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Abbasi B, Hajinasab MM, Mohammadi Zadeh Z, Ahmadi P. Diversity of the diet is correlated with osteoporosis in post-menopausal women: an Iranian case-control study. Front Public Health 2024; 12:1431181. [PMID: 39185118 PMCID: PMC11342058 DOI: 10.3389/fpubh.2024.1431181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024] Open
Abstract
Background Proper nutrition is a crucial factor in preventing osteoporosis, a significant pathological cause linked to skeletal weakness; this study investigated the relationship between dietary diversity score and food group diversity score with osteoporosis in postmenopausal women. Methods This case-control study was conducted on 378 menopausal women aged 45-85 in Tehran, Iran. The age-matching method to control the confounding effect of age was used. The method of dual-energy X-ray absorptiometry (DXA) was used for assessing the bone mineral density of lumbar vertebrae and femoral neck. The bone mass status was evaluated with WHO criteria. All subjects were divided into the osteoporosis group and the non-osteoporosis group according to their T-score. A convenience sampling method was utilized to select the participants, which included two groups: case (n = 189) and control (n = 189). Data was collected using demographic and anthropometric information questionnaires, a valid 147 item food frequency questionnaire, and a physical activity questionnaire. Statistical analyses were conducted using SPSS-26, and p-values less than 0.05 were deemed to be statistically significant. Results The results indicated significant differences in weight, body mass index, physical activity, smoking, and alcohol use between the two groups. The mean ± standard deviation of dietary diversity score (DDS) was lower in participants with osteoporosis (case) (3.31 ± 1.26) than in control (4.64 ± 1.33) (p < 0.001). The mean ± standard deviation of diversity score of cereals, fruits, and vegetables in the osteoporosis group (respectively: 0.71 ± 0.21, 0.94 ± 0.76, and 0.45 ± 0.44) was less than the control group (respectively: 0.80 ± 0.21, 1.64 ± 0.55 and 0.87 ± 0.42) (p < 0.001). After adjusting the confounding variables, the risk of osteoporosis had an inverse relationship with the diversity score of vegetable (OR = 0.16; 95%CI: 0.07-0.35), bread and cereal (OR = 0.21; 95% CI: 0.05-0.87) and fruit (OR = 0.35; 95%CI: 0.22-0.56) (p < 0.05). Nevertheless, no discernible correlation was seen between the tertiles of DDS, dairy and meat diversity score, and osteoporosis. Conclusion We found a correlation between the diversity score of fruits, vegetables, and grains and osteoporosis. However, there is no significant correlation between the DDS triads and the diversity score of dairy products and meats with osteoporosis.
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Affiliation(s)
- Behnood Abbasi
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Mahdi Hajinasab
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Zahra Mohammadi Zadeh
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Paniz Ahmadi
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Shobako N, Itoh H, Honda K. Typical Guidelines for Well-Balanced Diet and Science Communication in Japan and Worldwide. Nutrients 2024; 16:2112. [PMID: 38999861 PMCID: PMC11243298 DOI: 10.3390/nu16132112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/27/2024] [Accepted: 06/30/2024] [Indexed: 07/14/2024] Open
Abstract
Numerous studies have investigated healthy diets and nutrients. Governments and scientists have communicated their findings to the public in an easy-to-understand manner, which has played a critical role in achieving citizens' well-being. Some countries have published dietary reference intakes (DRIs), whereas some academic organizations have provided scientific evidence on dietary methods, such as traditional diets. Recently, more user-friendly methods have been introduced; the Health Star Rating system and Optimized Nutri-Dense Meals are examples from Australia and Japan, respectively. Both organizations adopt a novel approach that incorporates nudges. This review summarizes the science communication regarding food policies, guidelines, and novel methods in Japan and other countries. In the food policies section, we discuss the advantages and disadvantages of the DRIs and food-based guidelines published by the government. Dietary methods widely known, such as The Mediterranean diet, Nordic diet, Japanese traditional diet, and the EAT-Lancet guidelines, were also reviewed. Finally, we discussed future methods of science communications, such as nudge.
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Affiliation(s)
- Naohisa Shobako
- Division of Food Science and Biotechnology, Graduate School of Agriculture, Kyoto University, Uji 611-0011, Kyoto, Japan
| | - Hiroshi Itoh
- The Center for Preventive Medicine, Keio University, Minato-ku, Tokyo 106-0041, Japan;
| | - Keiko Honda
- Laboratory of Medicine Nutrition, Kagawa Nutrition University, Sakado-City 350-0214, Saitama, Japan;
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3
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Lim GH, Neelakantan N, Lee YQ, Park SH, Kor ZH, van Dam RM, Chong MFF, Chia A. Dietary Patterns and Cardiovascular Diseases in Asia: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100249. [PMID: 39009489 PMCID: PMC11294752 DOI: 10.1016/j.advnut.2024.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/29/2024] [Accepted: 05/23/2024] [Indexed: 07/17/2024] Open
Abstract
With emerging Asian-derived diet quality indices and data-driven dietary patterns available, we aimed to synthesize the various dietary patterns and quantify its association with cardiovascular diseases (CVDs) among Asian populations. We systematically searched PubMed, Embase, Scopus, and Web of Science for observational studies in South, Southeast, and East Asia. Dietary patterns were grouped "high-quality," which included high intakes of three or more of the following food groups: 1) fruits and vegetables, 2) whole grains, 3) healthy protein sources (legumes and nuts, fish and seafood, low-fat dairy, and lean meat and poultry), and 4) liquid plant oils. High-quality patterns were further subcategorized based on their derivation methods: non-Asian indices, Asian indices, data-driven patterns, and plant-based indices. Dietary patterns were grouped "low-quality," which included high intakes of two or more of the following: 5) ultraprocessed food, 6) beverages and foods with added sugars, 7) foods high in salt, and 8) alcoholic beverages. Data-driven dietary patterns characterized by animal food sources were labeled "animal-based," and studies using dietary diversity scores were labeled "diet diversity indices." Dietary patterns that could not be meaningfully categorized were summarized narratively. Study-specific effect estimates were pooled using a random-effects model. Forty-one studies were included in this review. Higher adherence to high-quality dietary patterns in the top compared with bottom tertile defined by non-Asian indices (RR: 0.78; 95% CI: 0.69, 0.88; GRADE: moderate), Asian indices (RR: 0.84; 95% CI: 0.79, 0.90; GRADE: low), and data-driven patterns (RR: 0.81; 95% CI: 0.74, 0.89; GRADE: moderate) were associated with lower CVD risk. Plant-based, low-quality, animal-based, and diet diversity indices dietary patterns were not associated with CVD. Associations of Asian diet quality indices and CVD risk were weaker than those with non-Asian indices, highlighting the need for current Asian diet quality criteria to be updated to better capture the impact of diet on CVD. The systematic review and meta-analysis was registered at PROSPERO as CRD42021244318.
