Associations of Diet Quality and All-Cause Mortality Across Levels of Cardiometabolic Health and Disease: A 7.6-Year Prospective Analysis From the Dutch Lifelines Cohort
Design: From the population-based
Lifelines cohort, 40,892 non-underweight participants aged ≥50 years with data
on diet quality and confounding factors were included (enrollment 2006-2013).
From food frequency questionnaire data, tertiles of the Lifelines diet score
were calculated (T1 = poorest, T3 = best diet quality). Four CMD categories
were defined: 1) CMD-free, 2) type 2 diabetes, 3) one cardiovascular disease
(CVD), 4) two or more CMDs. Months when deaths occurred were obtained from municipal
registries up until November 2019. Multivariable Cox proportional hazards
models were applied for the total population and stratified by CMD categories.
Results: After a median follow-up of 7.6 years, 1,438 participants died. Diet quality and CMD categories were independently associated with all-cause mortality in crude and adjusted models (p < 0.001). A dose-response relationship of diet quality with all-cause mortality was observed in the total population (P for trend < 0.001, T2 vs. T3 = 1.22 (1.07-1.41), T1 vs. T3 = 1.57 (1.37-1.80)). In stratified analyses, the association was significant for CMD-free individuals (T1 vs. T3 = 1.63 (1.38-1.93)) and for type 2 diabetes patients (1.87 (1.17-3.00)), but not for patients with one CVD (1.39 (0.93-2.08)) or multiple CMDs (1.19 (0.80-1.76)).
Conclusions: A high-quality diet can potentially lower all-cause mortality risk in the majority of the ageing population. Its effect may be greatest for CMD-free individuals and patients with type 2 diabetes. Tailored dietary guidelines may be required for patients with extensive histories of CMDs.