{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:14:21Z","timestamp":1790781261445,"version":"4.1.0"},"reference-count":72,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["AG000513"],"award-info":[{"award-number":["AG000513"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aging Cell"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    This study examined associations between diet quality, epigenetic age acceleration (EAA), and mortality in two U.S. cohorts: NHANES (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092158) and HRS (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091752), while accounting for demographic and socioeconomic (SES) determinants. Diet was evaluated as a potentially modifiable exposure within broader social and biological pathways. Participants were linked to the National Death Index. Cox proportional hazards models, additive Bayesian networks (ABN), generalized structural equation models (GSEM), and four\u2010way decomposition were used to estimate direct, indirect, and interaction effects, with SES specified as an upstream determinant of diet and aging processes. Higher diet quality (HEI\u20102015) was associated with lower EAA and reduced mortality. GrimAgeEAA was the strongest mortality predictor (NHANES: HR\u2009=\u20091.61; HRS: HR\u2009=\u20091.76, both\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001 per SD). ABN and GSEM identified SES as a driver of both diet and biological aging pathways. In HRS, approximately 44% of the inverse association between diet and mortality (HR\u2009=\u20090.85,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05) was explained by GrimAgeEAA (pure indirect effect), whereas mediation was not evident in NHANES. In sensitivity analyses adjusting for lifestyle factors and energy intake, the total effect in HRS was attenuated to non\u2010significance, with physical activity emerging as a key confounder. Diet quality also modified the association between PhenoAge and mortality (~22% attributable to interaction). Poor diet quality is associated with accelerated epigenetic aging and increased mortality risk, with patterns consistent with a modest mediating role of epigenetic mechanisms. However, these associations appear partly confounded by lifestyle factors, particularly physical activity, highlighting the importance of integrated behavioral and biological pathways.\n                  <\/jats:p>","DOI":"10.1111\/acel.70504","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T03:30:59Z","timestamp":1778038259000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Healthy Eating Index, Epigenetic Age Acceleration and Mortality Risk in\n                    <scp>US<\/scp>\n                    Adults"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-4523","authenticated-orcid":false,"given":"May A.","family":"Beydoun","sequence":"first","affiliation":[{"name":"Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA\/NIH\/IRP  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie T.","family":"Fanelli Kuczmarski","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA\/NIH\/IRP  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1683-3838","authenticated-orcid":false,"given":"Nicole","family":"Noren Hooten","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA\/NIH\/IRP  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hind A.","family":"Beydoun","sequence":"additional","affiliation":[{"name":"U.S. Department of Veterans Affairs VA National Center on Homelessness Among Veterans  Washington DC USA"},{"name":"Department of Management, Policy, and Community Health, School of Public Health University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-648X","authenticated-orcid":false,"given":"Jack","family":"Tsai","sequence":"additional","affiliation":[{"name":"U.S. Department of Veterans Affairs VA National Center on Homelessness Among Veterans  Washington DC USA"},{"name":"Department of Management, Policy, and Community Health, School of Public Health University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana I.","family":"Maldonado","sequence":"additional","affiliation":[{"name":"U.S. Department of Veterans Affairs  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1516-3251","authenticated-orcid":false,"given":"Sharmin","family":"Hossain","sequence":"additional","affiliation":[{"name":"Department of Human Services State of Maryland  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Nieva","sequence":"additional","affiliation":[{"name":"Department of Psychology Princeton University  Princeton New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele K.","family":"Evans","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA\/NIH\/IRP  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan B.","family":"Zonderman","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA\/NIH\/IRP  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2021.101869"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.111.140822"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114513003796"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.54870"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.73420"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140905"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0204141"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2025.02.012"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017\u201002462"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/acel.70159"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008756"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2007.06.016"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbih.2025.101152"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13148\u2010021\u201001220\u20104"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afae038"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43587\u2010024\u201000793\u2010y"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114522003701"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/21551197.2016.1247022"},{"issue":"6","key":"e_1_2_13_20_1","first-page":"466","article-title":"Socio\u2010Economic 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B.Mersha.2024.\u201cEpigenetic Age Acceleration and Mortality Risk Prediction in U.S. Adults. medRxiv.\u201dhttps:\/\/doi.org\/10.1101\/2024.08.21.24312373.","DOI":"10.1101\/2024.08.21.24312373"},{"key":"e_1_2_13_52_1","unstructured":"National Cancer Institute.2024.\u201cHealthy Eating Index.\u201dhttps:\/\/epi.grants.cancer.gov\/hei\/tools.html."},{"key":"e_1_2_13_53_1","unstructured":"National Center for Health Statistics (NCHS).2013.\u201c2013 NCHS Urbanu\u2013Rural Classification Scheme for Counties.\u201dU.S. Department of Health and Human Services Centers for Disease Control and Prevention. (Ingram D. D. & Franco S. J. 2014 NCHS Vital and Health Statistics Series 2 No. 166).https:\/\/stacks.cdc.gov\/view\/cdc\/22467."},{"key":"e_1_2_13_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2021.101314"},{"key":"e_1_2_13_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2021.101348"},{"key":"e_1_2_13_56_1","doi-asserted-by":"publisher","DOI":"10.3945\/an.113.004176"},{"key":"e_1_2_13_57_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195\u2010023\u201001379\u20103"},{"key":"e_1_2_13_58_1","doi-asserted-by":"publisher","DOI":"10.18632\/aging.101168"},{"key":"e_1_2_13_59_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2024"},{"key":"e_1_2_13_60_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980010003642"},{"key":"e_1_2_13_61_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.117.153148"},{"key":"e_1_2_13_62_1","volume-title":"Bayesian Networks: With Examples in R","author":"Scutari M.","year":"2019"},{"key":"e_1_2_13_63_1","doi-asserted-by":"publisher","DOI":"10.1089\/rej.2022.0059"},{"key":"e_1_2_13_64_1","volume-title":"Stata Statistical Software: Release 18","author":"StataCorp","year":"2023"},{"key":"e_1_2_13_65_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/9719584"},{"key":"e_1_2_13_66_1","doi-asserted-by":"crossref","unstructured":"Thomas A. 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P.Ryan A.Caspi et\u00a0al.2023.\u201cDiet Pace of Biological Aging and Risk of Dementia in the Framingham Heart Study. medRxiv.\u201dhttps:\/\/doi.org\/10.1101\/2023.05.24.23290474.","DOI":"10.1101\/2023.05.24.23290474"},{"key":"e_1_2_13_67_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26900"},{"key":"e_1_2_13_68_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glx227"},{"key":"e_1_2_13_69_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCGEN.122.003772"},{"key":"e_1_2_13_70_1","unstructured":"U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA).2015\u20132020.\u201cDietary Guidelines for Americans.\u201dhttps:\/\/health.gov\/dietaryguidelines\/2015\/guidelines."},{"key":"e_1_2_13_71_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000121"},{"key":"e_1_2_13_72_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15143148"},{"key":"e_1_2_13_73_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a114086"}],"container-title":["Aging Cell"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acel.70504","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acel.70504","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acel.70504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T22:18:46Z","timestamp":1779401926000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acel.70504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":72,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/acel.70504"],"URL":"https:\/\/doi.org\/10.1111\/acel.70504","archive":["Portico"],"relation":{},"ISSN":["1474-9718","1474-9726"],"issn-type":[{"value":"1474-9718","type":"print"},{"value":"1474-9726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-12-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70504"}}