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Affiliation(s)
- Gladys Huiyun Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Nithya Neelakantan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Yu Qi Lee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Su Hyun Park
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Zhi Heng Kor
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Nutrition and Exercise Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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Kobayashi M, Thielecke F. Editorial: Dietary diversity indicators: cultural preferences and health outcomes. Front Nutr 2024; 11:1433735. [PMID: 38962448 PMCID: PMC11220320 DOI: 10.3389/fnut.2024.1433735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/30/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
| | - Frank Thielecke
- Swiss Distance University of Applied Sciences, Brig, Switzerland
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5
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Imai T, Miyamoto K, Sezaki A, Kawase F, Shirai Y, Abe C, Sanada M, Inden A, Sugihara N, Honda T, Sumikama Y, Nosaka S, Shimokata H. Traditional japanese diet score and the sustainable development goals by a global comparative ecological study. Nutr J 2024; 23:38. [PMID: 38509554 PMCID: PMC10956220 DOI: 10.1186/s12937-024-00936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Reducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported in a global ecological study that the Japanese diet is associated with reducing obesity and extending healthy life expectancy etc. We then examined the relationship between the TJDS and environmental indicators. METHODS The average food (g/day/capita) and energy supplies (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. The TJDS was calculated from eight food groups (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, and eggs; food components that are relatively unused in the traditional Japanese diet: wheat, milk, and red meat) by country using tertiles, and calculated the total score from - 8 to 8, with higher scores meaning greater adherence to the TJDS. We used Land Use (m2), Greenhouse gas (GHG) emissions 2007/2013 (kg CO2eq), Acidifying emissions (g SO2eq), Eutrophying emissions (g PO43- eq), Freshwater (L), and water use (L) per food weight by Poore et al. as the environmental indicators and multiplied these indicators by each country's average food supply. We evaluated the cross-sectional and longitudinal associations between the TJDS and environmental indicators from 2010 to 2020. This study included 151 countries with populations ≥ 1 million. RESULTS Land use (β ± standard error; -0.623 ± 0.161, p < 0.001), GHG 2007 (-0.149 ± 0.057, p < 0.05), GHG 2013 (-0.183 ± 0.066, p < 0.01), Acidifying (-1.111 ± 0.369, p < 0.01), and Water use (-405.903 ± 101.416, p < 0.001) were negatively associated with TJDS, and Freshwater (45.116 ± 7.866, p < 0.001) was positively associated with TJDS after controlling for energy supply and latitude in 2010. In the longitudinal analysis, Land Use (β ± standard error; -0.116 ± 0.027, p < 0.001), GHG 2007 (-0.040 ± 0.010, p < 0.001), GHG 2013 (-0.048 ± 0.011, p < 0.001), Acidifying (-0.280 ± 0.064, p < 0.001), Eutrophying (-0.132 ± 0.062, p < 0.05), and Water use (-118.246 ± 22.826, p < 0.001) were negatively associated with TJDS after controlling for confounders. CONCLUSIONS This ecological study suggests that the traditional Japanese dietary pattern might improve SDGs except Fresh water.
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Affiliation(s)
- Tomoko Imai
- Department of Food Science and Nutrition, Doshisha Women's College of Liberal Arts, Kyoto, Japan.
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan.
| | - Keiko Miyamoto
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- Department of Nursing, Nagoya University of Arts and Sciences, Aichi, Japan
| | - Ayako Sezaki
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- National Cancer Center Japan, Tokyo, Japan
| | - Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan
- Graduate School of Nutritional Science, Nagoya University of Arts and Sciences, Aichi, Japan
| | - Yoshiro Shirai
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- Persuasive Technology Group, Life Science Laboratories, KDDI Research, Inc, Fujimino, Japan
| | - Chisato Abe
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- Department of Food and Nutrition, Tsu City College, Mie, Japan
| | - Masayo Sanada
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- Department of Nursing, Heisei College of Health Sciences, Gifu, Japan
| | - Ayaka Inden
- Clinical Nutrition Unit, Hamamatsu University Hospital, Shizuoka, Japan
| | - Norie Sugihara
- Faculty of Health and Social Services, Kanagawa University of Human Services, Kanagawa, Japan
| | - Toshie Honda
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- Department of Nursing, Nagoya University of Arts and Sciences, Aichi, Japan
| | - Yuta Sumikama
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- Department of Nutrition, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Saya Nosaka
- Department of Food Science and Nutrition, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Hiroshi Shimokata
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Aichi, Japan
- Graduate School of Nutritional Science, Nagoya University of Arts and Sciences, Aichi, Japan
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Taylor RM, Haslam RL, Herbert J, Whatnall MC, Trijsburg L, de Vries JHM, Josefsson MS, Koochek A, Nowicka P, Neuman N, Clarke ED, Burrows TL, Collins CE. Diet quality and cardiovascular outcomes: A systematic review and meta-analysis of cohort studies. Nutr Diet 2024; 81:35-50. [PMID: 38129766 DOI: 10.1111/1747-0080.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
AIMS To evaluate relationships between diet quality and cardiovascular outcomes. METHODS Six databases were searched for studies published between January 2007 and October 2021. Eligible studies included cohort studies that assessed the relationship between a priori diet quality and cardiovascular disease mortality and morbidity in adults. The Academy of Nutrition and Dietetics Checklist was used to assess the risk of bias. Study characteristics and outcomes were extracted from eligible studies using standardised processes. Data were summarised using risk ratios for cardiovascular disease incidence and mortality with difference compared for highest versus lowest diet quality synthesised in meta-analyses using a random effects model. RESULTS Of the 4780 studies identified, 159 studies (n = 6 272 676 adults) were included. Meta-analyses identified a significantly lower cardiovascular disease incidence (n = 42 studies, relative risk 0.83, 95% CI 0.82-0.84, p < 0.001) and mortality risk (n = 49 studies, relative risk 0.83, 95% CI 0.82-0.84, p < 0.001) among those with highest versus lowest diet quality. In sensitivity analyses of a high number of pooled studies (≥13 studies) the Mediterranean style diet patterns and adherence to the heart healthy diet guidelines were significantly associated with a risk reduction of 15% and 14% for cardiovascular disease incidence and 17% and 20% for cardiovascular disease mortality respectively (p < 0.05). CONCLUSIONS Higher diet quality is associated with lower incidence and risk of mortality for cardiovascular disease however, significant study heterogeneity was identified for these relationships.
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Affiliation(s)
- Rachael M Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Rebecca L Haslam
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jaimee Herbert
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Megan C Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Laura Trijsburg
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Jeanne H M de Vries
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Afsaneh Koochek
- Department of Food studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Paulina Nowicka
- Department of Food studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Nicklas Neuman
- Department of Food studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Erin D Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Tracy L Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Wakayama R, Takasugi S, Honda K, Kanaya S. Application of a Two-Dimensional Mapping-Based Visualization Technique: Nutrient-Value-Based Food Grouping. Nutrients 2023; 15:5006. [PMID: 38068864 PMCID: PMC10707954 DOI: 10.3390/nu15235006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Worldwide, several food-based dietary guidelines, with diverse food-grouping methods in various countries, have been developed to maintain and promote public health. However, standardized international food-grouping methods are scarce. In this study, we used two-dimensional mapping to classify foods based on their nutrient composition. The Standard Tables of Food Composition in Japan were used for mapping with a novel technique-t-distributed stochastic neighbor embedding-to visualize high-dimensional data. The mapping results showed that most foods formed food group-based clusters in the Standard Tables of Food Composition in Japan. However, the beverages did not form large clusters and demonstrated scattered distribution on the map. Green tea, black tea, and coffee are located within or near the vegetable cluster whereas cocoa is near the pulse cluster. These results were ensured by the k-nearest neighbors. Thus, beverages made from natural materials can be categorized based on their origin. Visualization of food composition could enable an enhanced comprehensive understanding of the nutrients in foods, which could lead to novel aspects of nutrient-value-based food classifications.
