What Children of Centenarians Eat: The Honest Singapore Take

One of my patients walked into clinic this week, phone open, very pleased with himself. "Doctor, I read that the children of people who lived to 100 eat more fish, more fruit, less sugar and less salt. So I just need to eat like them, right?"

I love this question because it is the right instinct, applied to a slightly oversold headline. The story he was reading came from a Tufts University press release earlier this month about the New England Centenarian Study, the largest cohort of 100-year-olds and their families in the world. The headlines made it sound like the children of centenarians had finally cracked the code. The actual data, when you read it carefully, is more interesting and more useful than the headline suggests, especially for those of us eating in Singapore.

So this is the post I wanted my patient to read before he started ordering grilled mackerel at every meal. What the study actually showed, what we already knew from a much bigger Singaporean cohort, and the food swaps that genuinely move the needle.

What the Centenarian Offspring Study Really Found

The Tufts press release, picked up by news outlets in early April, was based on an analysis from the New England Centenarian Study (NECS) presented at the Gerontological Society of America 2025 Annual Scientific Meeting and published as an abstract in Innovation in Aging in December 2025. The team, led by Andres V. Ardisson Korat at the Jean Mayer USDA Human Nutrition Research Center on Aging, looked at 335 children of centenarians and 128 controls (mean age 73.6 years, 55 per cent women) who had filled in a 131-item Harvard Food Frequency Questionnaire back in 2005.

They scored each participant's diet on four well-validated indices: the Alternative Healthy Eating Index (AHEI), the Healthy Eating Index (HEI), the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and the Planetary Health Diet Index (PHDI). The headline that travelled was "centenarian offspring eat more fish, fruit and vegetables, less sugar and sodium". The detail that did not travel quite as far was the actual statistical comparison.

That is not a failure of the study. It is the most useful finding in it. When the researchers looked across the indices, the differences in diet quality between centenarian offspring and controls were small and not statistically significant. Women scored slightly higher than men. Younger participants scored higher on AHEI. And education was positively associated with every single index they measured. When centenarian offspring with high school education were compared to control offspring with high school education, the gap was real. When both groups had postgraduate degrees, the gap basically disappeared.

In plain English: longevity does not run in families because of a secret family recipe. It runs in families partly because health-promoting habits, including good food, are easier to access if you have time, money and education. The most powerful longevity intervention in this dataset was not "eat fish like a centenarian's child". It was "go to school for a few more years".

Why This Story Still Has a Useful Spine

Here is where the headlines and the science do agree. The four diet patterns the study used (AHEI, HEI, MIND, PHDI), and their close cousin DASH, are some of the most consistently validated dietary scores we have. They are not fringe biohacker patterns. They are what nutrition epidemiology has been measuring for two decades, and they all reward roughly the same things: vegetables, fruit, whole grains, legumes, nuts, fish, plant oils, and they penalise the same things: refined grains, sugar-sweetened beverages, processed meat and excess sodium.

The cleanest local data on what these patterns actually do for longevity does not come from Boston. It comes from us. The Singapore Chinese Health Study, run out of the NUS Saw Swee Hock School of Public Health, followed 57,078 Singaporean Chinese adults aged 45 to 74 from 1993 to 2014. By the end of follow-up there had been 15,262 deaths in the cohort. In a 2018 paper in the Journal of Nutrition, Neelakantan and colleagues compared the highest versus the lowest fifth of diet quality and found:

• AHEI-2010: 18 per cent lower risk of all-cause mortality
• Alternate Mediterranean diet: 20 per cent lower risk of all-cause mortality
• DASH: 20 per cent lower risk of all-cause mortality
• Healthy Diet Indicator (WHO): 12 per cent lower risk of all-cause mortality

For cardiovascular and respiratory mortality, the highest-quality diets were associated with 14 to 28 per cent lower risk. For cancer mortality, the effect was smaller (5 to 12 per cent), which fits what we know biologically: cardiovascular disease is more nutrition-responsive than most cancers.

That is real, in real Singaporean people, eating real local food, with proper follow-up. It is a more useful piece of evidence for daily decision-making than a centenarian-offspring abstract from Boston.

What All These Diets Actually Have in Common

The Mediterranean diet, DASH, MIND, AHEI and the Planetary Health diet are sometimes presented as competing brands, like rival airlines. They are not. If you strip away the branding and look at what they all reward, they collapse into the same handful of habits.

More vegetables, every day, ideally something green. More fruit, but whole fruit, not juice. More legumes (lentils, chickpeas, beans, soy, tofu) and nuts. Whole grains over refined grains where you can. Fish, ideally oily fish, two or three times a week. Olive oil or other unsaturated plant oil as the dominant cooking fat. Less red meat. Substantially less processed meat (luncheon meat, sausage, ham, hot dogs). Less sugar, especially in drinks. Less sodium. Less ultra-processed food.

The Mediterranean diet adds wine in modest amounts, but the 2023 World Health Organization position is that no level of alcohol is safe for cancer risk, so I quietly drop that component. The MIND diet adds berries and leafy greens specifically for cognition. DASH adds an explicit emphasis on potassium-rich foods and low sodium for blood pressure. The Planetary Health Diet, from the EAT-Lancet Commission, makes the legumes and nuts more central and the red meat much smaller. They differ at the edges. They agree on the centre.

