Dietary Diversity and All-Cause and Cause-Specific Mortality in Japanese Community-Dwelling Older Adults

Mushroom consumption and cardiometabolic health outcomes in the general population: a systematic review

BACKGROUND/OBJECTIVES

Mushroom consumption, rich in diverse nutrients and bioactive compounds, is suggested as a potential significant contributor to preventing cardiometabolic diseases (CMDs). This systematic review aimed to explore the association between mushrooms and cardiometabolic health outcomes, utilizing data from prospective cohort studies and clinical trials focusing on the general population, with mushrooms themselves as a major exposure.

SUBJECTS/METHODS

All original articles, published in English until July 2023, were identified through searches on PubMed, Ovid-Embase, and google scholar. Of 1,328 studies, we finally selected 5 prospective cohort studies and 4 clinical trials.

RESULTS

Existing research is limited, typically consisting of 1 to 2 studies for each CMD and cardiometabolic condition. Examination of articles revealed suggestive associations in some cardiometabolic conditions including blood glucose (both fasting and postprandial), high-density lipoprotein cholesterol related indices, high-sensitivity C-reactive protein, and obesity indices (body weight, body mass index, and waist circumference). However, mushroom consumption showed no association with the mortality and morbidity of cardiovascular diseases, stroke, and type 2 diabetes, although there was a potentially beneficial connection with all cause-mortality, hyperuricemia, and metabolic syndrome.

CONCLUSION

Due to the scarcity of available studies, drawing definitive conclusions is premature. Further comprehensive investigations are needed to clarify the precise nature and extent of this relationship before making conclusive recommendations for the general population.

Development and validation of an occurrence-based healthy dietary diversity (ORCHID) score easy to operationalise in dietary prevention interventions in older adults: a French study

Healthy diet and dietary diversity have been associated with healthy ageing. Several scores have been developed to assess dietary diversity or healthy diets in epidemiological studies, but they are not adapted to be used in the context of preventive nutrition interventions. This study aimed to develop an occurrence-based healthy dietary diversity (ORCHID) score easy to implement in the field and to validate it using dietary data from older participants in the latest French food consumption survey (INCA3). The ORCHID score was made of several components representing the consumption occurrences of twenty food groups, in line with French dietary guidelines. The score was then validated using dietary data (namely three 24-h recalls and a food propensity questionnaire) from 696 participants aged 60 years and over in the INCA3 survey. Score validity was evaluated by describing the association of the score with its components, as well as with energy intakes, solid energy density (SED) and the probability of adequate nutrient intakes (assessed by the PANDiet). Higher scores were associated with more points in healthy components such as 'fruits' and 'vegetables' (r = 0·51, and r = 0·54, respectively). The score was positively associated with the PANDiet (r = 0·43) and inversely associated with SED (r = -0·37), while no significant association was found with energy intakes. The ORCHID score was validated as a good proxy of the nutritional quality of French older adults' diets. It could therefore be a useful tool for both public health research and nutrition interventions.

Diet quality and cardiovascular outcomes: A systematic review and meta-analysis of cohort studies

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.

Relationship between immune nutrition index and all-cause and cause-specific mortality in U.S. adults with chronic kidney disease

Objective

The available evidence regarding the association of immune nutrition status with chronic kidney disease (CKD) is limited. Thus, the present study examined whether immunonutrition indices were associated with renal function and mortality among CKD individuals.

Research design and methods

This study enrolled 6,099 U.S. adults with CKD from the NHANES 2005-2018 database. Participants were matched with National Death Index records until 31 December 2019 to determine mortality outcomes. The time-dependent receiver operating characteristic was utilized to identify the most effective index among the prognostic nutritional index (PNI), system inflammation score (SIS), Naples prognostic score (NPS), and controlling nutritional status (CONUT) for predicting mortality. Cox regression models were employed to evaluate the associations of immunonutrition indices with mortality in participants with CKD.