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Affiliation(s)
- Ryota Wakayama
- Meiji Co., Ltd., 2-2-1 Kyobashi, Chuo-ku 104-9306, Tokyo, Japan;
- Computational Systems Biology Laboratory, Division of Information Science, Graduate School of Science and Technology & Data Science Center, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma 630-0192, Nara, Japan
| | - Satoshi Takasugi
- Meiji Co., Ltd., 2-2-1 Kyobashi, Chuo-ku 104-9306, Tokyo, Japan;
| | - Keiko Honda
- Medicine Nutrition, Faculty of Nutrition, Kagawa Nutrition University, 3-9-21 Chiyoda, Sakado 350-0288, Saitama, Japan
| | - Shigehiko Kanaya
- Computational Systems Biology Laboratory, Division of Information Science, Graduate School of Science and Technology & Data Science Center, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma 630-0192, Nara, Japan
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8
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Nishi SK, Khoury N, Valle Hita C, Zurbau A, Salas-Salvadó J, Babio N. Vegetable and Fruit Intake Variety and Cardiovascular Health and Mortality: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2023; 15:4913. [PMID: 38068771 PMCID: PMC10707746 DOI: 10.3390/nu15234913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION A multitude of evidence supports the consumption of a higher quantity of vegetables and fruits for their cardiovascular benefits. Nonetheless, the extent to which variety is associated with cardiovascular health remains unclear. OBJECTIVE To conduct a systematic review and meta-analysis of observational studies (prospective cohort and cross-sectional studies) assessing the role of a variety of vegetable and fruit consumption in cardiovascular morbidity and mortality in adults. DATA SOURCES MEDLINE-PubMed, Cochrane databases, and reference lists were searched through March 2023. DATA EXTRACTION Two independent reviewers extracted data and assessed the risk of bias (National Heart, Lung, and Blood Institute Tool and Newcastle-Ottawa Scale). DATA ANALYSIS Data were pooled (fixed and random [DerSimonian and Laird] effects for <5 and ≥5 study comparisons, respectively), and heterogeneity was assessed using the Cochran Q statistic and quantified (I2 statistic). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the overall certainty of the evidence. Five cross-sectional (n = 45,761) and seven prospective studies (n = 253,422) met the eligibility criteria. Greater variety of vegetable and fruit consumption was prospectively related to decreased all-cause mortality (risk ratio, 0.89 [95% CI, 0.82-0.97], seven study comparisons, n = 196,925), while no significant associations were observed with assessed cardiovascular-related mortality or morbidity. For all outcomes, the certainty of the evidence was graded as "low" or "very low" owing to inconsistency and/or imprecision. CONCLUSIONS Overall, this study shows that greater variety in vegetable and fruit consumption may reduce all-cause mortality and highlights the need for additional studies with a higher degree of evidence to better understand its role in cardiovascular health.
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Affiliation(s)
- Stephanie K. Nishi
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada;
| | - Nadine Khoury
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
| | - Cristina Valle Hita
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
| | - Andreea Zurbau
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada;
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Nancy Babio
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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9
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Ricci H, Gaeta M, Franchi C, Poli A, Battino M, Dolci A, Schmid D, Ricci C. Fish Intake in Relation to Fatal and Non-Fatal Cardiovascular Risk: A Systematic Review and Meta-Analysis of Cohort Studies. Nutrients 2023; 15:4539. [PMID: 37960192 PMCID: PMC10647504 DOI: 10.3390/nu15214539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Epidemiological studies have shown that eating fish significantly reduces cardiovascular disease (CVD) incidence and mortality. However, more focused meta-analyses based on the most recent results from prospective cohort studies are needed. This systematic review and meta-analysis aims to update the association between fish intake and cardiovascular disease (CVD) risk using recent prospective studies. A systematic review and meta-analysis following the PRISMA guideline was conducted based on a random effects synthesis of multivariable-adjusted relative risks (RRs) of high vs. low categories of fish intake in relation to CVD incidence and mortality. Non-linear meta-regression was applied to investigate the shape of the association between fish intake and CVD risk. Sensitivity analysis and stratifications by type of CVD outcome, type of fish intake and type of cooking were performed. Based on 18 papers reporting 17 independent estimates of CVD risk (1,442,407 participants and 78,805 fatal and non-fatal CVD events), high vs. low intake of fish corresponded to about 8% reduced CVD risk (RR = 0.93 [0.88-0.98]). According to a non-linear dose-response meta-regression, 50 g of fish intake per day corresponded to a statistically significant 9% reduced fatal and non-fatal CVD risk (RR = 0.92 [0.90-0.95]). Similarly, fish intake in the range of a weekly intake of two to three portions of fish with a size of 150 g resulted in 8% fatal and non-fatal CVD risk reduction (RR = 0.93 [0.91-0.96]). The recommended two portions of fish a week reduces the risk of CVD outcomes by approximately 10%. A full portion of fish a day reduces CVD risk by up to 30%.
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Affiliation(s)
- Hannah Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom 2531, South Africa
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
- Italian Institute for Planetary Health (IIPH), 20124 Milan, Italy
| | - Andrea Poli
- Nutrition Foundation of Italy (NFI), 20124 Milan, Italy;
| | - Maurizio Battino
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy;
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
| | - Alberto Dolci
- Sustainable Development Department, Bolton Food SpA, 20124 Milan, Italy;
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Private University of Health Sciences, Medical Informatics and Technology, 6060 Hall, Austria;
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom 2531, South Africa
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Tang J, Dong JY, Eshak ES, Cui R, Shirai K, Liu K, Tamakoshi A, Iso H. Breakfast Type and Cardiovascular Mortality: The Japan Collaborative Cohort Study. J Atheroscler Thromb 2023; 30:1255-1264. [PMID: 36543187 PMCID: PMC10499662 DOI: 10.5551/jat.63564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/14/2022] [Indexed: 09/05/2023] Open
Abstract
AIM Little is known regarding the association between breakfast type and cardiovascular mortality. We examined the associations between breakfast type and risks of mortality from stroke, coronary heart disease (CHD), and total cardiovascular disease (CVD). METHODS A total of 85,319 males and females aged 40 to 79 years who were free from CVD and cancers at baseline were involved in this study. The participants were divided into five groups according to their self-reported breakfast types: Japanese breakfast, Western breakfast, mixed Japanese-Western breakfast, other breakfast, and skipping breakfast groups. All hazard ratios (HRs) were estimated using Cox proportional hazards regression models after adjusting for the potential confounding factors. RESULTS During the median 19-year follow-up, we identified CVD deaths of 5,870 subjects. Compared to the Japanese breakfast, the multivariable HRs (95% CIs) of total CVD were 0.64 (0.52-0.79) for mixed Japanese-Western breakfast, 0.90 (0.77-1.04) for Western breakfast, 1.24 (0.95-1.61) for other breakfast, and 1.31 (1.00-1.71) for skipping breakfast. The corresponding HRs (95% CIs) of total stroke were 0.67 (0.49-0.91), 0.83 (0.66-1.05), 1.15 (0.76-1.74), and 1.25 (0.82-1.92), and those of CHD were 0.73 (0.48-1.12), 1.08 (0.81-1.44), 1.09 (0.60-1.98), and 1.77 (1.11-2.83). CONCLUSION Compared to Japanese breakfast, mixed Japanese-Western breakfast may have a protective role in cardiovascular mortality whereas skipping breakfast may harm cardiovascular health.
