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Vega-Cabello V, Al Hinai M, Yévenes-Briones H, Caballero FF, Lopez-García E, Baylin A. Plant-Based Diets and Risk of Multimorbidity: The Health and Retirement Study. J Nutr 2024; 154:2264-2272. [PMID: 38705471 DOI: 10.1016/j.tjnut.2024.04.037] [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: 02/23/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Plant-based diets have gained attention due to their beneficial effects against major chronic diseases, although their association with multimorbidity is mostly unknown. OBJECTIVES We examined the association between the healthful (hPDI) and unhealthful plant-based diet indices (uPDI) with multimorbidity among middle-aged and older adults from the United States. METHODS Data on 4262 adults aged >50 y was obtained from the 2012-2020 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Food consumption was collected at baseline with a food frequency questionnaire and 2 PDIs were derived: the hPDI, with positive scores for healthy plant foods and reverse scores for less healthy plant foods and animal foods; and the uPDI, with only positive scoring for less healthy plant foods. Complex multimorbidity, defined as ≥3 coexistent conditions, was ascertained from 8 self-reported conditions: hypertension, diabetes, cancer, chronic lung disease, heart disease, stroke, arthritis, and depression. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS After a median follow-up of 7.8 y, we documented 1202 incident cases of multimorbidity. Compared with the lowest quartile, higher adherence to the hPDI was inversely associated with multimorbidity (HR for quartile 3: 0.77; 95% CI: 0.62, 0.96 and HR for quartile 4: 0.79; 95% CI, 0.63, 0.98; P-trend = 0.02). In addition, a 10-point increment in the hPDI was associated with a 11% lower incidence of multimorbidity (95% CI: 1, 20%). No significant associations were found for the uPDI after adjusting for sociodemographic and lifestyle factors. CONCLUSIONS Higher adherence to the hPDI was inversely associated with multimorbidity among middle-aged and older adults. Plant-based diets that emphasize consumption of high-quality plant foods may help prevent the development of complex multimorbidity.
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Affiliation(s)
- Veronica Vega-Cabello
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain
| | - Maymona Al Hinai
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States; Department of Food Science and Human Nutrition, Sultan Qaboos University College of Agriculture and Marine Science, Muscat, Oman
| | - Humberto Yévenes-Briones
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Felix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Lopez-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
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Schorr KA, Agayn V, de Groot LCPGM, Slagboom PE, Beekman M. A plant-based diet index to study the relation between diet and disease risk among adults: a narrative review. J Nutr Health Aging 2024; 28:100272. [PMID: 38815475 DOI: 10.1016/j.jnha.2024.100272] [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: 12/01/2023] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
Plant-based diets (PBD) may offer various health benefits and contribute to a sustainable way of life, but, if not planned correctly, may also confer risks, e.g., by focusing on plant foods with low nutrient density, such as foods primarily consisting of refined carbohydrates. A plant-based diet index (PDI) differentiating between a healthful, unhealthful, and overall PBD, offers a promising approach to standardize and compare studies and integrate results. In this review we (1) summarize current evidence on the PDI and disease risk of relevance to public health, (2) discuss the methodology of the PDI and how it can be sensibly applied in further studies and (3) indicate areas with a lack of knowledge, such as vulnerable populations. In summary, our amalgamation shows, that adherence to a healthier plant-based diet is associated with an 8-68% lower risk for metabolic risk factors, diabetes, and cardiovascular disease, while adherence to an unhealthier plant-based diet is associated with a 10-63% higher risk. Although differences in calculation methods and underlying diet patterns between populations should be accounted for, the PDI can be a useful tool to assess adherence to different plant-based diet patterns and their association with health outcomes in cohort studies across cultures.