Results

The PNI exhibited the strongest predictive power among the four indices evaluated and the restricted cubic spline analysis revealed a cutoff value of 51 for the PNI in predicting mortality. During a median follow-up of 72 months (39-115 months), a total of 1,762 (weighted 24.26%) CKD participants died from all causes. The Kaplan-Meier curve demonstrated a reduced risk of death for the subjects with a higher PNI compared to those in the lower group. Besides, after adjusting for multiple potential confounders, a higher PNI remained an independent predictor for lower risks of all-cause mortality (HR 0.80, 95%CI: 0.71-0.91, p < 0.001) and cardiovascular disease (CVD) mortality (HR 0.69, 95%CI: 0.55-0.88, p = 0.002) in individuals with CKD.

Conclusion

In CKD, a higher PNI level was significantly associated with lower mortality from all causes and CVD. Thus, the clinical utility of this immunonutrition indicator may facilitate risk stratification and prevent premature death among patients with CKD.

Dietary Diversity and Mild Cognitive Impairment in Middle-Aged and Older Chinese People: A Cross-Sectional Study

Background

The evidence concerning dietary diversity and cognitive function remains insufficient.

Objective

To investigate the association of dietary diversity score (DDS) with mild cognitive impairment (MCI) and cognitive performance in different domains.

Methods

Data from The Lifestyle and Healthy Aging of Chinese Square Dancer Study was used in this study. DDS was constructed based on the intake frequencies of 9 food groups assessed by a validated food frequency questionnaire. MCI was diagnosed by Petersen's criteria. A neuropsychological test battery was used to assess the performance on cognitive domains, and test scores were standardized to Z scores. Multiple linear regression models and logistic regression models were used to estimate the β and odds ratios and their 95% CIs, respectively.

Results

Among 1,982 participants, the mean (SD) age was 63.37 (5.00) years, 1,778 (89.71%) were women, and 279 (14.08%) had MCI. Compared to the DDS quartile (0, 6], the multivariable-adjusted odds ratios (95% CI) were 0.74 (0.48, 1.15) for DDS quartile (6, 7], 0.65 (0.43, 0.97) for DDS quartile (7, 8], and 0.55 (0.37, 0.84) for DDS quartile (8, 9]. Furthermore, higher DDS was positively associated with better performance of cognitive domains, including global cognitive function (β= 0.20, 95% CI: 0.12, 0.30), episodic memory (β= 0.21, 95% CI: 0.07, 0.35), attention (β= 0.15, 95% CI: 0.03, 0.26), language fluency (β= 0.24, 95% CI: 0.10, 0.38), and executive function (β= - 0.24, 95% CI: - 0.38, - 0.10).

Conclusions

This study indicated that higher DDS was associated with better cognitive function among middle-aged and older Chinese people.

Breakfast Type and Cardiovascular Mortality: The Japan Collaborative Cohort Study

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.

Dietary Diversity Changes and Cognitive Frailty in Chinese Older Adults: A Prospective Community-Based Cohort Study

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.

Socio-Demographic Factors Associated with Rural Residents' Dietary Diversity and Dietary Pattern: A Cross-Sectional Study in Pingnan, China

There is limited evidence regarding the factors correlated with dietary diversity (DD) and dietary pattern (DP) in rural residents of China. This study aims to identify the DD and DP of rural residents and their association with socio-demographic factors. A cross-sectional survey was conducted in Pingnan, China. The Food Frequency Questionnaire (FFQ) was applied to evaluate dietary intake. Latent class analysis (LCA) was used to identify patterns of six food varieties, including vegetables-fruits, red meat, aquatic products, eggs, milk, and beans-nuts. Generalized linear models and multiple logistic regression models were used to determine factors associated with the DD and DP. Three DPs were detected by LCA, namely "healthy" DP (47.94%), "traditional" DP (33.94%), and "meat/animal protein" DP (18.11%). Females exhibited lower DD (β = -0.23, p = 0.003) and were more likely to adhere to "traditional" DP (OR = 1.46, p = 0.039) and "meat/animal protein" DP (OR = 2.02, p < 0.001). Higher educational levels and annual household income (AHI) were positively associated with higher DD (p < 0.05) and less likely to have "traditional" DP and "meat/animal protein" DP (p < 0.05). Non-obese people exhibited higher DD (β = 0.15, p = 0.020) and were less likely to have "meat/animal protein" DP (OR = 0.59, p = 0.001). Our study reveals that females, those with lower educational levels and AHI, and obese people are more likely to have a lower DD and are more likely to adhere to "traditional" DP and "meat/animal protein" DP. The local, regional, and even national performance of specific diet-related health promotion measures and interventions must target these vulnerable populations to improve a healthier DD and DP.

