Association Between Dietary Patterns And Cardiovascular Diseases In Adults In Qingdao: A Prospective Cohort Study

Objective:Cardiovascular disease(CVD)is the leading cause of death from chronic noncommunicable diseases,the increasing prevalence and mortality have imposed a huge economic burden on populations and societies.Healthy diet has been shown to be one of the most effective methods to prevent and manage the onset and progression of CVD.Previous studies tended to explore the association between single food or nutrient and CVD,without taking into account the complexity of the daily eating.The purpose of this study was to systematically analyze the association between different dietary patterns and CVD morbidity and mortality by fitting the intake of representative dietary patterns of Qingdao residents to provide local scientific evidence on CVD prevention strategies.Method:Data were obtained from the China Kadoorie Biobank,Qingdao and the Qingdao residents’ health risk factors survey,three aspects of studies were conducted: Firstly,using data from CKB and Qingdao residents’ health risk factors survey to observe the daily intake of main food groups and the changes of body indexes of Qingdao residents from 2004 to2020.Secondly,factor analysis method was used to fit the main dietary patterns of Qingdao residents based on the baseline survey data of CKB,and detailed information of CVD morbidity and mortality was obtained from the Disease Surveillance Point System,the Qingdao Chronic Disease Registry System and the Health Insurance Database.Cox proportional hazard regression model was used to prospectively explore the association between different dietary patterns and the risk of total CVD and its major subtypes morbidity and total CVD mortality.Thirdly,likelihood ratio test was used to explore whether different baseline characteristics modified the associations between dietary patterns and CVD risk.Result:1.From 2004 to 2020,the population proportion of daily intake of wheat,vegetables and soy products decreased moderately,while the daily intake of red meat and fruit increased dramatically.In addition,the waist circumference,hip circumference,systolic blood pressure,diastolic blood pressure and female BMI of Qingdao residents had no statistical changes,while the BMI of male residents showed a significant upward trend(P=0.047).2.Four representative dietary patterns were identified:the high protein dietary patterns was characterized by a higher intake of poultry,fish,red meat and soy products;the balanced dietary pattern was characterized by a higher intake of eggs,vegetables,fruits,dairy products and red meat;the staple food dietary pattern was characterized by a higher intake of wheat and preserved vegetables and lower intake of rice and fruit;and the multigrain dietary pattern was characterized by a higher intake of mixed grains and soy products and lower intake of red meat.3.During a median follow-up of 9.2 years,5,742 new cases of CVD,1,696 new cases of cerebrovascular disease(CED),2,732 new cases of ischemic heart disease(IHD),and421 new cases of major coronary events(MCE)were recorded and with the incidence density of 21.29/1,000,5.59/1,000,9.72/1,000 and 1.45/1,000 person-years,respectively.A total of 449 death events from CVD were recorded,with a death density of 1.54 per 1,000person-years.The morbidity and mortality density of CVD increased along with the aging.4.Compared with the with the lowest level of dietary pattern score,the higher highprotein dietary pattern score group had a 14%(Hazard ratio,HR= 0.86;95% Confidence interval,CI:0.75-0.99)lower risk of total CVD;the highest balanced dietary pattern score group had a 10%(HR= 0.90;95% CI:0.84-0.97)and 24%(HR=0.76;95% CI:0.67-0.87)lower risk of CVD and CED,respectively;the highest multigrain dietary pattern score group had a 7%(HR=0.93;95% CI:0.86-0.99)lower risk of total CVD morbidity.5.Compared with the lowest level of dietary pattern score,the highest high protein dietary pattern score,multigrain dietary pattern score and the higher balanced dietary pattern score had a 31%(HR= 0.69;95% CI:0.51-0.93),26%(HR= 0.74;95% CI:0.57-0.95)and 25%(HR= 0.75;95% CI:0.57-0.98)lower risk of total CVD mortality,respectively.6.In the total incidence of CVD events,there were significant interactions between high-protein dietary pattern and age(P for interaction =0.007),staple food dietary pattern and gender(P for interaction =0.004),alcohol consumption status(P for interaction =0.033),multigrain dietary pattern and age(P for interaction =0.005),BMI(P for interaction=0.034);In the incidence of CED events,there were significant interactions between highprotein dietary pattern and age(P for interaction =0.037),education level(P for interaction=0.035),staple food dietary pattern and gender(P for interaction =0.004),marital status,(P for interaction =0.034)smoking status(P for interaction =0.015),multigrain dietary pattern and gender(P for interaction =0.028),BMI(P for interaction =0.034);In the incidence of IHD events,there were significant interactions both between staple food,multigrain dietary patterns and age(P for interaction =0.020,P for interaction =0.010).7.In total CVD mortality events,there were significant interactions between high protein dietary pattern and gender(P for interaction =0.005),diabetes(P for interaction=0.007),MET(P for interaction =0.037),staple food dietary pattern and alcohol consumption status(P for interaction =0.002),MET(P for interaction =0.003),multigrain dietary pattern and marital status(P for interaction =0.015).Conclusion:From 2004 to 2020,the proportion of daily intake of several main food types of Qingdao residents has changed to varying degrees.High protein diet,balanced diet and multigrain diet reduce the morbidity and mortality risk of CVD.In addition,factors such as gender,smoking,alcohol consumption,and BMI had influence on dietary patterns and the association of CVD morbidity and mortality.