Association of dietary diversity changes and mortality among older people: A prospective cohort study

Abstract

Background & aims: The association between dietary diversity (DD) changes and mortality remains unclear. We aimed to investigate the association between DD changes and all-cause mortality among older people. Methods: A total of 17,959 participants with a mean age of 84.8 years old were enrolled at baseline. Food groups were collected at baseline and follow-up using simplified food frequency questionnaire (FFQ), and then overall, plant-based and animal-based dietary diversity score (DDS) were calculated. DDS changes were calculated using DDS at baseline and the first follow-up. The association between three DDS changes (overall, plant-based and animal-based DDS) and subsequent all-cause mortality were evaluated. Nonparametrically restricted cubic splines and a multivariable-adjusted Cox proportional hazards model were used to estimate HRs and 95% CIs. Results: We documented 12,974 deaths over a 129,590 person-years of follow up. Compared with highto-high DDS pattern, participants with lower overall DDS patterns had increased mortality risk with HRs (95%CI) of 1.39 (1.29e1.49), 1.53 (1.37e1.70), 1.38 (1.18e1.60) and 1.55 (1.31e1.83) for medium-tomedium, low-to-low, low-to-high and high-to-low patterns, respectively. And compared with high-tohigh DDS pattern, the estimates were 1.34 (1.23e1.46), 1.49 (1.35e1.65), 1.43 (1.23e1.67) and 1.62 (1.40e1.88) for plant-based DDS, and 1.23 (1.15e1.31), 1.29 (1.20e1.40), 1.24 (1.12e1.37) and 1.28 (1.15 e1.44) for animal-based DDS for medium -to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. There was a U-shaped association between DDS change scores and mortality, and compared with participants with whose DDS remained stable, those with extreme declines and extreme improvements had higher risks of mortality with HRs (95% CI) of 1.15 (1.09e1.22) and 1.11 (1.04e1.17). Conclusions: Maintaining a lower DDS, extreme declines and extreme improvements in DDS were all associated with an increased risk of all-cause mortality.

Association between Dietary Diversity Changes and Cognitive Impairment among Older People: Findings from a Nationwide Cohort Study

“…Based on the randomly assigned centenarians’ code numbers, the predefined sex was determined to obtain comparable numbers of women and men for each age group. Detailed descriptions of the study design and data quality assessment have been provided in previous publications [ 31 , 32 ]. At each follow-up period, information on diet, lifestyle and medical history was updated through face-to-face interviews using structured questionnaires.…”

“…Participants were asked how often these foods were consumed, and the dietary information was recorded as frequent (≥5 times/week), occasional (1–4 times/week) or rare (<1/week). Considering the frequency of food consumption, we counted the number of food groups to measure the DDS, the nine food groups were given a score of 0 (rare), 1 (occasional) and 2 (frequent) without considering a minimum intake for the food groups [ 32 , 35 ]. Thus, the score of overall DDS, plant-based DDS (including fresh vegetables, preserved vegetables, fresh fruit, tea, garlic and food made from beans) and animal-based DDS (including meat, fish and eggs) was calculated based on a scale of 0–18, 0–12, and 0–6, respectively.…”

Dietary patterns and survival to 100 + years: an empty systematic review of cohort and case–control studies

“…The authors reported that regardless of how the participants’ DDS changed, e.g., from low to medium or high scores, from medium to high scores, or from high to medium or low scores, the individuals maintaining high scores (13–18 points) had a lower mortality risk. The results shows that a highly diverse diet throughout several years is associated with a lower mortality risk at ages ≥ 65 years [ 61 ]. However, this study did not have a follow-up time long enough to allow the population to be 100 + years and thus does not provide information regarding if this association persists among individuals reaching 100 years of age.…”

“…A diet diversity score (DDS) was calculated assigning 1 point per food group consumed 1-4 times/week and 2 points per food group consumed ≥ 5 times/week, allowing scores ranging from 0-18 points. Subsequently the [75] relation between changes in DDS and mortality was investigated [61]. The authors reported that regardless of how the participants' DDS changed, e.g., from low to medium or high scores, from medium to high scores, or from high to medium or low scores, the individuals maintaining high scores (13-18 points) had a lower mortality risk.…”

Preconception Dietary Patterns and Associations With IVF Outcomes: An Ongoing Prospective Cohort Study

“…Participants were required to recall their frequency of intake and portion size consumed during the past 12 months. The FFQ was derived and modified from the validated Chinese dietary FFQ from the Chinese Center for Disease Control and Prevention (41,42), which was widely used in various studies (43)(44)(45)(46)(47)(48). Previous studies suggested that the reproducibility and validity of the Chinese dietary FFQ were satisfactory and it can be used to classify the subjects according to their food consumption in 1 year (41,42).…”