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Affiliation(s)
- Kerstin A Schorr
- Innoso BV, Den Haag, The Neterhlands; Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | | - Marian Beekman
- Leiden University Medical Center, Leiden, The Netherlands
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Sattler ELP, Ogungbe O, Wallace AS, Aryan Z, Castilla‐Ojo N, Dai J, De Anda‐Duran I, Foti K, German CA, Hyde ET, Jafarian‐Kerman SR, Kendrick KN, King B, Lang AE, Tang O, Turkson‐Ocran R, Rodriguez LA, Wang FM, Zhang M, Hivert M, Lutsey PL. American Heart Association EPI|Lifestyle Scientific Sessions: 2022 Meeting Highlights. J Am Heart Assoc 2023; 12:e028695. [PMID: 37042282 PMCID: PMC10227275 DOI: 10.1161/jaha.122.028695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Elisabeth L. P. Sattler
- Department of Clinical and Administrative Pharmacy, College of PharmacyUniversity of GeorgiaGAAthensUSA
- Department of Nutritional Sciences, College of Family and Consumer SciencesUniversity of GeorgiaGAAthensUSA
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of NursingMDBaltimoreUSA
- Johns Hopkins University School of MedicineMDBaltimoreUSA
| | - Amelia S. Wallace
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMDBaltimoreUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins UniversityMDBaltimoreUSA
| | - Zahra Aryan
- Department of MedicineRutgers New Jersey Medical SchoolNJNewarkUSA
| | | | - Jin Dai
- Department of Epidemiology, Fielding School of Public HealthUniversity of CaliforniaCALos AngelesUSA
| | - Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineLANew OrleansUSA
| | - Kathryn Foti
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthALBirminghamUSA
| | | | - Eric T. Hyde
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California, San DiegoCALa JollaUSA
| | | | | | - Ben King
- Department of Health Systems and Population Health Sciences, Tilman J Fertitta Family College of MedicineUniversity of HoustonTXHoustonUSA
| | - Adam Edward Lang
- Department of Primary CareMcDonald Army Health CenterVAFort EustisUSA
- Department of Family Medicine and Population HealthVirginia Commonwealth University School of MedicineVARichmondUSA
| | - Olive Tang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMDBaltimoreUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins UniversityMDBaltimoreUSA
- Johns Hopkins University School of MedicineMDBaltimoreUSA
| | | | - Luis A. Rodriguez
- Division of ResearchKaiser Permanente Northern CaliforniaCAOaklandUSA
| | - Frances M. Wang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMDBaltimoreUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins UniversityMDBaltimoreUSA
| | - Mingyu Zhang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMDBaltimoreUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins UniversityMDBaltimoreUSA
- Department of Population MedicineHarvard Pilgrim Health Care Institute, Harvard Medical SchoolMABostonUSA
| | - Marie‐France Hivert
- Department of Population MedicineHarvard Pilgrim Health Care Institute, Harvard Medical SchoolMABostonUSA
- Diabetes Unit, Massachusetts General HospitalMABostonUSA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of MinnesotaMNMinneapolisUSA
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Peters BA, Xing J, Chen GC, Usyk M, Wang Z, McClain AC, Thyagarajan B, Daviglus ML, Sotres-Alvarez D, Hu FB, Knight R, Burk RD, Kaplan RC, Qi Q. Healthy dietary patterns are associated with the gut microbiome in the Hispanic Community Health Study/Study of Latinos. Am J Clin Nutr 2023; 117:540-552. [PMID: 36872018 PMCID: PMC10356562 DOI: 10.1016/j.ajcnut.2022.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dietary patterns high in healthy minimally processed plant foods play an important role in modulating the gut microbiome and promoting cardiometabolic health. Little is known on the diet-gut microbiome relationship in US Hispanics/Latinos, who have a high burden of obesity and diabetes. OBJECTIVE In a cross-sectional analysis, we sought to examine the relationships of 3 healthy dietary patterns-the alternate Mediterranean diet (aMED), the Healthy Eating Index (HEI)-2015, and the healthful plant-based diet index (hPDI)-with the gut microbiome in US Hispanic/Latino adults, and to study the association of diet-related species with cardiometabolic traits. METHODS The Hispanic Community Health Study/Study of Latinos is a multi-site community-based cohort. At baseline (2008-2011), diet was assessed by using 2, 24-hour recalls. Shotgun sequencing was performed on stool samples collected in 2014-17 (n = 2444). Analysis of Compositions of Microbiomes 2 (ANCOM2) was used to identify the associations of dietary pattern scores with gut microbiome species and functions, adjusting for sociodemographic, behavioral, and clinical covariates. RESULTS Better diet quality according to multiple healthy dietary patterns was associated with a higher abundance of species from class Clostridia, including [Eubacterium] eligens, Butyrivibrio crossotus, and Lachnospiraceae bacterium TF01-11, but functions related to better diet quality differed for the dietary patterns (e.g., aMED with pyruvate:ferredoxin oxidoreductase, hPDI with L-arabinose/lactose transport). Poorer diet quality was associated with a higher abundance of Acidaminococcus intestini and with functions of manganese/iron transport, adhesin protein transport, and nitrate reduction. Some healthy diet pattern-enriched Clostridia species were related to more favorable cardiometabolic traits such as lower triglycerides and waist-to-hip ratio. CONCLUSIONS Healthy dietary patterns in this population are associated with a higher abundance of fiber-fermenting Clostridia species in the gut microbiome, consistent with previous studies in other racial/ethnic groups. Gut microbiota may be involved in the beneficial effect of higher diet quality on cardiometabolic disease risk.
