LIFEstyle factors and LONGevity (LIFELONG) Study - Globally, the world population is aging. Yet, living to age 90 (defined here as exceptional longevity) is still rare and exceeds the US life expectancy at birth by 11 years and at age 65 by over 5 years. Individuals who reach age 90 have been shown to have delayed onset of major chronic diseases or improved survival from chronic diseases compared to those who die at younger ages. Genetic determinants only explain 25% of the variability in human lifespan, suggesting that modifiable factors may be key to promoting longevity and healthy aging. Yet, the dietary factors that optimize healthy longevity remains controversial and prospective evidence is lacking on whether modifiable factors impact the likelihood of older adults achieving exceptional longevity. Our over-arching goal is to provide evidence for recommendations on modifiable factors targeted towards older adults to promote healthy longevity in which lifespan approximates health span. This project leverages the Pooling Project of Prospective Studies of Diet and Cancer, an NCI consortium of large, well-characterized prospective cohorts worldwide, to assess the role of dietary and other modifiable factors in relation to exceptional longevity in older adults. Our aims focus on exposures that have been associated with chronic diseases and hypothesized to impact longevity. We propose to examine commonly consumed foods (i.e., coffee, alcohol, ultra-processed foods, red meat), dietary fiber, metrics associated with individual and planetary health (i.e., food group diversity and adherence to the EAT-Lancet planetary health diet), recommendation-based dietary scores which account for synergism between foods, and lifestyle scores of dietary and other modifiable factors with the likelihood of living to age 90 (exceptional longevity). We will examine whether associations are differential by socio- demographic, lifestyle, behavioral, and social factors and health conditions. The project will include 11 cohorts from three continents including nearly 317,000 participants aged 60-75 years old at study enrollment, among whom over 31,000 achieved exceptional longevity. Each cohort has high-quality exposure and covariate data captured at baseline and during follow-up and includes at least 200 individuals who lived to age 90. We will employ different analytic approaches to address potential biases common in mortality studies. This well powered project will allow for a comprehensive evaluation of modifiable factors overall and by pertinent health-related factors in relation to exceptional longevity, beyond the collective influence of morbid conditions that occur in older adulthood. Examination of repeated exposure measures will enhance precision of exposure classifications and evaluation of potential exposure changes with aging. The results will complement those gleaned from mortality studies which are focused on risk factors for premature death and studies of those over age 90 which lack control comparisons. The project will yield much-needed results on whether modifiable factors improve longevity in older adults and critical evidence for providing novel insights for chronic disease prevention, promoting health span, and re-orienting medical practice from examining individual diseases to holistic prevention efforts.