Dietary diversity predicts the mortality among older people: Data from the fifth Thai national health examination survey

OBJECTIVE

To examine the association between dietary diversity (DD) and mortality among Thai older people and to investigate whether age, sex, and nutritional status modify this association.

METHODS

The national survey conducted from 2013 to 2015 recruited 5631 people aged >60 years. Dietary diversity score (DDS) was assessed for the consumption of eight food groups using food frequency questionnaires. The Vital Statistics System provided the data on mortality in 2021. The association between DDS and mortality was analyzed by Cox proportional hazard model and adjusted for the complex survey design. Interaction terms between DDS and age, sex, and BMI were also tested.

RESULTS

The DDS was inversely associated with mortality (HR_adj 0.98, 95%CI: 0.96-1.00). This association was stronger in people aged >70 years (HR_adj 0.93, 95%CI: 0.90-0.96 for aged 70-79 years, and HR_adj 0.92, 95%CI: 0.88-0.95 for aged >80 years). Inverse association between DDS and mortality was also found in the underweight older population (HR_adj 0.95, 95%CI: 0.90-0.99). A positive association was found between DDS and mortality in the overweight/obese group (HR_adj 1.03, 95%CI: 1.00-1.05). However, the interaction between the DDS with sex to mortality was not statistically significant.

CONCLUSION

Increasing DD reduces mortality among Thai older people, especially in those above 70, and underweight. In contrast, an increase in DD also meant an increase in mortality among the overweight/obese group. Focus should be placed on the nutritional interventions aimed to improve DD for those 70 and over and underweight to reduce mortality.

Health-related quality of life and its association with socioeconomic status and diet diversity in Chinese older adults

Objectives

The study aimed at examining the combined association of socioeconomic status (SES) and diet diversity (DD) with health-related quality of life (HRQoL) and exploring whether DD played a mediating role in the relationship between varied SES and HRQoL among Chinese older persons.

Method

A multi-stage random sampling method was conducted in Shanxi Province of China, with 3,250 older adults participating in this cross-sectional survey. SES was divided into groups by quartiles and DD by means, and these variable groups were combined in pairs to generate a total of eight combinations. The PROCESS macro developed by Hayes was employed for the simple mediation analysis.

Results

Compared with the reference group (those with both high SES and high DD), older adults who were classified to have lower SES or DD had elevated odds of having worse HRQoL: low SES/ low DD (OR = 1.65, 95% CI 1.41-2.92); low SES/ high DD (OR = 1.45, 95% CI 1.17-1.80); middle low SES/ low DD (OR = 1.43, 95% CI 1.24-1.65); middle low SES/ high DD (OR = 1.23, 95% CI 1.03-1.47); upper high SES/ low DD (OR = 1.41, 95% CI 1.21-1.65); and high SES/ low DD (OR = 1.30, 95%CI 1.10-1.53). The mediation analysis revealed that DD mediated the relationship between SES and HRQoL (B=0.011, 95% CI 0.008-0.013), with its indirect effects accounting for 39.29% of the total effects.

Conclusions

These findings highlighted the role of DD as a mediator of the relationship between SES and HRQoL. As DD could be protective, modifiable, and easy for older adults to understand and implement, village clinics and community health stations should work collaboratively to design proper DD intervention measures for better HRQoL.

Does online food shopping boost dietary diversity? Application of an endogenous switching model with a count outcome variable

Increasingly, rural households in developing countries are shopping for food online, and the COVID-19 pandemic has accelerated this trend. In parallel, dietary guidelines worldwide recommend eating a balanced and healthy diet. With this in mind, this study explores whether online food shopping boosts dietary diversity-defined as the number of distinct food groups consumed-among rural households in China. Because people choose to shop for food online, it is important to account for the self-selection bias inherent in online food shopping. Accordingly, we estimate the treatment effects of online food shopping on dietary diversity using the endogenous switching model with a count outcome variable. The results indicate that online food shopping increases dietary diversity by 7.34%. We also find that education, asset ownership, and knowing the government's dietary guidelines are the main factors driving rural households' decisions to shop for food online.

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

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.

