Healthy Eating Predicts Lower Risks of Cardiometabolic Diseases in Chinese A report from the Shanghai Women’s and Men’s Health Studies Danxia Yu1, Xiao-Ou Shu1, Yong-Bing Xiang2, Gong Yang1, Honglan Li2, Yu-Tang Gao2, Wei Zheng1, and Xianglan Zhang1 1Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA; 2Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China. Introduction Results Results Noncommunicable diseases (NCDs) have become the No. 1 health threat in China, accounting for >80% of the disease burden and deaths. The number of NCD cases among Chinese adults over 40 will double or even triple by 2030, mainly due to cardiometabolic diseases, including coronary heart disease (CHD), stroke, and type 2 diabetes. The Dietary Guidelines for Chinese (Food Pagoda) aim to help Chinese people keep a balanced diet during recent nutrition transitions from traditional to more Westernized diets. Risk of Developing Cardiometabolic Diseases by Adherence to the 2007 Dietary Guidelines for Chinese Risk of Cardiometabolic Diseases by Recommended Dietary Intakes in the Chinese Food Pagoda Quintile of the Adherence Score 1 2 3 4 5 P-trend Total Cardiometabolic Diseases Cases, n 2493 2326 2128 1998 2010   Model 1 1.00 (ref) 0.92 (0.87, 0.97) 0.86 (0.81, 0.91) 0.82 (0.78, 0.87) 0.80 (0.76, 0.85) <0.0001 Model 2 0.96 (0.90, 1.01) 0.90 (0.85, 0.95) 0.87 (0.82, 0.93) 0.88 (0.83, 0.93) Coronary Heart Disease 196 205 164 147 146 1.03 (0.85, 1.25) 0.84 (0.68, 1.03) 0.77 (0.63, 0.96) 0.74 (0.59, 0.91) 0.0003 1.06 (0.87, 1.29) 0.86 (0.70, 1.06) 0.80 (0.65, 1.00) 0.79 (0.63, 0.99) 0.005 Stroke 1273 1176 1012 968 1037 0.91 (0.84, 0.99) 0.80 (0.74, 0.87) 0.83 (0.76, 0.90) 0.94 (0.87, 1.02) 0.85 (0.78, 0.92) 0.86 (0.79, 0.93) 0.0008 Type 2 Diabetes 1212 1133 1079 1019 969 0.94 (0.86, 1.02) 0.91 (0.84, 0.98) 0.87 (0.80, 0.94) 0.81 (0.75, 0.88) 0.98 (0.90, 1.06) 0.96 (0.88, 1.04) 0.92 (0.85, 1.00) 0.89 (0.82, 0.98) 0.006 Component (Max Score) Standard for Max Score Standard for Zero Score Adherence Score, mean± SD HR (95% CI) by per SD Increase P Grains (5) > 300 g/d 4.9 ± 0.4 1.05 (1.02, 1.07) 0.0001 Vegetables (5) > 400 g/d 3.8 ± 1.2 0.98 (0.96, 1.00) 0.04 Fruits (5) > 100 g/d 4.4 ± 1.3 0.95 (0.93, 0.96) <0.0001 Dairy (5) 1.6 ± 1.8 0.94 (0.92, 0.96) Beans (5) > 30 g/d 3.7 ± 1.3 1.00 (0.98, 1.02) 0.78 Meat (4) < 100 g/d > 150 g/d 3.4 ± 1.2 1.02 (1.00, 1.05) 0.03 Fish (3) > 50 g/d 2.2 ± 0.9 0.97 (0.95, 0.98) 0.0002 Eggs (3) < 50 g/d > 75 g/d 2.7 ± 0.7 1.01 (0.99, 1.03) 0.57 Total fat (5) < 30 g/d > 45 g/d 3.1 ± 2.0 1.02 (1.00, 1.04) Salt (5) < 6 g/d > 9 g/d 3.6 ± 1.8 0.01 Total score (45) 33.4 ± 4.4 0.95 (0.93, 0.97) Higher adherence to the Chinese dietary guidelines has been associated with lower mortality among Chinese men and women in Shanghai, especially lower mortality from diabetes and cardiovascular diseases. Objective Intakes between the minimum and maximum levels are scored proportionately. To examine whether higher adherence to the Dietary Guidelines for Chinese is associated with lower risks of developing cardiometabolic diseases, including CHD, stroke, and type 2 diabetes. Conclusion Higher adherence to the Dietary Guidelines for Chinese, which indicates a healthy dietary pattern, is associated with lower risks of developing cardiometabolic diseases in middle-aged and older Chinese adults. The beneficial associations were independent of sex, education level, smoking habit, obesity status, and history of hypertension. Reduced risks were observed for recommendations on increasing intakes of vegetables, fruits, dairy, and fish and decreasing salt intake. However, recommendations may need to be revised on grains, meat, and total fat intake in the current 2007 Dietary Guidelines for Chinese. Method Participants included 64,784 women and 52,511 men (aged 40-74 years), who were part of 2 population-based, prospective cohort studies in Shanghai and free of cardiovascular diseases, diabetes, and cancer at baseline (1997-2002 for women and 2002-2006 for men). Habitual diets were assessed via in-person interviews using validated food-frequency questionnaires. Incident cardiometabolic diseases were identified via follow-up home visits conducted every 2-3 years. During mean follow-ups of 5.6-10.0 years, 6,988 women and 3,967 men self-reported new diagnoses of CHD, stroke, or type 2 diabetes. Cox regression analyses were conducted, stratified by sex, and adjusted for age, total energy intake (Model 1), education, income, cigarette smoking, alcohol drinking, leisure-time physical activity, use of multivitamin, BMI, waist-to-hip ratio, history of hypertension, as well as menopausal status and hormone therapy for women (Model 2). by Sex by Smoking Habit by Obesity Status by Hypertension Status Funding and Correspondence Supported by grants R01HL079123 and R01CA082729 to X. Shu, R37CA070867 to W. Zheng, and R01HL095931 to X. Zhang. Dr. Danxia Yu, danxia.yu@vanderbilt.edu Dr. Xianglan Zhang, xianglan.zhang@vanderbilt.edu