饮食多样性变化与老年人死亡率的关联：一项前瞻性队列研究。

Association of dietary diversity changes and mortality among older people: A prospective cohort study.

机构信息

Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.

National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.

出版信息

Clin Nutr. 2021 May;40(5):2620-2629. doi: 10.1016/j.clnu.2021.04.012. Epub 2021 Apr 20.

DOI:10.1016/j.clnu.2021.04.012

PMID:33933728

Abstract

BACKGROUND & AIMS: The association between dietary diversity (DD) changes and mortality remains unclear. We aimed to investigate the association between DD changes and all-cause mortality among older people.

METHODS

A total of 17,959 participants with a mean age of 84.8 years old were enrolled at baseline. Food groups were collected at baseline and follow-up using simplified food frequency questionnaire (FFQ), and then overall, plant-based and animal-based dietary diversity score (DDS) were calculated. DDS changes were calculated using DDS at baseline and the first follow-up. The association between three DDS changes (overall, plant-based and animal-based DDS) and subsequent all-cause mortality were evaluated. Nonparametrically restricted cubic splines and a multivariable-adjusted Cox proportional hazards model were used to estimate HRs and 95% CIs.

RESULTS

We documented 12,974 deaths over a 129,590 person-years of follow up. Compared with high-to-high DDS pattern, participants with lower overall DDS patterns had increased mortality risk with HRs (95%CI) of 1.39 (1.29-1.49), 1.53 (1.37-1.70), 1.38 (1.18-1.60) and 1.55 (1.31-1.83) for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. And compared with high-to-high DDS pattern, the estimates were 1.34 (1.23-1.46), 1.49 (1.35-1.65), 1.43 (1.23-1.67) and 1.62 (1.40-1.88) for plant-based DDS, and 1.23 (1.15-1.31), 1.29 (1.20-1.40), 1.24 (1.12-1.37) and 1.28 (1.15-1.44) for animal-based DDS for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. There was a U-shaped association between DDS change scores and mortality, and compared with participants with whose DDS remained stable, those with extreme declines and extreme improvements had higher risks of mortality with HRs (95% CI) of 1.15 (1.09-1.22) and 1.11 (1.04-1.17).

CONCLUSIONS

Maintaining a lower DDS, extreme declines and extreme improvements in DDS were all associated with an increased risk of all-cause mortality.

摘要

背景与目的

饮食多样性（DD）变化与死亡率之间的关系尚不清楚。本研究旨在探讨老年人中 DD 变化与全因死亡率之间的关系。

方法

共纳入 17959 名平均年龄为 84.8 岁的参与者。在基线和随访时使用简化食物频率问卷（FFQ）收集食物组，然后计算总体、植物性和动物性饮食多样性得分（DDS）。使用基线和第一次随访时的 DDS 计算 DDS 变化。评估三种 DDS 变化（总体、植物性和动物性 DDS）与随后全因死亡率之间的关系。使用非参数限制性立方样条和多变量调整的 Cox 比例风险模型估计 HRs 和 95%CI。

结果

在 129590 人年的随访中，我们记录了 12974 例死亡。与高至高 DDS 模式相比，DDS 总体模式较低的参与者具有更高的死亡风险，HRs（95%CI）分别为 1.39（1.29-1.49）、1.53（1.37-1.70）、1.38（1.18-1.60）和 1.55（1.31-1.83），中-中、低-低、低-高和高-低模式分别为 1.34（1.23-1.46）、1.49（1.35-1.65）、1.43（1.23-1.67）和 1.62（1.40-1.88）。与高至高 DDS 模式相比，植物性 DDS 的估计值分别为 1.23（1.15-1.31）、1.29（1.20-1.40）、1.24（1.12-1.37）和 1.28（1.15-1.44），而动物性 DDS 的估计值分别为 1.23（1.15-1.31）、1.29（1.20-1.40）、1.24（1.12-1.37）和 1.28（1.15-1.44），中-中、低-低、低-高和高-低模式分别为 1.23（1.15-1.31）、1.29（1.20-1.40）、1.24（1.12-1.37）和 1.28（1.15-1.44）。DDS 变化评分与死亡率之间呈 U 形关联，与 DDS 保持稳定的参与者相比，DDS 极度下降和极度改善的参与者死亡率更高，HRs（95%CI）分别为 1.15（1.09-1.22）和 1.11（1.04-1.17）。