In the SUN cohort of 17,855 Spanish university graduates (mean age 37), followed a median 14.3 years with 525 deaths, adherence to the 2025-2030 Dietary Guidelines for Americans was not linked to lower mortality. Top versus bottom quartile gave an all-cause hazard ratio of 0.87 (0.67-1.13) and a CVD mortality ratio of 1.62 (0.86-3.04). Highest Mediterranean diet adherence, by contrast, was associated with 32% lower all-cause mortality (HR 0.68), 61% lower CVD mortality (HR 0.39) and 41% lower cancer mortality (HR 0.59). Plant-based components and limiting processed meat showed independent protective associations.
The contrast fits decades of evidence, including PREDIMED trial results for cardiovascular events, that Mediterranean-style eating tracks with longer life. The more interesting signal is the nonsignificant but elevated CVD point estimate for the new guidelines, consistent with their greater room for animal protein and fat. That estimate rests on few CVD deaths and a wide interval, so it is a hypothesis, not a verdict. Important caveats: this is observational, so residual confounding remains; participants are highly educated and young, with few deaths, limiting power and generalizability; diet was measured once at baseline; and the DGA score was constructed retrospectively by the authors, which may not match how real-world followers eat. The study came from a group with a long record of Mediterranean diet research, which is worth weighing. Editorially, this is confirmatory for the Mediterranean diet and a useful early warning on the new guidelines, not a definitive test of them. Practically, the shared protective features, more plants and fewer processed meats, remain the safest bet.