Liu Xuna, Wang Yiwen
Shaanxi Provincial People's Hospital, Xi'an, China.
Xi'an International Medical Center Hospital Affiliated to Northwest University, Xi'an, China.
Front Nutr. 2025 Mar 25;12:1514500. doi: 10.3389/fnut.2025.1514500. eCollection 2025.
Few studies have discussed the health benefits of total dietary intake of live microbes (TDIIM). We investigated the relationship between daily estimated TDIIM and mortality in US adults.
This cohort study included subjects ≥18 years from the 1999-2018 NHANES and their mortality data through December 31, 2019. The TDIIM counts were estimated based on a prior classification system, with foods categorized into low (<10^7 CFU/g), medium (10^7-10^10 CFU/g), and high (>10^10 CFU/g) levels of live microbes. Individual intakes were calculated by multiplying the microbial levels by the corresponding grams of food consumed. Weighted Cox regression models, Kaplan-Meier survival curves, and restricted cubic splines (RCS) were used to estimate the association between all-cause and cardiovascular (CVD) mortality and TDIIM.
Among 52,383 participants, during a median follow-up period of 118.75 months, a total of 7,711 deaths were recorded, of which 1,985 were CVD deaths. In the weighted Cox regression model, compared to participants with low TDIIM, those with high intake have lower risks of all-cause mortality (HR 0.91; 95% CI, 0.82-1.00; P for trend, 0.01), and CVD mortality (HR 0.77; 95% CI, 0.63-0.95; P for trend, 0.005). In the RCS analysis, the relationship between TDIIM and all-cause mortality exhibited a non-linear pattern with a gradual decline followed by a plateau at higher intakes, while a linear decreasing trend was observed with CVD mortality. Kaplan-Meier survival curves showed that participants with low TDIIM had a higher risk of all-cause mortality and CVD mortality.
In this cohort study of US adults, a higher estimated TDIIM reduced the risk of all-cause and CVD mortality. These findings suggest that the ingestion of live microbes in the diet may be advantageous for human health.
很少有研究探讨膳食中活微生物总摄入量（TDIIM）对健康的益处。我们调查了美国成年人每日估计的TDIIM与死亡率之间的关系。
这项队列研究纳入了1999 - 2018年美国国家健康与营养检查调查（NHANES）中年龄≥18岁的受试者及其截至2019年12月31日的死亡率数据。TDIIM计数是根据先前的分类系统估算的，食物被分为低（<10^7 CFU/g）、中（10^7 - 10^10 CFU/g）和高（>10^10 CFU/g）活微生物水平类别。个体摄入量通过将微生物水平乘以相应的食物摄入量克数来计算。使用加权Cox回归模型、Kaplan - Meier生存曲线和受限立方样条（RCS）来估计全因死亡率和心血管疾病（CVD）死亡率与TDIIM之间的关联。
在52383名参与者中，中位随访期为118.75个月，共记录了7711例死亡，其中1985例为CVD死亡。在加权Cox回归模型中，与TDIIM低的参与者相比，摄入量高的参与者全因死亡率风险较低（风险比[HR] 0.91；95%置信区间[CI]，0.82 - 1.00；趋势P值，0.01），CVD死亡率风险较低（HR 0.77；95% CI，0.63 - （此处原文有误，应为0.95）0.95；趋势P值，0.005）。在RCS分析中，TDIIM与全因死亡率之间的关系呈现非线性模式，摄入量逐渐增加时先逐渐下降然后趋于平稳，而与CVD死亡率则呈现线性下降趋势。Kaplan - Meier生存曲线显示，TDIIM低的参与者全因死亡率和CVD死亡率风险较高。
在这项针对美国成年人的队列研究中，较高的估计TDIIM降低了全因死亡率和CVD死亡率风险。这些发现表明，饮食中摄入活微生物可能对人类健康有益。
