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Background Dietary diversity is thought to reduce risk of malnutrition although it is also linked to obesity. We examined whether dietary diversity is associated with all-cause mortality in Japanese elderly by body mass index (BMI). Methods The current study included 2,944 people aged 64-65 years who participated in the NISSIN project in 1996-2005. Dietary diversity was measured by the Food Variety Score (FVS) which calculates frequency of all food items consumed daily using a self-administered food frequency questionnaire. Participants were divided into tertiles according to their FVS (1st: low, 2nd: middle, 3rd: high). Multivariate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using the Cox proportional hazard regression model. In stratified analysis, BMI was used to divide the participants into 3 groups: lean (BMI &amp;lt;20), normal (BMI 20–24.9), and overweight/obese (BMI ≥ 25). Results Overall, 454 (30.7%) men and 222 (15.2%) women died over the median follow-up period of 16.6 years. No significant association between FVS and all-cause mortality was observed overall. However, when grouped by BMI, in the lean, multivariate adjusted HRs were 0.32 (CI: 0.17-0.59) in the middle FVS and 0.41 (CI: 0.19 -0.91) in the high FVS, compared with the low FVS. No significant association was found for normal and overweight/obese. Conclusions These findings indicate dietary diversity should be promoted for lean older adults. Key messages BMI should be considered when promoting dietary diversity.

516Association of dietary diversity with all-cause mortality by body mass index in Japanese older adults