Association of Mushrooms and Algae Consumption with Mortality among Chinese Older Adults: A Prospective Cohort Study

Mushrooms and algae are important sources of dietary bioactive compounds, but their associations with mortality remain unclear. We examined the association of mushrooms and algae consumption with subsequent risk of all-cause mortality among older adults. This study included 13,156 older adults aged 65 years and above in the Chinese Longitudinal Healthy Longevity Survey (2008–2018). Consumption of mushrooms and algae at baseline and age of 60 were assessed using a simplified food frequency questionnaire (FFQ). We used Cox proportional hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). During 74,976 person-years of follow-up, a total of 8937 death cases were documented. After adjustment for demographic, lifestyle, and other dietary factors, participants who consumed mushrooms and algae at least once per week had a lower risk of all-cause mortality than rare consumers (0–1 time per year) (HR = 0.86; 95% CI: 0.80–0.93). Compared to participants with rare intake at both age 60 and the study baseline (average age of 87), those who maintained regular consumptions over time had the lowest hazard of mortality (HR = 0.86; 95% CI: 0.76–0.98). Our findings supported the potential beneficial role of long-term consumption of mushrooms and algae in reducing all-cause mortality among older adults. Further studies are warranted to evaluate the health benefit for longevity of specific types of mushrooms and algae.

Association of Eating Behavior, Nutritional Risk, and Frailty with Sarcopenia in Taiwanese Rural Community-Dwelling Elders: A Cross-Sectional Study

This cross-sectional study assessed the association of eating behavior, nutritional risk, and frailty with sarcopenia in 208 community-dwelling individuals aged ≥65 years who were recruited from random rural community care centers in Chiayi County, Taiwan. The participants’ eating behavior was categorized into six categories. The gait speed (GS), grip strength, and appendicular skeletal muscle mass (ASM) were assessed based on these three parameters, which revealed that 50.9% of the participants had sarcopenia. In an adjusted model, water intake (odds ratio (OR) = 0.99, p = 0.044), dairy product intake (OR = 0.42, p = 0.049), body mass index (BMI) (OR = 0.77, p = 0.019), and marital status with widowed (OR = 0.31, p = 0.005) were significantly associated with sarcopenia. After eight steps of eliminating the least significant independent variable, age (p = 0.002), sex (p = 0.000), marital status with widowed (p = 0.001), water intake (p < 0.018), dairy product intake (p < 0.019), and BMI (p = 0.005) were found to be indispensable predictors of sarcopenia. The logistic regression model with these six indispensable variables had a predictive value of 75.8%. Longitudinal analyses are warranted to examine whether eating behavior is a risk factor for sarcopenia onset.

Dietary Antioxidant Indices in Relation to All-Cause and Cause-Specific Mortality Among Adults With Diabetes: A Prospective Cohort Study

Background

The potential beneficial effect of individual antioxidants on mortality has been reported. However, the association of overall intakes of dietary antioxidants with all-cause and cause-specific mortality among adults with diabetes remained unclear.

Methods

A total of 4,699 US adults with diabetes were enrolled in 2003–2014 in the National Health and Nutrition Examination Survey (NHANES) and followed for mortality until 31 December 2015. The Dietary Antioxidant Quality Score (DAQS) and the Dietary Antioxidant Index (DAI), which indicate the total antioxidant properties, were calculated based on the intakes of vitamins A, C, E, zinc, selenium, and magnesium. The Cox proportional hazards regression models were used to investigate the associations of the DAQS or the DAI with all-cause and cause-specific mortality.

Results

A total of 913 deaths occurred during 27,735 person-years of follow-up, including 215 deaths due to cardiovascular disease (CVD) and 173 deaths due to cancer. The higher intakes of antioxidant vitamins A, E, magnesium, and selenium were associated with lower all-cause mortality. The adjusted hazard ratios (HRs) (95% CIs) comparing the highest DAQS (5–6) to the lowest DAQS (0–2) were 0.70 (0.53–0.92) for all-cause mortality, 0.56 (0.35–0.90) for CVD mortality, and 0.59 (0.33–1.04) for cancer mortality. Consistent inverse associations were found between the DAI and mortality.

Conclusion

Higher intake of overall dietary antioxidants was associated with lower risk of death from all-cause and CVD in adults with diabetes. Future dietary intervention studies are needed to determine whether increasing overall antioxidant micronutrients intake could prevent premature death among adults with diabetes.