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Affiliation(s)
- Jingyun Tang
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jia-Yi Dong
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ehab S. Eshak
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Renzhe Cui
- Department of Internal Medicine, Okanami General Hospital, Mie, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Keyang Liu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Graduate School of Medicine, Hokkaido University, Japan, Sapporo, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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11
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Zhong WF, Song WQ, Wang XM, Li ZH, Shen D, Liu D, Zhang PD, Shen QQ, Liang F, Nan Y, Xiang JX, Chen ZT, Li C, Li ST, Lv XG, Lin XR, Lv YB, Gao X, Kraus VB, Shi XM, Mao C. Dietary Diversity Changes and Cognitive Frailty in Chinese Older Adults: A Prospective Community-Based Cohort Study. Nutrients 2023; 15:3784. [PMID: 37686817 PMCID: PMC10490160 DOI: 10.3390/nu15173784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Evidence for the effects of dietary diversity changes and cognitive frailty (CF) in the older adults is not clear. This study aimed to investigate the relationship between dietary diversity changes and CF in older adults Chinese. A total of 14,382 participants (mean age: 82.3 years) were enrolled. Dietary diversity scores (DDSs) were collected and calculated using a food frequency questionnaire. DDS changes between baseline and first follow-up were categorized into nine patterns. The associations between DDS changes and the incidence of CF were estimated using Cox proportional hazards models. During an 80,860 person-year follow-up, 3023 CF cases were identified. Groups with a decrease in DDS had increased CF risk compared with the high-to-high DDS group, with adjusted hazard ratios (HRs; 95% confidence intervals (Cis)) of 1.30 (1.06, 1.59), 2.04 (1.51, 2.74), and 1.81 (1.47, 2.22) for high-to-medium, high-to-low, and medium-to-low groups, respectively. Lower overall DDS groups were associated with greater CF risks, with HRs (95% CIs) of 1.49 (1.19, 1.86) for the low-to-medium group and 1.96 (1.53, 2.52) for the low-to-low group. Compared with the high-to-high group, significant associations with CF were found in other DDS change groups; HRs ranged from 1.38 to 3.12 for the plant-based DDS group and from 1.24 to 1.32 for the animal-based DDS group. Additionally, extreme and moderate declines in overall DDS increased CF risk compared with stable DDS, with HRs (95% CIs) of 1.67 (1.50, 1.86) and 1.13 (1.03, 1.24), respectively. In conclusion, among older adults, a declining or persistently low DDS and a moderately or extremely declining DDS were linked to higher incident CF. Plant-based DDS changes correlated more strongly with CF than animal-based DDS changes.
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Affiliation(s)
- Wen-Fang Zhong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Wei-Qi Song
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Xiao-Meng Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Dong Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Pei-Dong Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Qiao-Qiao Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
- School of Nursing, Southern Medical University, Guangzhou 510515, China
| | - Fen Liang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Ying Nan
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
- School of Nursing, Southern Medical University, Guangzhou 510515, China
| | - Jia-Xuan Xiang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Zi-Ting Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Chuan Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Shi-Tian Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Xiao-Gang Lv
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Xiu-Rong Lin
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
| | - Yue-Bin Lv
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China;
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai 200433, China;
| | - Virginia Byers Kraus
- Division of Rheumatology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA;
| | - Xiao-Ming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China;
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (W.-F.Z.); (W.-Q.S.); (X.-M.W.); (Z.-H.L.); (D.S.); (D.L.); (P.-D.Z.); (Q.-Q.S.); (F.L.); (Y.N.); (Z.-T.C.); (C.L.); (S.-T.L.); (X.-G.L.); (X.-R.L.)
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Zheng G, Cai M, Liu H, Li R, Qian Z, Howard SW, Keith AE, Zhang S, Wang X, Zhang J, Lin H, Hua J. Dietary Diversity and Inflammatory Diet Associated with All-Cause Mortality and Incidence and Mortality of Type 2 Diabetes: Two Prospective Cohort Studies. Nutrients 2023; 15:2120. [PMID: 37432291 PMCID: PMC10180882 DOI: 10.3390/nu15092120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 07/12/2023] Open
Abstract
A higher dietary diversity score (DDS) and a lower energy-adjusted dietary inflammatory index (E-DII) may be associated with lower risks of type 2 diabetes (T2D) and mortality. This cohort study aimed to investigate the associations of DDS and E-DII with all-cause mortality, incidence of T2D, and mortality of T2D, as well as the joint effects of these two dietary factors. A total of 181,360 participants without all types of diabetes at baseline from the UK Biobank and 42,139 participants from the US NHANES were included. Cox proportional hazards models were used to assess the associations of DDS and E-DII with outcomes. In the UK Biobank data, 8338 deaths, 3416 incident T2D cases, and 353 T2D deaths occurred during a median follow-up of 12.5 years. In the US NHANES data, 6803 all-cause deaths and 248 T2D-specific deaths were recorded during a median follow-up of 9.6 years. We observed that higher DDS and lower E-DII were significantly associated with lower risks of total mortality and incident T2D. Compared with low DDS, the hazard ratios (HRs) and 95% confidence intervals (CIs) of high DDS were 0.69 (0.64, 0.74) for all-cause mortality, 0.79 (0.70, 0.88) for incident T2D in the UK Biobank, and 0.69 (0.61, 0.78) for all-cause mortality in the US NHANES. Compared with participants in tertile 3 of E-DII, those in tertile 1 had a lower risk of overall death [HR 0.86 (95% CI: 0.81, 0.91) in UK Biobank; 0.83 (0.77, 0.88) in US NHANES] and incident T2D [0.86 (0.79, 0.94)] in UK Biobank. No evidence was observed of the interactive effects of DDS and E-DII on either all-cause mortality or the incidence and mortality of T2D. There was no significant association found between any exposure and T2D mortality in this study. In conclusion, our results revealed that higher DDS and lower E-DII were associated with both total mortality and incident T2D in UK and US adults.
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Affiliation(s)
- Guzhengyue Zheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Huiling Liu
- Food Inspection and Quarantine Center, Shenzhen Customs, Shenzhen 518016, China
| | - Rui Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Steven W Howard
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Amy E Keith
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Junguo Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Junjie Hua
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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13
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Otsuka R, Zhang S, Ihira H, Sawada N, Inoue M, Yamagishi K, Yasuda N, Tsugane S. Dietary diversity and risk of late-life disabling dementia in middle-aged and older adults. Clin Nutr 2023; 42:541-549. [PMID: 36863290 DOI: 10.1016/j.clnu.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND & AIMS A balanced diet integrating several foods and nutrients may promote the maintenance of brain function. Previous studies have substantiated the above hypothesis in the regional population in Japan. This study aimed to investigate the potential effect of dietary diversity on the risk of disabling dementia in a nationwide large-scale cohort of the Japanese population. METHODS A total of 38,797 participants (17,708 men and 21,089 women) aged 45-74 years were followed up for a median of 11.0 years. The daily frequencies of the consumption of each of the 133 food and beverage items listed on a food frequency questionnaire (excluding five alcoholic beverages) were measured. The dietary diversity score was calculated as the number of food items consumed per day. Multivariable adjusted Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of the dietary diversity score quintile groups. RESULTS We documented 4302 participants with disabling dementia (11.1%) during the follow-up period. Among women, the dietary diversity score was inversely associated with disabling dementia (highest quintile HR [with the lowest quintile as the reference]: 0.67; 95% CI: 0.56-0.78; Q1-Q5 p for trend <0.001), but this was not true among men (highest quintile HR: 1.06; 95% CI: 0.87-1.29; Q1-Q5 p for trend = 0.415). These results did not change substantially when using disabling dementia with stroke as the outcome; the association remained significant among women but was absent among men. CONCLUSIONS Our findings indicate that eating a variety of foods may prevent disabling dementia only among women. Thus, the habit of consuming a variety of food items has important public health implications for women.
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Affiliation(s)
- Rei Otsuka
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| | - Shu Zhang
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| | - Hikaru Ihira
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan.
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan.
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan; Division of Prevention, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan.
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
| | - Nobufumi Yasuda
- Department of Public Health, Kochi University Medical School, Kochi, Japan.
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan; National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.
