Beydoun May A, Georgescu Michael F, Fanelli-Kuczmarski Marie T, Maino Vieytes Christian A, Banerjee Sri, Beydoun Hind A, Evans Michele K, Zonderman Alan B
Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, 21224 USA.
Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, 21224 USA.
J Acad Nutr Diet. 2025 Mar 4. doi: 10.1016/j.jand.2025.02.012.
All-cause mortality risk and dementia occurrence have been previously hypothesized to be linked with food insecurity and poor dietary quality.
The aims of the study were to test mediation and interactions between food insecurity, diet quality, and dementia status in relation to all-cause mortality.
The interplay of food insecurity, diet quality, and dementia in their associations with all-cause mortality was studied, in terms of interactions and mediating effects, using secondary longitudinal data from a sample of older US adults from the Health and Retirement Study (HRS, 2012-2020). Reduced (age, sex, race/ethnicity-adjusted, M1) and fully adjusted (sociodemographic, lifestyle, and health-related factor-adjusted, M2) models were tested, and stratification by sex and race/ethnicity was carried out.
PARTICIPANTS/SETTING: US older adults (n = 2894; 2012-2014, mean baseline age of 76.4 y) were selected from this national longitudinal sample.
The outcome of interest was all-cause mortality risk for follow-up until the end of 2020.
Cox proportional hazards, four-way decomposition, and generalized structural equations models (GSEM) were used.
Overall, 902 deaths occurred (51 per 1000 person-years). Food insecurity (yes vs no) was not associated with mortality risk in M1, although inversely related to this outcome in M2 (Cox models and GSEM). Food insecurity was directly related to Ln(dementia odds) in M1 only (β ± standard error [SE]: 0.23 ± 0.05, P < .001, GSEM). Diet quality as measured by HEI-2015 (z-scored), although inversely related to food insecurity in reduced GSEM (β ± SE: -0.18 ± 0.06, P = .005), was also inversely related to both Ln(dementia odds), z-scored (β ± SE: -0.14 ± 0.03l P < .001) and mortality risk (LnHR ± SE: -0.14 ± 0.03; P < .001, M1). Ln(dementia odds) was strongly associated with mortality risk (HR = 1.39; 95% CI, 1.31-1.48; P < .001, M2). In both four-way decomposition models and GSEM, the total effect of diet quality on mortality risk was partially mediated through Ln(dementia odds) (M1 and M2), explaining 15%-21% of this total effect.
Diet quality-mortality risk association was partially mediated through dementia, with inconsistent findings observed for food insecurity.
先前有假设认为全因死亡风险和痴呆症的发生与粮食不安全及不良饮食质量有关。
本研究旨在检验粮食不安全、饮食质量和痴呆症状态之间关于全因死亡率的中介作用和相互作用。
利用来自美国健康与退休研究（HRS，2012 - 2020）中美国老年成年人样本的二次纵向数据，从相互作用和中介效应方面研究粮食不安全、饮食质量和痴呆症与全因死亡率之间的相互关系。对简化模型（调整年龄、性别、种族/族裔，M1）和完全调整模型（调整社会人口统计学、生活方式和健康相关因素，M2）进行了检验，并按性别和种族/族裔进行了分层。
参与者/研究背景：从这个全国纵向样本中选取了美国老年成年人（n = 2894；2012 - 2014年，平均基线年龄76.4岁）。
感兴趣的结局是随访至2020年底的全因死亡风险。
使用了Cox比例风险模型、四向分解模型和广义结构方程模型（GSEM）。
总体而言，发生了902例死亡（每1000人年51例）。在M1中，粮食不安全（是与否）与死亡风险无关，尽管在M2中与该结局呈负相关（Cox模型和GSEM）。粮食不安全仅在M1中与Ln（痴呆症比值）直接相关（β ± 标准误[SE]：0.23 ± 0.05，P <.001，GSEM）。用HEI - 2015（标准化）衡量的饮食质量，尽管在简化GSEM中与粮食不安全呈负相关（β ± SE： - 0.18 ± 0.06，P =.005），但也与Ln（痴呆症比值）标准化后呈负相关（β ± SE： - 0.14 ± 0.03；P <.001）以及与死亡风险呈负相关（LnHR ± SE： - 0.14 ± 0.03；P <.001，M1）。Ln（痴呆症比值）与死亡风险密切相关（HR = 1.39；95%CI，1.31 - 1.48；P <.001，M2）。在四向分解模型和GSEM中，饮食质量对死亡风险的总效应部分通过Ln（痴呆症比值）介导（M1和M2），解释了该总效应的15% - 21%。
饮食质量 - 死亡风险关联部分通过痴呆症介导，而关于粮食不安全的研究结果不一致。