Validity of dietary diversity assessed using short-form questionnaire among older Japanese community dwellers

The validity of dietary variety score (DVS) using a short-form questionnaire has not been investigated using dietary diversity based on a quantitative distribution of consumed foods in older Japanese. We examined the association between DVS and objective dietary diversity using a Quantitative Index for Dietary Diversity (QUANTIDD) based on the quantitative distribution of foods consumed by older Japanese community dwellers. The subjects were 65 older Japanese community dwellers aged 60?79 years. We used two kinds of scores for assessment of dietary diversity. At first, dietary diversity was determined using DVS calculated from answers to a questionnaire about frequencies of intake of 10 food groups. Second, dietary intake was assessed using a 3-day dietary record with photographs, and dietary diversity was determined using QUANTIDD. The relationships between DVS and QUANTIDD were assessed using partial correlation coefficients controlling for confounders. The correlation coefficient between DVS and QUANTIDD was moderate (r=0.212-0.458). After controlling for confounders, those correlation coefficient between DVS and QUANTIDD remained moderate. The findings suggest that there was a moderate relationship between DVS and QUANTIDD, and DVS using a short-form questionnaire may be useful for assessing dietary diversity in older Japanese community dwellers. J. Med. Invest. 69 : 31-37, February, 2022.

Association between Dietary Diversity and All-Cause Mortality: A Multivariable Model in a Mediterranean Population with 18 Years of Follow-Up

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.

Interaction of Eating Status and Dietary Variety on Incident Functional Disability among Older Japanese Adults

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.

Combined impacts of physical activity, dietary variety, and social interaction on incident functional disability in older Japanese adults

BACKGROUND

This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults.

METHODS

Participants were 7,822 initially non-disabled residents (3,966 men; 3,856 women) aged 65-84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system's nationally unified database.

RESULTS

During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (0.59-0.78), 0.87 (0.77-0.99), and 0.91 (0.79-1.03), respectively. Incident disability HRs (95% CIs) gradually reduced with increased frequency of satisfying these behaviors (any one: 0.82, 0.65-1.03; any two: 0.65, 0.52-0.82; and all three behaviors: 0.54, 0.43-0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (-0.2, 7.9), 9.6% (4.8-14.1), and 16.0% (8.7-22.8), respectively.

CONCLUSION

Combining active physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Adding the insufficient behavior element to individual habits and preexisting social group activities may be effective in preventing disability in the community.

Prospective study of dietary mushroom intake and risk of mortality: results from continuous National Health and Nutrition Examination Survey (NHANES) 2003-2014 and a meta-analysis

Background

Whether mushroom consumption, which is a rich source of potent antioxidants ergothioneine and glutathione, vitamins, and minerals (e.g., selenium & copper), is associated with a lower mortality risk is not well understood. This study aimed to examine the association between mushroom consumption and risk of mortality in a prospective cohort study and a meta-analysis of prospective cohort studies.

Methods

We followed 30,378 participants from the continuous National Health and Nutrition Examination Survey (NHANES) extant data (2003-2014). Dietary mushroom intake was assessed using up to two 24-h recalls. Mortality was evaluated in all participants linked to the National Death Index mortality data through December 31, 2015. We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). We also conducted a meta-analysis, including results from our present study and 4 other cohort studies.

Results

During a mean (SD) of 6.7 (3.4) years of follow-up, a total of 2855 death cases were documented among NHANES participants. In our analysis of continuous NHANES, we found a non-significant association between mushroom consumption and all-cause mortality (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.67-1.06) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors, including total energy. The meta-analysis of prospective cohort studies, including 601,893 individuals, showed that mushroom consumption was associated with a lower risk of all-cause mortality (pooled risk ratio: 0.94; 95% CI: 0.91, 0.98).

Conclusion

In a meta-analysis of prospective cohort studies, mushroom consumption was associated with a lower risk of all-cause mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00738-w.

Is eating a mixed diet better for health and survival?: A systematic review and meta-analysis of longitudinal observational studies

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.

