The Association of Dietary Fiber Intake in Three Meals with All-Cause and Disease-Specific Mortality among Adults: The U.S. National Health and Nutrition Examination Survey, 2003–2014

The timing of food intake can significantly alter the body’s metabolism of nutrient intake and affect the occurrence of chronic diseases. However, whether and how the intake time of dietary fiber could influence mortality risks is largely unknown. This study aims to reveal the association between total dietary fiber intake and fiber intake at different times with all-cause, cancer, and cardiovascular disease (CVD) mortality rates. A total of 31,164 adults who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 are included in this study. Dietary fiber intake was measured using 2-day, 24 h dietary recall. The main exposures in this study were the intake of dietary fiber at breakfast, lunch, and dinner via regression analysis of the residual method. The main outcomes were the all-cause, cancer, and CVD mortality rates. Cox proportional hazards regression models were used to evaluate the survival relationship between dietary fiber intake at different times and mortality rates. Among the 31,164 adults, 2915 deaths, including 631 deaths due to cancer and 836 deaths due to CVD, were documented. Firstly, after adjusting for potential confounders, compared to the participants in the lowest quintile of total dietary fiber intake, the participants in the highest quintile of fiber intake had lower all-cause (HR = 0.686, 95% CI: 0.589–0.799, p for trend <0.001) and cancer (HR = 0.606, 95% CI: 0.446–0.824, p for trend = 0.015) mortality risks. Secondly, compared to the participants in the lowest quintile of dietary fiber intake at dinner, the participants in the highest quintile of fiber intake had lower all-cause (HR = 0.796, 95% CI: 0.668–0.949, p for trend = 0.009) and cancer (HR = 0.564, 95% CI: 0.388–0.822, p for trend = 0.005) mortality risks. Furthermore, equivalently replacing each standard deviation of dietary fiber consumed at breakfast with that at dinner was associated with lower cancer mortality risks (HR = 0.846, 95% CI: 0.747–0.958). In conclusion, this study demonstrates that, in the NHANES (2003–2014) cohort, to reduce all-cause and cancer mortality risks, the optimal dietary fiber intake time is in the evening.     

Mediterranean Diet and Mortality in People with Cardiovascular Disease: A Meta-Analysis of Prospective Cohort Studies

The association of the Mediterranean diet (MD) with mortality among people with a history of cardiovascular disease (CVD) has not been systematically examined. Hereby, our objective was to investigate the association of MD with all-cause and cardiovascular mortality in people with a history of CVD. We searched five electronic databases including Embase, PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials to screen eligible studies published before 31 August 2020. A random-effect model was used to examine the association of a 2-unit increment in MD score with the risk of all-cause and cardiovascular mortality. We conducted sensitivity and subgroup analyses and examined potential publication bias by Egger’s and Begg’s tests. Seven cohort studies (eight datasets) with a total of 37,879 participants who had a history of CVD were eligible for the main analysis. The pooled hazard ratios were 0.85 (95% CIs: 0.78–0.93; n = 8) for all-cause mortality and 0.91 (95% CIs; 0.82–1.01; n = 4) for cardiovascular mortality for each 2-unit increment in a score of adherence to MD. Subgroup analyses for all-cause mortality showed that the association appeared relatively stronger in Mediterranean areas (HR = 0.76 [0.69–0.83]) than non-Mediterranean areas (HR = 0.95 [0.93–0.98]) and in studies with a shorter duration (HR = 0.75 [0.66–0.84] for <7 years vs. HR = 0.94 [0.91–0.98] for ≥7 years). No evidence of publication bias was observed. The present meta-analysis of prospective cohort studies provided evidence that adherence to MD improved survival in people with a history of CVD.     

Cholesterol and Egg Intakes with Cardiometabolic and All-Cause Mortality among Chinese and Low-Income Black and White Americans

We examined the associations of dietary cholesterol and egg intakes with cardiometabolic and all-cause mortality among Chinese and low-income Black and White Americans. Included were 47,789 Blacks, 20,360 Whites, and 134,280 Chinese aged 40–79 years at enrollment. Multivariable Cox models with restricted cubic splines were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes using intakes of 150 mg cholesterol/day and 1 egg/week as the references. Cholesterol intake showed a nonlinear association with increased all-cause mortality and a linear association with increased cardiometabolic mortality among Black Americans: HRs (95% CIs) associated with 300 and 600 mg/day vs. 150 mg/day were 1.07 (1.03–1.11) and 1.13 (1.05–1.21) for all-cause mortality (P-linearity = 0.04, P-nonlinearity = 0.002, and P-overall < 0.001) and 1.10 (1.03–1.16) and 1.21 (1.08–1.36) for cardiometabolic mortality (P-linearity = 0.007, P-nonlinearity = 0.07, and P-overall = 0.005). Null associations with all-cause or cardiometabolic mortality were noted for White Americans (P-linearity ≥ 0.13, P-nonlinearity ≥ 0.06, and P-overall ≥ 0.05 for both). Nonlinear inverse associations were observed among Chinese: HR (95% CI) for 300 vs. 150 mg/day was 0.94 (0.92–0.97) for all-cause mortality and 0.91 (0.87–0.95) for cardiometabolic mortality, but the inverse associations disappeared with cholesterol intake > 500 mg/day (P-linearity ≥ 0.12; P-nonlinearity ≤ 0.001; P-overall < 0.001 for both). Similarly, we observed a positive association of egg intake with all-cause mortality in Black Americans, but a null association in White Americans and a nonlinear inverse association in Chinese. In conclusion, the associations of cholesterol and egg intakes with cardiometabolic and all-cause mortality may differ across ethnicities who have different dietary patterns and cardiometabolic risk profiles. However, residual confounding remains possible.     