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14
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Soy Consumption and the Risk of Type 2 Diabetes and Cardiovascular Diseases: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15061358. [PMID: 36986086 PMCID: PMC10058927 DOI: 10.3390/nu15061358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Soy is rich in plant protein, isoflavones, and polyunsaturated fatty acids. To clarify the associations between soy intake and type 2 diabetes (T2D) and cardiovascular diseases (CVDs) events, we performed a meta-analysis and review. A total of 1963 studies met the inclusion criteria, and 29 articles with 16,521 T2D and 54,213 CVDs events were identified by the eligibility criteria. During a follow-up of 2.5–24 years, the risk of T2D, CVDs, coronary heart disease, and stroke in participants with the highest soy consumption decreased by 17% (total relative risk (TRR) = 0.83, 95% CI: 0.74–0.93), 13% (TRR = 0.87, 95% CI: 0.81–0.94), 21% (TRR = 0.79, 95% CI: 0.71–0.88), and 12% (TRR = 0.88, 95% CI: 0.79–0.99), respectively, compared to the lowest sot consumption. A daily intake of 26.7 g of tofu reduced CVDs risk by 18% (TRR = 0.82, 95% CI: 0.74–0.92) and 11.1 g of natto lowered the risk of CVDs by 17% (TRR = 0.83, 95% CI: 0.78–0.89), especially stroke. This meta-analysis demonstrated that soy consumption was negatively associated with the risks of T2D and CVDs and a specific quantity of soy products was the most beneficial for the prevention of T2D and CVDs. This study has been registered on PROSPERO (registration number: CRD42022360504).
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Shvabskaia OB, Karamnova NS, Izmailova OV, Drapkina OM. Healthy Eating in Population Models of Nutrition: Asian Diet Style Summary. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2023. [DOI: 10.20996/1819-6446-2022-12-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The population of Japan and Okinawa is known for the longest life expectancy, which many researchers rightly associate with the nature of nutrition existing in these territories. The Japanese diet and Okinawan diet, along with other traditional diets, are real examples of historically established sustainable patterns of healthy eating. Asian eating styles have marked differences from European eating patterns, not only in differences in food sources, but also in eating habits. The article presents the historical, climatic and cultural features of these diets; the issues of food composition, energy and nutritional value of these models of nutrition are considered in detail with an analysis of the differences existing between them; highlights the benefits of products grown mainly in Japan, which are ration-forming for the population of this country; as well as the results of scientific studies on the protective effect of the Japanese and Okinawan diets on human health and disease prevention.
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Affiliation(s)
- O. B. Shvabskaia
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. S. Karamnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. V. Izmailova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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16
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Takabayashi S, Okada E, Hirata T, Takimoto H, Nakamura M, Sasaki S, Takahashi K, Nakamura K, Ukawa S, Tamakoshi A. Nutritional Adequacy Assessment of the Japanese Diet Using the Number of Dishes Compared to Existing Dietary Diversity Indices: A Cross-Sectional Analysis from the 2012 National Health and Nutrition Survey, Japan. J Nutr Sci Vitaminol (Tokyo) 2023; 69:197-205. [PMID: 37394425 DOI: 10.3177/jnsv.69.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The Japanese diet has attracted attention as a factor contributing to the Japanese population's longevity. A typical Japanese meal, traditionally called "ichiju-sansai," is composed of various dishes. This study assessed the nutritional adequacy of the Japanese diet using the number of dishes in all meals (NDAM) compared to existing dietary diversity indices (DDIs). This cross-sectional study used data from the 2012 National Health and Nutrition Survey. A total of 25,976 participants aged ≥20 y were included in this study. NDAM was calculated for whole dishes or single foods (except supplements and beverages) from one-day weighted dietary records. The food variety score (FVS), number of foods, dietary diversity score (DDS), and number of food groups are some of the existing DDIs. NDAM had relatively high positive correlation coefficients with potassium, magnesium, and dietary fiber. The partial correlation coefficients with an indicator of the overall nutrient adequacy of NDAM was 0.42 for men and 0.42 for women. It was almost the same as that of the FVS (men: 0.44, women: 0.42) and DDS (men: 0.44, women: 0.43). On the other hand, NDAM, similar to existing DDIs, was also positively correlated with nutrient restriction in both sexes. These findings indicate that the nutrient adequacy of NDAM is similar to that of the existing DDIs. Because of the higher sodium intake and cholesterol intake in higher NDAM and existing DDIs, the effect of higher NDAM on health outcomes must be investigated in future studies.
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Affiliation(s)
- Saeka Takabayashi
- Department of Public Health, Graduate School of Medicine, Hokkaido University
| | - Emiko Okada
- Department of Nutritional Epidemiology and Nutrition Education, National Institute of Health and Nutrition
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Nutrition Education, National Institute of Health and Nutrition
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Kunihiko Takahashi
- Department of Biostatistics, Medical and Dental Data Science Center, Tokyo Medical and Dental University
| | - Koshi Nakamura
- Department of Public Health and Hygiene, Graduate School of Medicine, University of the Ryukyus
| | - Shigekazu Ukawa
- Graduate School of Human Life and Ecology, Osaka Metropolitan University
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine
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Yu Y, Cao N, He A, Jiang J. Age and cohort trends of the impact of socioeconomic status on dietary diversity among Chinese older adults from the perspective of urban–rural differences: A prospective cohort study based on CLHLS 2002–2018. Front Nutr 2022; 9:1020364. [PMID: 36337670 PMCID: PMC9632445 DOI: 10.3389/fnut.2022.1020364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
The association between socioeconomic status (SES) and dietary diversity score (DDS) has been widely discussed, but little is known about the age and cohort effects on DDS and how the SES effect on DDS varies with age and across successive cohorts among urban and rural older adults in China. Thus, this study aimed to examine the temporal change in DDS among Chinese older adults and SES heterogeneities in such change from the perspective of urban–rural differentiation. Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2002 and 2018 were used, and a total of 13,728 participants aged between 65 and 105 years were included in this study. A total of eight food groups were used to assess DDS, while education, family income, and perceived income status were used to assess SES. A linear mixed model was used to estimate the age and cohort effects on DDS and their urban–rural and SES disparities. The results show that higher SES, including more education, family income, and perceived income status, was associated with higher DDS (for urban older adults, β = 0.1645, p = 0.0003, β = 0.2638, p < 0.0001, β = 0.2917, p < 0.0001, respectively; for rural older adults, β = 0.0932, p = 0.0080, β = 0.4063, p < 0.0001, β = 0.2921, p < 0.0001, respectively). The DDS of older adults increased with age and across successive cohorts in both urban and rural China. Moreover, we found the three-way interaction effect of SES, age, and cohort was statistically significant in both urban and rural China. Thus, living in an urban area and having higher SES are associated with higher DDS, but these associations change with age and across successive cohorts. The dietary health of earlier cohorts and rural oldest-old in China deserves more attention.
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Affiliation(s)
- Yan Yu
- Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Clinical Research Center for Infectious Diseases, Wuhan Research Center for Communicable Disease Diagnosis and Treatment, Chinese Academy of Medical Sciences, Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
| | - Na Cao
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Junfeng Jiang
- School of Sociology, Central China Normal University, Wuhan, China
- *Correspondence: Junfeng Jiang,
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18
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Qu X, Na X, Yang J, Yu H, Chen A, Zhao A. Reaching and maintaining higher dietary diversity is associated with decreased risk of all-cause mortality: A longitudinal study from the China Health and Nutrition Survey. Front Nutr 2022; 9:947290. [PMID: 36225878 PMCID: PMC9549334 DOI: 10.3389/fnut.2022.947290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
It is generally believed that higher dietary diversity is associated with better health status. The dietary diversity of individuals may change with age; however, evidence on the trajectory of change in the long-term and whether it is related to all-cause mortality is still scant. In this study, we used data from the China Health and Nutrition Survey (CHNS) collected in five follow-ups between 2004 and 2015 to explore the association between changes in dietary diversity scores (DDS) and all-cause mortality, as well as the dynamic change in DDS with age. In total, 6,737 subjects (aged between 30 and 60 at enrollment) were included in the analysis. Latent Class Trajectory Modeling (LCTM) was used to explore the different trajectories of DDS changes among participants. Four classes were identified: class 1 with the lowest average DDS (3.0) that showed a gradual decline during the follow-ups; class 2 with relatively low DDS (4.0) that experienced slight growth; class 3 with medium DDS (5.2) that also demonstrated similar growth rate to class 2; and class 4 with the highest DDS (6.7) maintained at a high level. Cox proportional hazards regression models were applied to investigate the association between the DDS trajectories and the risk of death. Only class 4, which was characterized by the highest and stable DDS, had significant reduced risk of all-cause mortality of 71.0% (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.10–0.83), 68% (HR: 0.32; 95% CI: 0.11–0.89), and 66.0% (HR: 0.34; 95% CI: 0.12–0.94), compared to classes 1, 2, and 3, respectively, while the first three classes showed no significant inter-class differences. When considering the average DDS during the study period, each point of increase in DDS corresponded to a 22% reduced risk of mortality (HR: 0.78; 95% CI: 0.69–0.89). In summary, reaching and maintaining a higher DDS was associated with a decreased risk of all-cause mortality. Therefore, promoting diversified eating and increasing the accessibility of varieties of foods should be paid more attention from policymakers and be more emphasized in dietary guidelines.
