases, including cardiovascular, metabolic, and neurological diseases. Randomized clinical trials have demonstrated that lifestyle modifications, particularly in nutrition, can alter the trajectory of chronic disease progression. For instance, adherence to a healthy diet, such as the Mediterranean diet, has been associated with reduced cardiovascular risk and improved life expectancy due to its anti-inflammatory and antioxidant properties. A diet high in fibers, fruits, and vegetables, coupled with a low intake of processed foods, contributes to reduced inflammation and enhanced immune function [57].

Moreover, the complexity of dietary intake is highlighted in the investigation of dietary patterns, which encompass the combinations of foods consumed rather than focusing solely on individual nutrients. Studies indicate that plant-based dietary patterns rich in fruits, vegetables, and whole grains are effective in preventing chronic diseases, while diets high in red and processed meats, refined grains, and added sugars increase disease risk [3].

In the context of promoting healthy aging and longevity, maintaining a healthy weight and adopting specific dietary patterns, such as the Mediterranean, DASH (Dietary Approaches to Stop Hypertension), and plant-based diets, have been associated with lower mortality rates and improved health outcomes. These dietary patterns typically emphasize nutrient-rich plant foods, limited consumption of red and processed meats, and the use of culinary herbs and spices [17].

To facilitate dietary change, several strategies can be implemented. These include personalizing dietary recommendations based on individual preferences, cultural contexts, and specific health needs. For instance, personalized nutrition strategies that align with the principles of predictive, preventive, and personalized medicine (PPPM) can effectively address chronic disease management [63]. Additionally, interventions should focus on creating supportive food environments that promote access to nutritious options, particularly for vulnerable populations, such as the elderly [17].

Further, successful dietary interventions often require collaboration among legislators, health professionals, industry stakeholders, and individuals to address both personal food choices and the broader environmental factors influencing these choices. Evidence suggests that effective strategies for dietary change can emerge from individual-based trials that inform community-level interventions [64].

In summary, diet is a pivotal factor in the prevention and management of chronic diseases. Practical dietary recommendations should prioritize whole, nutrient-dense foods, emphasize plant-based dietary patterns, and adapt to individual and cultural needs. The successful implementation of these strategies can significantly enhance public health outcomes and mitigate the burden of chronic diseases in society.

6.3 Public Health Initiatives ​

Diet plays a crucial role in the development and management of chronic diseases, influencing health outcomes across various life stages. Public health entities emphasize the importance of healthy diets and physical activity as key lifestyle factors in mitigating the risk of chronic diseases, including cardiovascular and metabolic disorders, cancer, and neurological diseases (Santos 2022). Randomized clinical trials have demonstrated that lifestyle modifications, particularly in nutrition, can alter the trajectory of chronic disease development and progression. The Mediterranean diet, for instance, is highlighted for its anti-inflammatory and antioxidant properties, which contribute to reducing cardiovascular risk and enhancing adult life expectancy (Santos 2022).

The Academy of Nutrition and Dietetics posits that primary prevention through dietary intervention is the most effective and cost-efficient strategy to prevent chronic diseases. Registered dietitians play a pivotal role in delivering nutrition-focused preventive services, advocating for policy initiatives, and conducting research in health promotion (Slawson et al. 2013). This approach emphasizes the integration of health-promotion strategies at various societal levels, including intrapersonal, interpersonal, institutional, community, and public policy, to effectively reduce morbidity and mortality rates associated with chronic diseases.

Recent epidemiological studies have underscored the significance of dietary factors in promoting healthy aging and longevity. Maintaining a healthy weight and adhering to specific dietary patterns, such as the Mediterranean and DASH diets, are associated with lower mortality rates and improved health outcomes (Hu 2024). These diets typically feature a high intake of nutrient-rich plant foods while limiting processed foods and red meats, which are linked to increased chronic disease risk. Additionally, combining a healthy diet with other lifestyle modifications could extend disease-free life expectancy by several years (Hu 2024).

In terms of public health initiatives, addressing the dietary patterns prevalent in various populations is essential for chronic disease prevention. Innovative strategies, such as personalized dietary recommendations tailored to individual preferences and cultural contexts, are necessary to enhance the adoption of healthy eating behaviors (Xiao et al. 2024). Furthermore, public health policies must aim to create an environment where nutritious food options are accessible, particularly in underserved communities, to reduce health disparities associated with diet-related chronic diseases (Matthews & Kurnat-Thoma 2024).

Overall, the evidence strongly supports the notion that dietary interventions can significantly influence the risk and management of chronic diseases. The integration of personalized nutrition strategies into clinical care and public health initiatives is imperative for improving health outcomes and promoting a healthier population (Dai 2025). Such comprehensive approaches will not only enhance individual health but also alleviate the broader social and economic burdens posed by chronic diseases in aging populations.

7 Conclusion ​

The findings of this review highlight the critical role of diet in the prevention and management of chronic diseases, emphasizing that dietary patterns rather than individual nutrients are key to influencing health outcomes. Evidence supports that diets rich in fruits, vegetables, whole grains, and healthy fats, such as the Mediterranean diet, are associated with lower risks of conditions like cardiovascular diseases, diabetes, and certain cancers. Conversely, the Western diet, characterized by high intakes of processed foods and sugars, correlates with increased chronic disease prevalence. Furthermore, lifestyle factors, including physical activity and socioeconomic status, significantly affect dietary choices and health outcomes. To combat the rising burden of chronic diseases, future research should focus on personalized dietary recommendations and public health initiatives that enhance access to healthy foods, particularly in underserved populations. Addressing the multifaceted nature of dietary influences on health will be essential in developing effective strategies for chronic disease prevention and management, ultimately leading to improved population health and reduced healthcare costs.

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