Associations of healthy dietary patterns with mortality among people with prediabetes

The comprehensive relationship between combined anti-inflammatory and healthy diets and all-cause mortality in rheumatoid arthritis: results from NHANES 2003-2018

BACKGROUND

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune inflammatory disorder. Diet is recognized as a modifiable factor that may influence inflammation and potentially accelerate RA progression. Nevertheless, the effects of diverse dietary patterns and their combined impact on RA progression and long-term mortality remain inadequately understood. This study examined the association between dietary patterns and mortality in patients with RA, focusing on the Healthy Eating Index (HEI-2015) and Dietary Inflammatory Index (DII) and evaluating their combined effects.

METHODS

The analysis included 2,069 patients with RA from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2018. Weighted multi-variable Cox regression models estimated the relationship between the DII, HEI-2015, combined dietary patterns, and all-cause mortality in patients with RA. Linear associations between the DII, HEI-2015, and all-cause mortality were analyzed using restricted cubic splines (RCS). Dietary factors associated with mortality were identified through the Least Absolute Shrinkage and Selection Operator (LASSO) method, and subgroup and sensitivity analyses were conducted to strengthen the findings.

RESULTS

Participants had a median age of 59 years (IQR: 48-69), with 42.1% male. Adjusting for potential confounders, the hazard ratio (HR) for individuals adhering to healthy and anti-inflammatory dietary patterns, as opposed to unhealthy and pro-inflammatory patterns, was 0.70 (95% CI: 0.53-0.92; adjusted P = 0.01; trend P = 0.02). In weighted Cox analyses of the DII and HEI-2015, higher quartiles showed no significant mortality risk difference from the lowest quartiles. The LASSO-Cox model identified 12 dietary components predictive of all-cause mortality in patients with RA, with an AUC of 0.749 (0.682-0.815) at 1 year, 0.763 (0.724-0.802) at 3 years, 0.783 (0.749-0.802) at 5 years, and 0.868 (0.712-0.938) for all death events. Kaplan-Meier analysis revealed that the low-risk dietary group exhibited significantly lower mortality compared to the high-risk group (P < 0.001).

CONCLUSIONS

These findings suggest that combining a higher HEI-2015 with a lower DII score correlates with reduced all-cause mortality risk among patients with RA, supporting dietary modification as a potential strategy to prevent premature death in this population.

Patterns of protein intake and mortality in patients with type 2 diabetes: results from NHANES

We aimed to look at the potential relationship between patterns of protein intake and risk of death in adults with type 2 diabetes. We included 4646 adults with type 2 diabetes participating in NHANES (1999-2018). We estimated intake of proteins from 11 animal- and plant-based food groups and then, used principal component analysis to explore data-driven patterns of protein intake. All-cause mortality was ascertained through linkage to National Death Index until December 31, 2019 (n = 969 deaths). Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Four dietary protein patterns were identified: "healthy" (high in proteins from legumes, fruits, nuts, seeds, and fish and low in red meat protein), "red meat and egg" (high in red meat and egg proteins and low in fish and poultry proteins), "vegetables/fish" and "dairy/nuts" patterns. The HRs of all-cause mortality for the highest compared to the lowest quartile of "healthy" and "red meat and egg" protein patterns were, respectively, 0.77 (95%CI: 0.62, 0.97; Ptrend = 0.014) and 1.28 (95%CI: 1.06, 1.54; Ptrend = 0.033). Greater adherence to a healthy protein pattern may be associated with a reduced risk of death in patients with type 2 diabetes, while greater adherence to a dietary pattern rich in red meat and egg proteins and low in fish and poultry proteins may be associated with a higher risk.

Cumulative exposure to AHA Life's Essential 8 is associated with nonalcoholic fatty liver disease: a large cohort study

BACKGROUND AND AIM

We aimed to explore the associations of baseline and cumulative cardiovascular health with nonalcoholic fatty liver disease (NAFLD) development and regression using the new Life's Essential 8 score.

METHODS

From a health screening database, participants who underwent at least 4 health examinations between 2012 and 2022 were recruited and categorized into two cohorts: (a) the NAFLD development cohort with no history of NAFLD prior to Exam 4 and (b) the NAFLD regression cohort with diagnosed NAFLD prior to Exam 4. The LE8 score was calculated from each component. The outcomes were defined as newly incident NAFLD or regression of existing NAFLD from Exam 4 to the end of follow-up.

RESULTS

In the NAFLD development cohort, of 21,844 participants, 3,510 experienced incident NAFLD over a median follow-up of 2.3 years. Compared with the lowest quartile of cumulative LE8, individuals in the highest quartile conferred statistically significant 76% lower odds (hazard ratio [HR] 0.24, 95% confidence interval [CI], 0.21-0.28) of NAFLD incidence, and corresponding values for baseline LE8 were 42% (HR 0.58, 95% CI 0.53-0.65). In the NAFLD regression cohort, of 6,566 participants, 469 experienced NAFLD regression over a median follow-up of 2.4 years. Subjects with the highest quartile of cumulative LE8 had 2.03-fold (95% CI, 1.51-2.74) higher odds of NAFLD regression, and corresponding values for baseline LE8 were 1.61-fold (95% CI, 1.24-2.10).

CONCLUSION

Cumulative ideal cardiovascular health exposure is associated with reduced NAFLD development and increased NAFLD regression. Improving and preserving health behaviors and factors should be emphasized as an important part of NAFLD prevention and intervention strategies.