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Affiliation(s)
- Xiaochen Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiaona Na
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jiaqi Yang
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
| | - Haoran Yu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Aiwen Chen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- *Correspondence: Ai Zhao
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Takabayashi S, Hirata T, Zhao W, Kimura T, Ukawa S, Tsushita K, Wakai K, Kawamura T, Ando M, Tamakoshi A. Association of dietary diversity with all‐cause mortality by body mass index in Japanese older adults: An age‐specific prospective cohort study (
NISSIN
project). Geriatr Gerontol Int 2022; 22:736-744. [DOI: 10.1111/ggi.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/17/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Saeka Takabayashi
- Department of Public Health Graduate School of Medicine, Hokkaido University Sapporo Japan
| | - Takumi Hirata
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
- Institute for Clinical and Translational Science, Nara Medical University Kashihara Japan
| | - Wenjing Zhao
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
- School of Public Health and Emergency Management Southern University of Science and Technology Shenzhen People's Republic of China
| | - Takashi Kimura
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
| | - Shigekazu Ukawa
- Department of Social Services and Clinical Psychology Graduate School of Human Life Science, Osaka City University Osaka Japan
| | - Kazuyo Tsushita
- Comprehensive Health Science Center, Aichi Health Promotion Public Interest Foundation Japan
| | - Kenji Wakai
- Department of Preventive Medicine Nagoya University, Graduate School of Medicine Nagoya Japan
| | | | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research Nagoya University Hospital Nagoya Japan
| | - Akiko Tamakoshi
- Department of Public Health Graduate School of Medicine, Hokkaido University Sapporo Japan
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
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20
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Shirota M, Watanabe N, Suzuki M, Kobori M. Japanese-Style Diet and Cardiovascular Disease Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Nutrients 2022; 14:nu14102008. [PMID: 35631146 PMCID: PMC9147868 DOI: 10.3390/nu14102008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/27/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
This systematic review and meta-analysis elucidate the effects of the Japanese-style diet and characteristic Japanese foods on the mortality risk of cardiovascular disease (CVD), cerebrovascular disease (stroke), and heart disease (HD). This review article followed the PRISMA guidelines. A systematic search in PubMed, The Cochrane Library, JDreamIII, and ICHUSHI Web identified prospective cohort studies on Japanese people published till July 2020. The meta-analysis used a random-effects model, and heterogeneity and publication bias were evaluated with I2 statistic and Egger’s test, respectively. Based on inclusion criteria, we extracted 58 articles, including 9 on the Japanese-style diet (n = 469,190) and 49 (n = 2,668,238) on characteristic Japanese foods. With higher adherence to the Japanese-style diet, the pooled risk ratios (RRs) for CVD, stroke, heart disease/ischemic heart disease combined (HD/IHD) mortality were 0.83 (95% CI, 0.77–0.89, I2 = 58%, Egger’s test: p = 0.625, n = 9 studies), 0.80 (95% CI, 0.69–0.93, I2 = 66%, Egger’s test: p = 0.602, n = 6 studies), and 0.81 (95% CI, 0.75–0.88, I2 = 0%, Egger’s test: p = 0.544, n = 6 studies), respectively. Increased consumption of vegetables, fruits, fish, green tea, and milk and dairy products decreased the RR for CVD, stroke, or HD mortality. Increased salt consumption elevated the RR for CVD and stroke mortality. Increased consumption of dietary fiber and plant-derived protein decreased the RR for CVD, stroke, and HD/IHD mortality. The Japanese-style diet and characteristic Japanese foods may reduce CVD mortality. Most studies conducted diet surveys between 1980 and the 1990s. This meta-analysis used articles that evaluated the same cohort study by a different method. A new large-scale cohort study matching the current Japanese dietary habits is needed to confirm these findings.
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Affiliation(s)
- Masayuki Shirota
- Institute of Food Research, National Agriculture and Food Research Organization, 2-1-2 Kannondai, Tsukuba-shi 305-8642, Ibaraki, Japan;
| | - Norikazu Watanabe
- Yakujihou Marketing Jimusho Inc., Level 3, Sanno Park Tower, 2-11-1 Nagata-cho, Chiyoda-ku, Tokyo 100-6162, Japan; (N.W.); (M.S.)
| | - Masataka Suzuki
- Yakujihou Marketing Jimusho Inc., Level 3, Sanno Park Tower, 2-11-1 Nagata-cho, Chiyoda-ku, Tokyo 100-6162, Japan; (N.W.); (M.S.)
| | - Masuko Kobori
- Institute of Food Research, National Agriculture and Food Research Organization, 2-1-2 Kannondai, Tsukuba-shi 305-8642, Ibaraki, Japan;
- Correspondence: ; Tel.: +81-29-838-8011
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21
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Torres-Collado L, García-de la Hera M, Cano-Ibañez N, Bueno-Cavanillas A, Vioque J. Association between Dietary Diversity and All-Cause Mortality: A Multivariable Model in a Mediterranean Population with 18 Years of Follow-Up. Nutrients 2022; 14:nu14081583. [PMID: 35458145 PMCID: PMC9029508 DOI: 10.3390/nu14081583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/21/2022] Open
Abstract
We evaluated the relationship between the dietary diversity score (DDS) and all-cause, CVD and cancer mortality in an adult Mediterranean population. We analyzed the data of 1540 participants from the Valencia Nutrition Survey. The DDS was estimated using a validated food frequency questionnaire and was categorized into quartiles (Q), where the first quartile indicates the lowest dietary diversity. Deaths were ascertained during an 18-year follow-up period. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). There were 403 deaths during the follow-up period (40% due to CVD). An inverse association was observed between the DDS and all-cause and CVD mortality. Compared with participants in the lowest DDS quartile (Q1), participants in the highest DDS quartile (Q4) showed 32% and 45% less risk of death for all-cause and CVD mortality, in sex- and age-adjusted models, respectively. Regarding the food groups in the DDS, an inverse association was identified between total vegetable consumption diversity and all-cause and CVD mortality in the highest quartiles, (Q3 vs. Q1, HR: 0.70; 95% CI: 0.50, 0.99) and (Q4 vs. Q1, HR: 0.52; 95% CI: 0.30, 0.91), respectively. This study suggests that a higher diversity in food intake, particularly in vegetables, may be associated with a lower risk of all-cause and CVD mortality. This association should be further investigated in other wider populations.
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Affiliation(s)
- Laura Torres-Collado
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 03010 Alicante, Spain; (L.T.-C.); (J.V.)