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Affiliation(s)
- Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Jiaqian Xing
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Guo-Chong Chen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mykhaylo Usyk
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, UNC Gillings Global School of Public Health, Chapel Hill, NC, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rob Knight
- Departments of Pediatrics, Computer Science and Engineering, Bioengineering, and Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; Departments of Pediatrics, Microbiology & Immunology, Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Thompson AS, Tresserra-Rimbau A, Karavasiloglou N, Jennings A, Cantwell M, Hill C, Perez-Cornago A, Bondonno NP, Murphy N, Rohrmann S, Cassidy A, Kühn T. Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK. JAMA Netw Open 2023; 6:e234714. [PMID: 36976560 PMCID: PMC10051114 DOI: 10.1001/jamanetworkopen.2023.4714] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/08/2023] [Indexed: 03/29/2023] Open
Abstract
Importance Plant-based diets have gained popularity for both environmental and health reasons, but a comprehensive assessment of their quality in relation to risk of mortality and major chronic diseases is lacking. Objective To examine whether healthful vs unhealthful plant-based dietary patterns are associated with mortality and major chronic diseases among UK adults. Design, Setting, and Participants This prospective cohort study used data from adults in the UK Biobank, a large-scale population-based study. Participants were recruited between 2006 and 2010 and followed up using record linkage data until 2021; follow-up for different outcomes ranged between 10.6 and 12.2 years. Data analysis was conducted from November 2021 to October 2022. Exposures Adherence to a healthful vs unhealthful plant-based diet index (hPDI vs uPDI) derived from 24-hour dietary assessments. Main Outcomes and Measures The main outcomes were hazard ratios (HRs) and 95% CIs of mortality (overall and cause specific), cardiovascular disease (CVD [total, myocardial infarction, ischemic stroke, and hemorrhagic stroke]), cancer (total, breast, prostate, and colorectal), and fracture (total, vertebrae, and hip) across quartiles of hPDI and uPDI adherence. Results This study included 126 394 UK Biobank participants. They had a mean (SD) age of 56.1 (7.8) years; 70 618 (55.9%) were women. The majority of participants (115 371 [91.3%]) were White. Greater adherence to the hPDI was associated with lower risks of total mortality, cancer, and CVD, with HRs (95% CIs) of 0.84 (0.78-0.91), 0.93 (0.88-0.99), and 0.92 (0.86-0.99), respectively, for participants in the highest hPDI quartile compared with the lowest. The hPDI was also associated with lower risks of myocardial infarction and ischemic stroke, with HRs (95% CIs) of 0.86 (0.78-0.95) and 0.84 (0.71-0.99), respectively. By contrast, higher uPDI scores were associated with higher risks of mortality, CVD, and cancer. The associations observed did not show heterogeneity across strata of sex, smoking status, body mass index, or socioeconomic status or with polygenic risk scores (specifically with regard to CVD end points). Conclusions and Relevance The findings of this cohort study of middle-aged UK adults suggest that a diet characterized by high-quality plant-based foods and lower intakes of animal products may be beneficial for health, irrespective of established chronic disease risk factors and genetic predisposition.
