1. 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 years), who were part of 2 population-based, prospective cohort studies in Shanghai and free of cardiovascular diseases, diabetes, and cancer at baseline ( for women and 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 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 R01HL and R01CA to X. Shu, R37CA to W. Zheng, and R01HL to X. Zhang.
Dr. Danxia Yu,
Dr. Xianglan Zhang,