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain; (N.C.-I.); (A.B.-C.)
| | - Manuela García-de la Hera
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 03010 Alicante, Spain; (L.T.-C.); (J.V.)
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain; (N.C.-I.); (A.B.-C.)
- Correspondence: ; Tel.: +34-965919517
| | - Naomi Cano-Ibañez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain; (N.C.-I.); (A.B.-C.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Aurora Bueno-Cavanillas
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain; (N.C.-I.); (A.B.-C.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Jesús Vioque
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 03010 Alicante, Spain; (L.T.-C.); (J.V.)
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain; (N.C.-I.); (A.B.-C.)
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22
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Chalermsri C, Rahman SM, Ekström EC, Muangpaisan W, Aekplakorn W, Satheannopakao W, Ziaei S. Socio-demographic characteristics associated with the dietary diversity of Thai community-dwelling older people: results from the national health examination survey. BMC Public Health 2022; 22:377. [PMID: 35193523 PMCID: PMC8864924 DOI: 10.1186/s12889-022-12793-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background Dietary diversity (DD) is an indicator of nutrient intake and is related to health outcomes in older people. Currently, limited research exists regarding factors associated with DD in older people in developing countries, such as Thailand, despite rapid growth in this population. Therefore, this study aims to examine the association between socio-demographic characteristics and DD in Thai older people. Methods A cross-sectional study based on the fifth Thai National Health Examination Survey (NHES-V) conducted between 2013 and 2015 was performed. A total of 7,300 nationally representative older participants aged ≥ 60 years were included. The individual-level dietary diversity score (DDS) was assessed as the frequency of consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4 according to the frequency of consumption. The DDS was calculated as the sum of the scores, ranging from 0 to 32. Socio-demographic characteristics, including age, sex, highest education level, wealth index, living conditions, and residential area, were assessed. Data were analyzed using multiple linear regression and adjusted for complex survey design. Results The participants had a mean age of 69.7 (SD 7.6) years. The mean DDS of participants was 18.4 (SD 3.9). In the adjusted model, a higher educational level, a higher wealth index, and living in an urban area were positively associated with DDS, with adjusted β (95% CI) values of 1.37 (1.04, 1.70) for secondary education or higher, 0.81 (0.55, 1.06) for the richest group, and 0.24 (0.10, 0.44) for living in an urban area. Nevertheless, living alone had negative associations with DDS, with a β (95% CI) of - 0.27 (- 0.53, - 0.00). Conclusions This study showed that a higher educational level, a higher wealth index, and living in an urban area had a positive association, whereas living alone had a negative association with DD among Thai older participants. Interventions aiming to improve dietary diversity among older people might benefit from targeting more vulnerable groups, particularly those with less education and wealth, those living alone, or those in rural areas.
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Affiliation(s)
- Chalobol Chalermsri
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | - Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Shirin Ziaei
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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23
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Hata T, Seino S, Yokoyama Y, Narita M, Nishi M, Hida A, Shinkai S, Kitamura A, Fujiwara Y. Interaction of Eating Status and Dietary Variety on Incident Functional Disability among Older Japanese Adults. J Nutr Health Aging 2022; 26:698-705. [PMID: 35842760 PMCID: PMC9209632 DOI: 10.1007/s12603-022-1817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To examine whether eating status and dietary variety were associated with functional disability during a 5-year follow-up analysis of older adults living in a Japanese metropolitan area. DESIGN A 5-year follow-up study. SETTING Ota City, Tokyo, Japan. PARTICIPANTS A total of 10,308 community-dwelling non-disabled adults aged 65-84 years. MEASUREMENTS Eating status was assessed using a self-reported questionnaire. Dietary variety was assessed using the dietary variety score (DVS). Based on the responses, participants were classified according to eating alone or together and DVS categories (low: 0-3; high: 4-10). Functional disability incidence was prospectively identified using the long-term care insurance system's nationally unified database. Multilevel survival analyses calculated the adjusted hazard ratio (HR) and 95% confidence interval (CI) for incident functional disability. RESULTS During a 5-year follow-up, 1,991 (19.3%) individuals had functional disabilities. Eating status or DVS were not independently associated with incident functional disability. However, interaction terms between eating status and DVS were associated with functional disability; HR (95% CI) for eating together and low DVS was 1.00 (0.90-1.11), eating alone and high DVS was 0.95 (0.77-1.17), and eating alone and low DVS was 1.20 (1.02-1.42), compared to those with eating together and high DVS. CONCLUSION Older adults should avoid eating alone or increase dietary variety to prevent functional disability. This can be ensured by providing an environment of eating together or food provision services for eating a variety of foods in the community.
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Affiliation(s)
- T Hata
- Yoshinori Fujiwara, MD, PhD., Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae, Itabashi City, Tokyo 173-0015, Japan, E-mail: , Phone: +81 (3) 3964-3241 ext. 4257, Fax: +81 (3) 3579-4776
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24
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Positive Association between High Protein Food Intake Frequency and Physical Performance and Higher-Level Functional Capacity in Daily Life. Nutrients 2021; 14:nu14010072. [PMID: 35010947 PMCID: PMC8746446 DOI: 10.3390/nu14010072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022] Open
Abstract
Nutritional factors, including low protein intake and poor dietary variety, affect age-associated impairment in physical performance resulting in physical frailty. This cross-sectional study investigated the association between intake frequency of major high protein foods and both physical performance and higher-level functional capacity using the food frequency score (FFS) and high protein food frequency score (PFFS) among community-dwelling older adults. The data of 1185 older adults categorized into quartiles based on FFS and PFFS were analyzed. After adjusting for covariates, FFS and PFFS were significantly associated with physical performance [FFS, usual gait speed (p for trend = 0.007); PFFS, usual gait speed (p for trend < 0.001), maximum gait speed (p for trend = 0.002), timed up and go (p for trend = 0.025)], and higher-level functional capacity [FFS (p for trend < 0.001); PFFS (p for trend < 0.001)]. After excluding PFFS data, the participants’ scores were associated with only higher-level functional capacity. Multi-regression analysis with higher-level functional capacity as the covariate showed that FFS and PFFS were significantly correlated with physical performance. Hence, improving food intake frequency, particularly that of high protein foods, and dietary variety may help maintain higher-level functional capacity and physical performance in community-dwelling older adults.
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Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies. Nutrients 2021; 13:nu13072342. [PMID: 34371852 PMCID: PMC8308510 DOI: 10.3390/nu13072342] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 12/17/2022] Open
Abstract
Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.
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Mozaffari H, Hosseini Z, Lafrenière J, Conklin AI. Is eating a mixed diet better for health and survival?: A systematic review and meta-analysis of longitudinal observational studies. Crit Rev Food Sci Nutr 2021; 62:8120-8136. [PMID: 34039222 DOI: 10.1080/10408398.2021.1925630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The role of dietary diversity in chronic disease or survival is controversial. This meta-analysis quantified the health impact of dietary diversity. Random-effects models pooled risk ratios (RRs) and 95% confidence intervals (CIs) of 20 longitudinal studies. Total dietary diversity was associated with a 22% lower risk of all-cause mortality (RR 0.78 [95%CI: 0.64, 0.96]), and was inversely associated with incident cancer- or CVD-specific mortality only in subgroup analyses (RR range: 0.53 to 0.90, p < 0.05). Similarly, diversity across healthy foods was inversely associated with all-cause mortality (RR 0.84 [95%CI: 0.73, 0.96]). An inverse association between total diet diversity and incident CVD was significant in non-European populations consuming diets with diverse food groups (RR: 0.93 [95% CI: 0.86-0.99]). Effects on cancer risk are unstudied. Diversity within fruits and/or vegetables showed null associations for all outcomes, except potentially for squamous cell-type carcinomas. More robust research is warranted. Findings indicated greater dietary diversity may benefit overall survival.
