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

To explore the longitudinal associations between a Chinese healthy diet and the progression of cardiometabolic multimorbidity (CMM) development among Chinese adults. A prospective analysis was conducted utilising 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-h dietary recalls combined with the weighing method. A 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 (CMD), 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 CMD to first CMD and then to CMM. Quantile G-computation was utilised to evaluate the relative contribution of each food component. Over a median follow-up period of 7·3 years, 2214 (11·8 %) participants developed first CMD, and 156 (0·83 %) progressed to CMM. Comparing participants in the highest quintile of dietary scores with 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 first CMD 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 first CMD to CMM, respectively. Our study revealed that greater adherence to the Chinese healthy diet is negatively associated with the risk of CMM.