And the centre is what showed up in the Singapore Chinese Health Study. Higher consumption of vegetables, fruit, nuts and long-chain omega-3 fats; lower consumption of red meat; avoidance of high alcohol intake. Those were the components most strongly associated with lower mortality.

Where Singapore Specifically Loses Points

If you took an average Singaporean adult and scored them against the AHEI or DASH today, two components would tend to drag the score down hard.

Sodium. The Health Promotion Board's Recommended Dietary Allowance for sodium is less than 2,000 mg per day, in line with the WHO. The latest national surveys put the average Singaporean intake at around 3,600 mg per day, with about nine in ten adults exceeding the recommended limit. That is roughly one-and-a-half teaspoons of salt above target every single day. Most of it does not come from your home salt shaker. It comes from soya sauce, fish sauce, oyster sauce, chilli sauce, dark sauce, kicap manis, ikan bilis, dried shrimp, salted vegetables, instant noodles, sausages, luncheon meat and the soup of every noodle dish you have ever loved. The HPB has been pushing salt-reduction since 2022, with the new Nutri-Grade rules for sauces and seasonings due to take effect in mid-2027.

Refined carbohydrate and sugar. The local diet is rice and noodles dominant. That is not the problem on its own. The problem is the version: white rice, refined noodles, sweetened drinks (kopi-O kosong is a beautiful exception, kopi siu dai is a kind compromise, teh-C alia is doing you no favours), and processed snack food. Singapore's Health Promotion Board put sugar-sweetened drinks under the Nutri-Grade label scheme precisely because the average daily intake of sugar from drinks alone was clinically worrying.

The other problem area is fish. Singaporeans eat fish, but a lot of it is in fishball form, fish cake form, or deep-fried form, all of which are processed and salty. Two servings a week of properly cooked fish (steamed, grilled, baked, lightly stir-fried) is what the diet score actually rewards.

The Food Swaps That Move the Needle

I have stopped giving patients menu plans. They do not stick. What sticks is two or three permanent swaps, made at the meals you already eat. So here are mine, picked specifically because they are realistic in a Singapore week.

1. Build the plate by quarters, not by recipe

At hawker, food court or home dinner, mentally split the plate into four quarters. One quarter rice or noodles (yes, brown rice if you can stomach it, but white rice is not the villain people think; the villain is portion). One quarter vegetables or salad. One quarter protein (fish, tofu, egg, lean chicken, lean pork). The last quarter is your "and" (extra vegetables, soup, fruit). This single mental shift outperforms most fancy diets in clinic because it works at chicken rice stalls, in cai png queues and at zi char tables.

2. Replace one drink a day

The Singapore Chinese Health Study and dozens of others have shown that sugar-sweetened beverages independently raise mortality risk. The simplest swap is to replace one sugary or syrup-sweetened drink each day with water, plain tea, kopi-O kosong, or sparkling water. If you drink two bubble teas a week, dropping to one shifts your weekly sugar load by 30 to 50 grams. That is meaningful over a year.

3. Two fish meals a week, real fish

Steamed, grilled, baked, or in a clear soup. Salmon, mackerel, sardines, snapper, threadfin, cod, ikan kembong, ikan tenggiri, anchovies. The omega-3 evidence is strongest for cardiovascular outcomes and has consistent signals for cognitive decline. Fish balls and fish cakes do not count. Their ratio of fish to flour to salt is closer to a sausage than to a fillet.

4. One green vegetable, every dinner

Singaporeans are excellent at vegetables when we want to be. We have kangkong, kailan, chye sim, xiao bai cai, bayam, sayur manis, bok choy, broccoli, French beans, ladies' fingers, brinjal. The trick is making the green side compulsory. If you order zi char, order one green dish. If you order cai png, take two vegetable sides instead of one. If you cook at home, the vegetable goes in the wok before you are allowed to call dinner ready.

5. Reduce the salty extras, not the salt shaker

Most patients I see have already tried to cook with less salt at home. The bigger lever is the sauces and the preserved foods. Halving your soya sauce ration, swapping regular soya sauce for low-sodium soya sauce when available, asking for chilli sauce on the side instead of poured on, and treating processed meats (luncheon meat, otah of dubious origin, hot dogs, ham, bacon) as occasional rather than daily, makes a measurable dent in 24-hour urinary sodium within four weeks.

Two Honest Caveats Most Articles Skip

First, the MIND diet randomised controlled trial published in the New England Journal of Medicine in 2023 was largely negative. It compared a MIND diet plus mild calorie restriction with a control diet plus mild calorie restriction in 604 older adults at risk of cognitive decline, over three years. The cognitive function and brain imaging outcomes did not differ significantly between groups. Both groups lost weight. The trial does not "disprove" the MIND diet, but it does push back on the breathless headlines from observational studies, and reminds us that weight loss itself is a powerful confounder. If you read older blog posts claiming the MIND diet "prevents Alzheimer's", that statement is not currently supported by the highest-quality trial evidence.