The association of circulating systemic inflammation with premature death and the protective role of the Mediterranean diet: a large prospective cohort study of UK biobank

BACKGROUND

Although previous studies have identified specific circulating inflammatory markers associated with the risk of mortality, they have often overlooked the broader impact of a comprehensive inflammatory response on health outcomes. This study aims to assess the association between circulating systemic inflammation and age-related hospitalization and premature death, as well as explore the potential mediating effects of various dietary patterns on these associations.

METHODS

A total of 448,574 participants enrolled in the UK Biobank study were included. Circulating C-reactive protein(CRP), white blood cell count(WBC), platelet count(Plt), and neutrophil/lymphocyte ratio(NLR) were measured, which were used to establish a weighted systemic inflammatory index of inflammation index(INFLA-Score). Dietary intake information was documented through 24-hour dietary recalls, and dietary pattern scores including Dietary Approaches to Stop Hypertension(DASH), Mediterranean(MED), and Healthy Eating Index-2020(HEI-2020) were calculated. Cox proportional hazards regression models were performed to assess the associations between INFLA-Score and age-related disease hospitalization, cause-specific and all-cause premature death.

RESULTS

During a median follow-up of 12.65 years, 23,784 premature deaths were documented. After adjusting for multiple covariates, higher levels of CRP, WBC, NLR, and INFLA-Score were significantly associated with increased risks of age-related disease hospitalization(HRCRP=1.19; 95%:1.17-1.21; HRWBC=1.17; 95%:1.15-1.19; HRNLR=1.18; 95%:1.16-1.20; HRINFLA-Score=1.19; 95%:1.17-1.21) and premature death(HRCRP=1.68; 95%:1.61-1.75; HRWBC=1.23; 95%:1.18-1.27; HRNLR=1.45; 95%:1.40-1.50; HRINFLA-Score=1.58; 95%:1.52-1.64). Compared to the lowest INFLA-Score group, the highest INFLA-Score group was associated with increased values of whole-body and organ-specific biological age, and had a shortened life expectancy of 2.96 (95% CI 2.53-3.41) and 4.14 (95% CI 3.75-4.56) years at the age of 60 years in women and men, respectively. Additionally, we observed no significant association of the INFLA-Score with aging-related hospitalization and premature death among participants who were more adhering to the Mediterranean (MED) dietary pattern(HRAging-related hospitalization=1.07; 95%:0.99-1.16;HRPremature death=1.19; 95%:0.96-1.47).

CONCLUSION

A higher INFLA-Score was correlated with an increased risk of age-related hospitalization and premature death. Nevertheless, adherence to a Mediterranean (MED) diet may mitigate these associations.

The Healthy Eating Index-2015 and All-Cause/Cause-Specific Mortality: A Systematic Review and Dose-Response Meta-Analysis

This meta-analysis was undertaken to determine the predictive value of Healthy Eating Index (HEI)-2015 in all-cause, cancer-cause, and cardiovascular disease (CVD)-cause mortality. This review was registered with PROSPERO as CRD42023421585. PubMed and Web of Science were searched for articles published by September 15, 2023. The hazard ratio (HR) was calculated with exact confidence intervals (CIs) of 95%. Statistical heterogeneity among studies was measured by Cochran's Q test (χ2) and the I2 statistic. Eighteen published studies were finally identified in this meta-analysis. The results showed that the HEI-2015 was associated with all-cause mortality either as a categorical variable (HR: 0.80; 95% CI: 0.79, 0.82) or continuous variable (HR: 0.90; 95% CI: 0.88, 0.92). The HEI-2015 was also associated with cancer-cause mortality as categorical variable (HR: 0.81; 95% CI: 0.78, 0.83) or continuous variable (HR:  0.90; 95% CI: 0.81, 0.99). The categorical HEI-2015 was also independently correlated with decreasing CVD-cause mortality (HR: 0.81; 95% CI: 0.75, 0.87). A nonlinear dose-response relation between the HEI-2015 and all-cause mortality was found. In the linear dose-response analysis, the risk of mortality from cancer decreased by 0.42% per 1 score increment of the HEI-2015 and the risk of CVD-cause mortality decreased by 0.51% with the increment of the HEI-2015 per 1 score. Our analysis indicated a significant relationship between the HEI-2015 and all-cause, cancer-cause, and CVD-cause mortality.

Adherence to the 2015-2020 Dietary Guidelines for Americans Compared with the Mediterranean Diet in Relation to Risk of Prediabetes: Results from NHANES 2007-2016

Prediabetes presents a high-risk state for the development of various diseases and is reversible by adhering to a healthy lifestyle. We conducted this analysis to explore the associations of the Healthy Eating Index-2015 (HEI-2015) and the Alternate Mediterranean Diet Index (aMed index) with the risk of prediabetes. The data were derived from the National Health and Nutrition Examination Survey, including 20,844 participants. Multivariable-adjusted odds ratios (OR) of prediabetes and 95% confidence intervals (CI) by tertile of diet quality scores were estimated using a weighted logistic regression. Compared to those in the lowest tertile, the multivariable-adjusted OR of prediabetes for the highest tertile was 0.82 (95% CI: 0.72, 0.94; p for trend = 0.005) for HEI-2015 and 0.87 (95% CI: 0.76, 0.98; p for trend = 0.02) for the aMed index. After mutual adjustment, the association for HEI-2015 (p for trend = 0.03) but not for the aMed index (p for trend = 0.59) remained significant. Among the component food groups and nutrients, higher intakes of red and processed meat, sodium, and total saturated fatty acids were associated with a higher risk of prediabetes, while moderate alcohol consumption was associated with a lower risk. In conclusion, adherence to the 2015-2020 Dietary Guidelines for Americans, as compared with the Mediterranean Diet, appeared to be more strongly associated with a lower risk of prediabetes among adults in the United States.