Association between the traditional Chinese diet, non-communicable diseases and all-cause mortality: a longitudinal study based on China Health and Nutrition Survey (CHNS)

Abstract Purpose Traditional diets may reduce non-communicable disease (NCDs) risk. No research has examined associations between the traditional Chinese diet (TCD), defined using an a priori method, and NCD-related outcomes or all-cause mortality. This study aimed to assess the relationship between TCD adherence, NCD-related outcomes, and all-cause mortality. Methods This longitudinal study utilised data from the China Health and Nutrition Survey (CHNS) between 1997 and 2011. Eligible participants were aged 18–74, had no NCDs at baseline, and participated in at least two survey waves. TCD adherence was assessed using a recently developed TCD index. Higher index scores indicate greater adherence; participants were categorised into low (0–6), medium (7–11), and high (12–23) adherence. Mixed-effects multilevel logistic regression and Cox proportional hazards models assessed associations with CVD, diabetes, cancer, obesity/central obesity, hypertension, and all-cause mortality. Results Among 11,158 participants (mean age 42.2 years, 51.3% women), high TCD adherence was associated with lower risk of CVD (OR: 0.73, 95% CI 0.61, 0.87) and all-cause mortality (HR: 0.73, 95% CI 0.63, 0.87), but higher risk of obesity (OR: 1.19, 95% CI 1.08, 1.32) and central obesity (OR: 1.19, 95% CI 1.12, 1.26). However, when standardising the energy intake on a common basis, TCD adherence was inversely associated with obesity and central obesity. Conclusions Higher adherence to the TCD was associated with reduced risk of CVD and all-cause mortality in this sample of Chinese adults. The positive association with obesity highlights the need to consider total energy intake in future dietary recommendations.