Second, the Mediterranean diet evidence is real but had a wobble. The PREDIMED trial, the most cited evidence for primary prevention of cardiovascular disease with a Mediterranean diet plus olive oil or nuts, was retracted from the New England Journal of Medicine in 2018 because of randomisation issues at some sites and republished after reanalysis. The reanalysed paper still showed roughly a 30 per cent reduction in major cardiovascular events with Mediterranean diet plus extra-virgin olive oil or mixed nuts versus a low-fat control. So the conclusion held, but it is more honest to say the evidence is "strong observational plus one large reanalysed trial" rather than the legendary headline finding many of us first read in 2013.

None of this changes the practical recommendation. It just means I tell patients the truth: the evidence base is good, not perfect, and it converges on the same boring food.

Where Comprehensive Testing Helps

A diet score is a population-level tool. It does not tell you, today, whether your blood pressure responds to sodium, whether your LDL responds to saturated fat, whether your insulin resistance is the dominant problem, or whether you are quietly losing muscle while you optimise your AHEI. For most healthy adults, the basic principles are enough. For patients who want to know whether what they are doing is actually working, the useful tests are not exotic: a fasting metabolic panel, lipid panel including ApoB, HbA1c, blood pressure (ideally a 24-hour reading), 25-hydroxyvitamin D, body composition (DXA or a good BIA), and increasingly, biological age testing. None of these on their own changes a life. Together, repeated annually, they tell you whether your dietary efforts are landing or you are spending willpower without return.

I am very wary of telling people to chase tests they do not need. If you are 35, eating reasonably and feeling fine, the highest-yield investment is the food on your plate this week, not a panel of biomarkers. If you are 50 and serious about the next 30 years, a baseline assessment is a fair use of one afternoon and one bill.

The Bottom Line

The children of centenarians do not eat a magical diet. They eat slightly better, in slightly more accessible circumstances, scored on the same diet indices that anyone with a Harvard food questionnaire and a calculator can use on themselves tomorrow. The bigger truth in the data, which the headlines underplayed, is that education and socioeconomic status are doing most of the work. We cannot give every Singaporean a graduate degree, but we can level the playing field by making the basic food swaps boring, cheap and visible.

If you are reading this on your phone, in a hawker centre, deciding what to order, here is the whole post compressed into one sentence. Order something with vegetables, something with fish or tofu or egg, drink water or kopi-O kosong, and skip the second helping of soya sauce. That is the AHEI, the DASH, the MIND, the Mediterranean and the Planetary Health Diet, all at once, in the language of a Singapore lunch.

The patient who started this post has been doing roughly that for six weeks. He has not lost dramatic weight. His blood pressure is down 8 mmHg systolic. His lipid panel improved enough that we held off on titrating his statin. He still eats char kway teow once a week and is unbothered about it. That is the right model. Not the centenarian recipe. The centenarian's life context, replicated in small, durable food choices, ordered one meal at a time.

References

1. Ardisson Korat AV, Bhupathiraju SN, Ramos Padilla P, et al. Adherence to Various Dietary Quality Indices in the New England Centenarian Study. Innovation in Aging. 2025;9(Suppl 2):igaf122.2015. (Abstract presented at the Gerontological Society of America 2025 Annual Scientific Meeting). DOI: 10.1093/geroni/igaf122.2015
2. Neelakantan N, Koh WP, Yuan JM, van Dam RM. Diet-Quality Indexes Are Associated with a Lower Risk of Cardiovascular, Respiratory, and All-Cause Mortality among Chinese Adults. Journal of Nutrition. 2018;148(8):1323-1332. DOI: 10.1093/jn/nxy094
3. Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. New England Journal of Medicine. 2018;378(25):e34. DOI: 10.1056/NEJMoa1800389
4. Barnes LL, Dhana K, Liu X, et al. Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons. New England Journal of Medicine. 2023;389(7):602-611. DOI: 10.1056/NEJMoa2302368
5. Tessier AJ, Wang F, Korat AA, et al. Optimal dietary patterns for healthy aging. Nature Medicine. 2025;31(5):1644-1652. DOI: 10.1038/s41591-025-03570-5
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7. Health Promotion Board, Singapore. Recommended Dietary Allowances and Dietary Guidelines for Adult Singaporeans. HealthHub; updated 2024. URL: healthhub.sg
8. Ministry of Health, Singapore. Measures to Promote Low-Sodium Diet Amongst Singaporeans. 11 January 2022. URL: moh.gov.sg
9. Ministry of Health, Singapore. Nutri-Grade Requirements for Key Sources of Sodium and Saturated Fat Intake to Take Effect from Mid-2027. URL: moh.gov.sg
10. World Health Organization. No level of alcohol consumption is safe for our health. WHO Europe; 4 January 2023. URL: who.int
11. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. The Lancet. 2019;393(10170):447-492. DOI: 10.1016/S0140-6736(18)31788-4
12. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. New England Journal of Medicine. 2001;344(1):3-10. DOI: 10.1056/NEJM200101043440101