Joint Associations of Food Groups with All-Cause and Cause-Specific Mortality in the Mr. OS and Ms. OS Study: A Prospective Cohort

Abstract

Despite continuous growth in dietary pattern research, the relative importance of each dietary component in the overall pattern and their joint effects on mortality risk have not been examined adequately. We explored the individual and joint associations of multiple food groups with all-cause and cause-specific mortality (cardiovascular disease (CVD) or cancer), by analyzing data from a cohort of 3995 Hong Kong Chinese older adults in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox proportional hazards models were used to examine the associations of food groups with mortality risk. The individual and joint contribution of food groups to mortality risk has been quantified by a machine learning approach, i.e., the Quantile G-Computation. When comparing the highest with the lowest quartile of intake, dark green and leafy vegetables (hazard ratio (HR) = 0.82, 95% confidence interval (CI) = 0.70 to 0.96, Ptrend = 0.049), fruit (HR = 0.79, 95% CI = 0.68 to 0.93, Ptrend = 0.006), legumes (HR = 0.75, 95% CI = 0.63 to 0.87, Ptrend = 0.052), mushroom and fungi (HR = 0.76, 95% CI = 0.65 to 0.88, Ptrend = 0.023), soy and soy products (HR = 0.77, 95% CI = 0.66 to 0.90, Ptrend = 0.143), and whole grains (HR = 0.76, 95% CI = 0.65 to 0.89, Ptrend = 0.008) were inversely associated with all-cause mortality. Legume intake was associated with a lower risk of CVD mortality, while fruit, nuts, soy and soy products were associated with a lower risk of cancer mortality. From the Quantile G-Computation, whole grains, legumes, fruits, mushroom and fungi, soy and soy products had a higher relative weighting on mortality risk, and the joint effect of food groups was inversely associated with the mortality risk due to all-causes (HR = 0.39, 95% CI = 0.27 to 0.55), CVD (HR = 0.78, 95% CI = 0.67 to 0.91), and cancer (HR = 0.31, 95% CI = 0.15 to 0.65). From a sex-stratified analysis, most associations between food groups (whole grains, legumes, fruits, mushroom and fungi, soy and soy products) and mortality risk remained significant among men. In conclusion, whole grains, legumes, fruits, mushroom and fungi, soy and soy products were the main contributors to a reduction in mortality risk, and their joint effects were stronger than individual food groups. Moreover, the sex-specific association of sweets and desserts with cancer mortality may be worth further investigation.

Legume Consumption and Risk of All-Cause and Cause-Specific Mortality: A Systematic Review and Dose–Response Meta-Analysis of Prospective Studies

“…After the exclusion of 2851 duplicate records and 5716 irrelevant documents based on title and abstract screening, 216 potentially relevant full-text articles were considered for further review. After further exclusions were made, 32 prospective cohorts (31 publications) were included in the analyses [ [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [34] , [35] , [36] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] ]. Of the 31 articles, 1 included data from 2 cohort studies [ 24 ].…”

“…All were population-based cohort studies that were conducted in the general adult population, and studies in patients with a history of disease were excluded. Five studies were conducted in the United States [ 29 , 40 , 43 , 44 , 61 ], 14 in Europe [ 26 , 30 , 31 , 34 , 35 , 39 , 41 , [64] , [65] , [66] , [67] , [68] , [69] , [70] ], 10 in Asia [ 23 , 24 , 27 , 28 , 36 , 38 , 42 , 45 , 63 ], 1 in Australia [ 62 ], and 2 internationally [ 22 , 25 ]. These studies enrolled 1,141,793 participants, ranging from 161 to 258,911.…”

“…Although there have been meta-analyses on the association between legumes and mortality [ 18 , 32 , 33 ], these studies have missed several cohort studies [ 30 , [34] , [35] , [36] , [37] ] and did not consider cause-specific deaths. In addition, 14 prospective cohort studies examining the association between legume consumption and mortality have been published recently [ [25] , [26] , [27] , [28] , [29] , 31 , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] ], which include over half a million participants; thus, an updated meta-analysis is warranted. Consequently, our objectives were to conduct an updated systematic review and meta-analysis of prospective observational studies in the general population to determine the association between legume consumption and the risk of mortality from all causes, as well as CVD, CHD, stroke, and cancer, and to evaluate the strength and shape of the dose–response relationships and certainty of the evidence for these associations.…”

Dried Fruits, Nuts, and Cancer Risk and Survival: A Review of the Evidence and Future Research Directions

“…For example, Chen et al [ 105 ] estimated a summary RRs for high (5+ servings/week) compared with low nut (never/almost never) consumption of 0.87 (95% CI: 0.80–0.93) for cancer mortality (11 studies 21,353 deaths), while Aune et al reported a summary estimate of 0.83 (95% CI: 0.75–0.92) per 28 g/d for cancer mortality [ 106 ]. When updating the latter analysis by adding results from 6 additional cohort studies that have since been published [ 109 , 110 , 111 , 112 , 113 , 114 ] ( Supplementary Table S1 ), the summary estimate was 0.87 (95% CI: 0.81–0.94, I 2 = 60%, n = 13) per 28 g/d ( Figure 1 A) based on data from 13 cohort studies (12 publications), and there was evidence of nonlinearity ( P nonlinearity = 0.005) with most of the reductions in risk observed with an intake of 15–20 g/day ( Figure 1 B).…”

“… Nuts and total cancer mortality, linear ( A ), and nonlinear ( B ) dose-response analysis (updated analysis based on Aune et al) [ 106 , 110 , 111 , 112 , 113 , 114 , 119 , 120 , 121 , 122 , 123 , 124 ]. …”