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To examine the association between dietary diversity and all-cause, cardiovascular disease, and cancer mortality among Chinese, and to examine the possibility of exposure-response relationships.
We established a historical cohort by linking health examination records of 57 737 adults (2015-2022) with death registry data. The dietary diversity score (DDS, 0-9 scores) was assessed and divided into three groups based on the number of points (0-3 scores), moderate (4-6 scores) and sufficient (7-9 scores). We used restricted cubic splines (RCS) combined with Cox proportional hazards regression model to analyze the association between DDS and mortality, and Kaplan-Meier curves was applied to describe the survival status across DDS groups.
The association between DDS and cancer mortality was not statistically significant (P>0.05). In contrast, nonlinear associations were observed for all-cause and cardiovascular disease mortality (P < 0.01). When DDS was lower than 3, risks of all-cause and cardiovascular disease mortality increased progressively with decreasing DDS. Compared with a DDS of 9, participants with DDS scores of 4-8 had no significant increase in cardiovascular disease mortality risk. For all-cause mortality, the lowest risk was observed at a DDS of 6, with the protective effect attenuating at scores >6 (β=0.01, P < 0.001). Compared with the adequate group, individuals with moderate and inadequate dietary diversity had 26% (HR=1.26, 95% CI: 1.06-1.50) and 45% (HR=1.45, 95% CI: 1.03-2.03) higher risks of cardiovascular disease mortality, respectively.
Inadequate dietary diversity was significantly and nonlinearly associated with increased risks of all-cause and cardiovascular disease mortality. The lowest risk of death was observed at a moderate DDS level, with no additional benefit at higher scores. Individuals with a DDS < 3 were at substantially higher risk of both all-cause and cardiovascular disease mortality.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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