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Affiliation(s)
- Alysha S. Thompson
- Institute for Global Food Security, School of Biological Sciences, Queen’s University, Belfast, United Kingdom
| | - Anna Tresserra-Rimbau
- Institute for Global Food Security, School of Biological Sciences, Queen’s University, Belfast, United Kingdom
- Department of Nutrition, Food Science, and Gastronomy, School of Pharmacy and Food Sciences, Institute for Research on Nutrition and Food Safety, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición, Institute of Health Carlos III, Madrid, Spain
| | - Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Amy Jennings
- Institute for Global Food Security, School of Biological Sciences, Queen’s University, Belfast, United Kingdom
| | - Marie Cantwell
- Institute for Global Food Security, School of Biological Sciences, Queen’s University, Belfast, United Kingdom
| | - Claire Hill
- Centre for Public Health, Queen’s University, Belfast, United Kingdom
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nicola P. Bondonno
- Institute for Global Food Security, School of Biological Sciences, Queen’s University, Belfast, United Kingdom
- Danish Cancer Society Research Centre, Copenhagen, Denmark
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Neil Murphy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Aedín Cassidy
- Institute for Global Food Security, School of Biological Sciences, Queen’s University, Belfast, United Kingdom
| | - Tilman Kühn
- Institute for Global Food Security, School of Biological Sciences, Queen’s University, Belfast, United Kingdom
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg, Germany
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Jiao Y, Li W, Jia X, Wang Z, Wang H, Zhang B, Jiang H, Ding G. Association between regional dietary patterns and cardiovascular health status among elderly in China. RESEARCH SQUARE 2023:rs.3.rs-2328623. [PMID: 36711608 PMCID: PMC9882597 DOI: 10.21203/rs.3.rs-2328623/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives To evaluate the cardiovascular health (CVH) status of the elderly and analyze the effects of dietary patterns and demographic characteristics on CVH. Methods A total of 4299 individuals aged 60 years and above from the China Health and Nutrition Survey in 2018 were selected as the research objects. Cluster analysis was used to analyze the dietary patterns. The definition of "Life's Essential 8" of CVH released by American Heart Association (AHA)in 2022 was used to evaluate CVH status. Finally, multinomial logit model was used to analyze the impact of demographic economic characteristics on CVH. Results Three dietary patterns were obtained by cluster analysis. In pattern 1, the intake of wheat, other grains, tubers and legumes was higher. Pattern 2 was dominated by high intake of aquatic products, vegetables and fruits; Pattern 3 was dominated by higher intake of rice and livestock meat. The total CVH score was 68.50, and sleep and blood pressure had the highest and lowest scores (85.85 and 37.64). Pattern 1 and Pattern 2 have slightly higher CVH scores. There were 16%-18% of the elderly with high CVH, and there was no significant difference in the distribution of high, moderate and low CVH among the three patterns (p=0.29). More than 50% of the elderly have 3-4 ideal metrics, 0.2% of the elderly have all 8 metrics reached the ideal state only in pattern 1. Multinomial logit analysis showed that the elderly in pattern 2 had 6-8 ideal metrics, which was 1.81 times higher than that in pattern 1; The presence of 6-8 ideal metrics in female was 3.42 times higher than that in male; Those with a college degree and above have 6-8 ideal metrics, which was 1.99 times of those with a primary school degree and below. Compared with 60-69 years, the presence of 6-8 ideal metrics in 70 years and above was 35% lower (OR=0.65,95%=0.49-0.87). The presence of 6-8 ideal metrics in high income group were 31% lower than those in low income group (OR=0.69,95%=0.47-1.00). Conclusions The elderly in China were in moderate CVH. Dietary pattern characterized by higher intake of aquatic products, vegetables and fruits were more likely to have more ideal CVH metrics. It is necessary to take targeted intervention measures for the elderly and health factors with low scores to promote the improvement of CVH status.
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Affiliation(s)
| | - Weiyi Li
- Chinese Center for Disease Control and Prevention
| | - Xiaofang Jia
- Chinese Center for Disease Control and Prevention
| | - Zhihong Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention
| | - Huijun Wang
- Chinese Center for Disease Control and Prevention
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention
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Association between Healthy Eating Index-2015 and Age-Related Cataract in American Adults: A Cross-Sectional Study of NHANES 2005-2008. Nutrients 2022; 15:nu15010098. [PMID: 36615757 PMCID: PMC9823857 DOI: 10.3390/nu15010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Healthy Eating Index-2015 (HEI-2015), a healthy eating pattern proposed by Dietary Guidelines for Americans, is proven to be protective against various diseases. However, whether it is associated with age-related cataracts is unknown. METHODS This population-based cross-sectional study included 6395 participants from the National Health and Nutrition Examination Survey (NHANES) in the cycles from 2005 to 2008. HEI-2015 was calculated from 24-h dietary recall interviews, ranging from 0 to 100, and higher HEI-2015 represents better diet quality. Age-related cataract was generated from the questionnaire. The association between HEI-2015 and cataract was assessed with logistic regression models. Propensity score weighting, restricted cubic spline, and subgroup analysis were conducted to further explore the relationship. RESULTS 6395 participants were included in the study, with a mean [standard deviation (SD)] age of 48.7 (15.3) years and 3115 (48.7%) being male. HEI-2015 was negatively associated with cataracts after adjusting all covariates included, both as a continuous variable [odds ratio (OR): 0.991, 95% confidence interval (CI): 0.984-0.997, p = 0.006] and quartiles with the highest quartile compared to the lowest (OR: 0.739, 95% CI: 0.559-0.980, p = 0.035). After propensity score weighting, the association remained significant. Restricted cubic spline revealed no non-linear relationship (p for non-linearity 0.085). Subgroup analysis showed that there were no interaction effects. CONCLUSIONS Adherence to the healthy eating pattern, HEI-2015, was associated with a lower risk of age-related cataracts.
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