Dietary Diversity and Healthy Aging: A Prospective Study

Population aging is a global phenomenon. The present study determined the effects of dietary diversity score (DDS) and food consumption on healthy aging. A subset of the data of the China Health and Nutrition Survey was utilized in this study. DDSs were calculated using the dietary data collected in the years 2009 and 2011. A healthy aging score (HAS) was calculated by summing the standardized scores on physical functional limitation, comorbidity, cognitive function, and psychological stress based on the data collected in the year 2015, with a lower HAS indicating a healthier aging process. Life quality was self-reported in the year 2015. This study found that DDS was inversely associated with HAS (T3 vs. T1: β −0.16, 95%CI −0.20 to −0.11, p-trend <0.001). The consumption of meat and poultry, aquatic products, and fruits was inversely associated with HAS, and participants in the highest tertile of staple foods consumption had a higher HAS than those in the lowest tertile. HAS was inversely associated with good self-reported life quality and positively associated with bad life quality. In conclusion, food consumption may influence the aging process, and adherence to a diverse diet is associated with a healthier aging process in elderly people.

Dietary Patterns and Muscle Mass, Muscle Strength, and Physical Performance in the Elderly: A 3-Year Cohort Study

OBJECTIVES

Nutritional support effectively prevents and treats sarcopenia; however, the influence of overall dietary patterns on sarcopenia parameters is less investigated. This study aimed to determine the association between adherence to Mediterranean-style diet (MD), Dietary Approaches to Stop Hypertension (DASH), Japanese Food Guide Spinning Top (JFG-ST), and modified JFG-ST (mJFG-ST) and muscle mass, muscle strength, and physical performance in community-dwelling Japanese elderly.

DESIGN AND SETTINGS

This prospective cohort study recruited individuals aged over 60 years from a community college in Nagoya, Japan.

PARTICIPANTS AND MEASUREMENTS

A total of 666 participants were followed up annually from 2014 to 2017. Demographic data, anthropometric measurements, and sarcopenia parameters including walking speed (WS), hand grip strength in the dominant hand (HGS), and skeletal mass index (SMI) were recorded. Self-recall dietary intake was assessed using a validated food frequency questionnaire comprising 29 food groups. Adherence to MD, DASH, JFG-ST, and mJFG-ST was determined by tertiles.

RESULTS

At baseline, the mean age of all participants (56.5% women) was 69.4±4.4 years. WS, HGS, and SMI were 1.4±0.2 (m/s), 28.9±8.1 (kg), and 6.7±1.0 (kg/m2), respectively. In longitudinal analysis, participants with higher JFG-ST adherence scores were more likely to have higher SMI (Q3 vs. Q1: mean difference, 0.048; p=0.04) after adjustment, and its benefits were more evident in men (Q2 vs. Q1: mean difference, 0.098; p=0.047; Q3 vs. Q1: mean difference, 0.091; p=0.017) than in women. WS and HGS were not associated with any type of dietary pattern.

CONCLUSIONS

Adherence to JFG-ST was positively associated with SMI in Japanese community-dwelling elderly adults aged over 60 years, specifically in men. The country-specific dietary recommendations are required to be developed for sarcopenia prevention.

Beneficial Effect of Dietary Diversity on the Risk of Disability in Activities of Daily Living in Adults: A Prospective Cohort Study

Disability in activities of daily living (ADL) is common in elderly people. Dietary diversity is associated with several age-related diseases. The evidence on dietary diversity score (DDS) and ADL disability is limited. This study was based on the China Health and Nutrition Survey. Prospective data of 5004 participants were analyzed. ADL disability was defined as the inability to perform at least one of the five self-care tasks. Cox proportional regression models were conducted to estimate the association of cumulative average DDS with the risk of ADL disability. Logistic regression models were performed to estimate the odds ratios for the average DDS, the baseline DDS, and the recent DDS prior to the end of the survey in relation to ADL disability, respectively. The results indicate that higher average DDS was associated with a decreased risk of ADL disability (T3 vs. T1: hazard ratio 0.50; 95% confidence interval 0.39-0.66). The association was stronger among participants who did not had comorbidity at baseline than those who did (P-interaction 0.035). The average DDS is the most pronounced in estimating the association of DDS with ADL disability of the three approaches. In summary, higher DDS has beneficial effects on ADL disability, and long-term dietary exposure is more preferable in the investigation of DDS and ADL.