Modified diet balance index-16 scores and frailty index-defined health deficit accumulation in a prospective Chinese adult health-check cohort

Introduction Prospective evidence linking diet quality to multi-domain health deficit accumulation is limited in non-Western adults, and few studies distinguish dietary insufficiency from excessive intake. Methods We included 23,673 Chinese adults aged ≥25 years from the Beijing MJ Health Screening Center. Baseline diet was assessed using a modified diet balance index-16 framework, which yielded Total Score (TS), Low Bound Score (LBS), High Bound Score (HBS), and Diet Quality Distance (DQD). A 29-item frailty index identified health deficit accumulation at FI ≥0.25. Cox models estimated hazard ratios (HRs) for reaching this threshold. Results During a median follow-up of 3.21 years, 307 participants reached FI ≥0.25. Compared with low TS, medium and high TS were associated with lower risk (HR 0.74, 95% CI 0.56–0.97, and HR 0.64, 95% CI 0.43–0.95). High LBS was associated with higher risk (HR 1.48, 95% CI 1.04–2.10). DQD showed no clear association, and the HBS association was not statistically significant. Discussion A more favorable modified DBI-16 profile and less dietary insufficiency were associated with lower risk of FI-defined health deficit accumulation.