Effect of long-term caloric restriction on DNA methylation measures of biological aging in healthy adults from the CALERIE trial

<jats:title>Abstract</jats:title><jats:p>The geroscience hypothesis proposes that therapy to slow or reverse molecular changes that occur with aging can delay or prevent multiple chronic diseases and extend healthy lifespan<jats:sup>1–3</jats:sup>. Caloric restriction (CR), defined as lessening caloric intake without depriving essential nutrients<jats:sup>4</jats:sup>, results in changes in molecular processes that have been associated with aging, including DNA methylation (DNAm)<jats:sup>5–7</jats:sup>, and is established to increase healthy lifespan in multiple species<jats:sup>8,9</jats:sup>. Here we report the results of a post hoc analysis of the influence of CR on DNAm measures of aging in blood samples from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial, a randomized controlled trial in which <jats:italic>n</jats:italic> = 220 adults without obesity were randomized to 25% CR or ad libitum control diet for 2 yr (ref. <jats:sup>10</jats:sup>). We found that CALERIE intervention slowed the pace of aging, as measured by the DunedinPACE DNAm algorithm, but did not lead to significant changes in biological age estimates measured by various DNAm clocks including PhenoAge and GrimAge. Treatment effect sizes were small. Nevertheless, modest slowing of the pace of aging can have profound effects on population health<jats:sup>11–13</jats:sup>. The finding that CR modified DunedinPACE in a randomized controlled trial supports the geroscience hypothesis, building on evidence from small and uncontrolled studies<jats:sup>14–16</jats:sup> and contrasting with reports that biological aging may not be modifiable<jats:sup>17</jats:sup>. Ultimately, a conclusive test of the geroscience hypothesis will require trials with long-term follow-up to establish effects of intervention on primary healthy-aging endpoints, including incidence of chronic disease and mortality<jats:sup>18–20</jats:sup>.</jats:p>