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Affiliation(s)
- Hadis Mozaffari
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zeinab Hosseini
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacynthe Lafrenière
- School of Nutrition, Institute of Nutrition and Functional Foods, Laval University, Québec city, Québec, Canada
| | - Annalijn I Conklin
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Kiuchi Y, Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Kimura M, Kanouchi H, Takenaka T, Kubozono T, Ohishi M. The Association between Dietary Variety and Physical Frailty in Community-Dwelling Older Adults. Healthcare (Basel) 2021; 9:32. [PMID: 33401433 PMCID: PMC7823748 DOI: 10.3390/healthcare9010032] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk & dairy products, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Physical frailty was assessed using Fried's component (slowness, weakness, exhaustion, low physical activity, and weight loss). The participants were classified into frail, pre-frail, and non-frail groups. The prevalence of physical frailty was 6.6%. This study found significant associations between physical frailty and low FFS after adjusting for covariates (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84-0.97, p < 0.01). The optimal cutoff point of the FFS for physical frailty was ≤16 points. FFS lower than the cutoff point were significantly associated with physical frailty after adjusting for covariates (OR 3.46, 95% CI 1.60-7.50, p < 0.01). Diet variety assessed using the FFS cutoff value of ≤16 points was related to the physical frailty status in community-dwelling older adults.
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Affiliation(s)
- Yuto Kiuchi
- Department of Health Science, Graduate School of Health Sciences Kagoshima University, Kagoshima 890-8544, Japan; (Y.K.); (K.T.); (Y.T.)
| | - Hyuma Makizako
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Yuki Nakai
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Kazutoshi Tomioka
- Department of Health Science, Graduate School of Health Sciences Kagoshima University, Kagoshima 890-8544, Japan; (Y.K.); (K.T.); (Y.T.)
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Yoshiaki Taniguchi
- Department of Health Science, Graduate School of Health Sciences Kagoshima University, Kagoshima 890-8544, Japan; (Y.K.); (K.T.); (Y.T.)
- Department of Physical Therapy, Kagoshima Medical Professional College, Kagoshima 891-0133, Japan
| | - Mika Kimura
- Center for Health Promotion, International Life Sciences Institute, Tokyo 102-0083, Japan;
| | - Hiroaki Kanouchi
- Department of Clinical Nutrition, School of Rehabilitation, College of Health and Human Science, Osaka Prefecture University, Osaka 583-8555, Japan;
| | - Toshihiro Takenaka
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan; (T.K.); (M.O.)
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan; (T.K.); (M.O.)
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28
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Zhang J, Liang D, Zhao A. Dietary Diversity and the Risk of Fracture in Adults: A Prospective Study. Nutrients 2020; 12:E3655. [PMID: 33261013 PMCID: PMC7761242 DOI: 10.3390/nu12123655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
Nutrition plays an important and modifiable role in bone health. This study aimed to investigate the effect of dietary diversity on the risk of any type of fracture in adults. Data from the China Health and Nutrition Survey collected between waves 1997 and 2015 were used. A total of 10,192 adults aged 40 years and older were included in the analysis. Both dietary diversity score (DDS) based on Chinese dietary guidelines (DDS-CDG) and minimum dietary diversity for women (DDS-MDD-W) were computed. Cox proportional hazards regression models were conducted to determine the association. Stratified analyses were conducted in women by the age of fracture using the case-control study approach. In men, higher scores in both the DDS-CDG (hazard ratio (HR) 0.70, 95% CI 0.56-0.88) and DDS-MDD-W (HR 0.67, 95% CI 0.54-0.82) were associated with decreased risk of fracture, however, the associations were not significant in women (DDS-CDG: HR 0.94, 95% CI 0.79-1.12; DDS-MDD-W: HR 0.93, 95% CI 0.79-1.09). In the stratified analyses, higher DDS-CDG (odds ratio (OR) 0.74, 95% CI 0.58-0.95) and higher DDS-MDD-W (OR 0.76, 95% CI 0.60-0.95) were associated with lower risks of fracture in women aged 40 to 60 years; in women aged over 60 years, no association was observed (DDS-CDG: OR 1.10, 95% CI 0.83-1.46; DDS-MDD-W: OR 1.00, 95% CI 0.79-1.27). In summary, higher dietary diversity was associated with decreased risk of fracture in men and middle-aged women, but not in women aged over 60 years.
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Affiliation(s)
- Jian Zhang
- Vanke School of Public Health, Tsinghua University, Beijing 100091, China;
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Dong Liang
- China National Center for Food Safety Risk Assessment, Beijing 100021, China;
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100091, China;
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Why has Japan become the world's most long-lived country: insights from a food and nutrition perspective. Eur J Clin Nutr 2020; 75:921-928. [PMID: 32661353 PMCID: PMC8189904 DOI: 10.1038/s41430-020-0677-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/31/2020] [Accepted: 06/29/2020] [Indexed: 11/08/2022]
Abstract
In an international comparison of recent mortality statistics among G7 countries, Japan had the longest average life expectancy, primarily due to remarkably low mortality rates from ischemic heart disease and cancer (particularly breast and prostate). As recently as the 1960s, life expectancy in Japan was the shortest among the G7 countries, owing to relatively high mortality from cerebrovascular disease—particularly intracerebral hemorrhage—and stomach cancer. Mortality rates for these diseases subsequently decreased significantly while the already low rates for ischemic heart disease and cancer also decreased, resulting in Japanese life expectancy becoming the longest. The low mortality rates from ischemic heart disease and cancer are thought to reflect the low prevalence of obesity in Japan; low intake of red meat, specifically saturated fatty acids; and high intakes of fish, specifically n-3 polyunsaturated fatty acids, plant foods such as soybeans, and nonsugar-sweetened beverages such as green tea. The decreasing mortality rates from cerebrovascular disease are thought to reflect the increases in animal foods, milk, and dairy products and consequently in saturated fatty acids and calcium, together with a decrease in salt intake which may have led to a decrease in blood pressure. This decrease in salt and highly salted foods also seems to account for the decrease in stomach cancer. The typical Japanese diet as characterized by plant food and fish as well as modest Westernized diet such as meat, milk and dairy products might be associated with longevity in Japan.
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Dietary Diversity and All-Cause and Cause-Specific Mortality in Japanese Community-Dwelling Older Adults. Nutrients 2020; 12:nu12041052. [PMID: 32290256 PMCID: PMC7230563 DOI: 10.3390/nu12041052] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
We examined associations between dietary diversity and all-cause and cause-specific mortality in 386 men and 413 women (age range, 60–79 years at baseline) who took part in the National Institute for Longevity Sciences-Longitudinal Study of Aging study from 1997 to 2000. Dietary intake was assessed using three-day dietary records and photographs. The Quantitative Index for Dietary Diversity was used to determine the dietary diversity among thirteen food groups. Dietary diversity score and each food intake were examined by sex-stratified tertiles, and hazard ratios (HR) were calculated to compare the risk for all-cause and cause-specific deaths across tertiles, after controlling for age, sex, body mass index, alcohol intake, smoking status, education, physical activity, and disease history. During a mean follow-up of 15.7 years, 289 subjects (36.2%) died. Compared to the subjects in the lowest tertile, the multivariate-adjusted HR for all-cause and cancer mortality was 0.69 (95% confidence interval (CI): 0.51–0.94) and 0.57 (95% CI: 0.33–0.98), respectively (trend p < 0.05), in subjects in the highest tertile of dietary diversity. There were no significant associations between dietary diversity score and death from cardiovascular or cerebrovascular disease. Eating a variety of foods might contribute to longevity in older Japanese community dwellers.
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