Chinese healthy diet and cardiometabolic multimorbidity risks: a prospective cohort study from the China Health and Nutrition Survey

To explore the longitudinal associations between an Chinese healthy diet and the progression of cardiometabolic multimorbidity (CMM) development among Chinese adults. A prospective analysis was conducted utilizing data from 18,720 participants in the China Health and Nutrition Survey, spanning from 1997 to 2018. Dietary data were collected by three consecutive 24-hour dietary recalls combined with weighing method. An Chinese healthy diet score was developed by assigning scores to various food components. CMM was defined as the coexistence of two or more cardiometabolic diseases (CMDs), including myocardial infarction, stroke, and type 2 diabetes, diagnosed through blood indicators and clinical diagnosis. We employed a multistate model to examine the associations between the Chinese healthy diet and the longitudinal progression from being free of CMDs to first cardiometabolic disease (FCMD), then to CMM. Quantile G-computation was utilized to evaluate the relative contribution of each food component. Over a median follow-up period of 7.3 years, 2,214 (11.8%) participants developed FCMD, 156 (0.83%) progressed to CMM. Comparing participants in the highest quintile of dietary scores to those in the lowest, we observed a 55% lower risk of transitioning from baseline to CMM (HR = 0.45, 95% CI: 0.23 - 0.87), and a 60% lower risk of transition from FCMD to CMM (HR = 0.40, 95% CI: 0.20 - 0.81). Fresh fruits contributed to 42.8% and 43.0% for delaying CMM and transition from FCMD to CMM, respectively. Our study revealed that greater adherence to the Chinese healthy diet is negatively associated with the risk of CMM.