Coffee Consumption and All-Cause,Cardiovascular, and Cancer Mortality in an Adult Mediterranean Population

We assessed the association between usual coffee consumption and all-cause, cardiovascular (CV), and cancer mortality in an adult population in Spain, taking into account both the amount and type of coffee consumed. We used baseline data on coffee consumption and other personal variables, and the number of deaths during an 18-year follow-up period, for 1567 participants aged 20 years and older from the Valencia Nutrition Study in Spain. Total, caffeinated, and decaffeinated coffee consumption was assessed using a validated food frequency questionnaire. Cox regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). During the 18-year follow-up period, 317 died; 115 due to CV disease and 82 due to cancer. Compared with no-consumption, the consumption of ≤1 cup per day and >1 cup per day of coffee was associated with a lower risk of all-cause mortality, HR = 0.73 (95% CI: 0.56–0.97) and HR 0.56 (95% CI: 0.41–0.77), respectively. A lower cancer mortality was observed among drinkers of more than 1 cup per day compared with nondrinkers, HR 0.41 (95% CI 0.20–0.86). Regarding the type of coffee, only the overall consumption of caffeinated coffee was associated with lower all-cause mortality at 12 and 18 years of follow-up, HR = 0.66 (95% CI:0.46–0.94) and HR = 0.59 (95% CI: 0.44–0.79), respectively. In conclusion, this study suggests that the moderate consumption of coffee, particularly caffeinated coffee (range 1–6.5 cups per day), is associated with a lower all-cause and cancer mortality after a long follow-up period. No significant association was found between coffee consumption and CVD mortality.     

Low-Carbohydrate Diets and Mortality in Older Asian People: A 15-Year Follow-Up from a Prospective Cohort Study

The long-term effects of a low-carbohydrate diet (LCD) on mortality, accounting for the quality and source of the carbohydrate, are unclear. Hence, we examined the associations of LCDs with all-cause and cause-specific mortality in a prospective cohort study. A total of 20,206 participants (13.8% diabetes) aged 50+ years were included. Overall, vegetable-based and meat-based LCD scores were calculated based on the percentage of energy as total and subtypes of carbohydrates, fat, and protein. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During 294,848 person-years of follow-up, 4624 deaths occurred, including 3661 and 963 deaths in participants without and with diabetes, respectively. In all participants, overall LCD score was not associated with all-cause and cause-specific mortality, after multivariable adjustment. However, for the highest versus the lowest quartiles of vegetable-based LCD, the adjusted HRs (95%CIs) of all-cause and CVD mortality were 1.16 (1.05–1.27) and 1.39 (1.19–1.62), respectively. The corresponding values for highest versus lowest quartiles of meat-based LCD for all-cause and CVD mortality were 0.89 (0.81–0.97) and 0.81 (0.70–0.93), respectively. Similar associations were found in participants without diabetes. In patients with diabetes, the adjusted HR (95%CI) of CVD mortality for the highest versus the lowest quartiles of vegetable-based LCD was 1.54 (1.11–2.14). Although there were no significant associations with overall LCD score, we found that the vegetable-based LCD score was positively, whereas the meat-based LCD score was negatively, associated with all-cause and CVD mortality in older Asian people.     

Unhealthy Lifestyle,Genetics and Risk of Cardiovascular Disease and Mortality in 76,958 Individuals from the UK Biobank Cohort Study

To examine associations of unhealthy lifestyle and genetics with risk of all-cause mortality, cardiovascular disease (CVD) mortality, myocardial infarction (MI) and stroke. We used data on 76,958 adults from the UK Biobank prospective cohort study. Favourable lifestyle included no overweight/obesity, not smoking, physical activity, not sedentary, healthy diet and adequate sleep. A Polygenic Risk Score (PRS) was derived using 300 CVD-related single nucleotide polymorphisms. Cox proportional hazard ratios (HR) were used to model effects of lifestyle and PRS on risk of CVD and all-cause mortality, stroke and MI. New CVD (n = 364) and all-cause (n = 2408) deaths, and stroke (n = 748) and MI (n = 1140) events were observed during a 7.8 year mean follow-up. An unfavourable lifestyle (0–1 healthy behaviours) was associated with higher risk of all-cause mortality (HR: 2.06; 95% CI: 1.73, 2.45), CVD mortality (HR: 2.48; 95% CI: 1.64, 3.76), MI (HR: 2.12; 95% CI: 1.65, 2.72) and stroke (HR:1.74; 95% CI: 1.25, 2.43) compared to a favourable lifestyle (≥4 healthy behaviours). PRS was associated with MI (HR: 1.35; 95% CI: 1.27, 1.43). There was evidence of a lifestyle-genetics interaction for stroke (p = 0.017). Unfavourable lifestyle behaviours predicted higher risk of all-cause mortality, CVD mortality, MI and stroke, independent of genetic risk.     

Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People

Later life changes in body weight may be associated with an increased risk of mortality in older adults. The objective of this study was to examine whether weight change over four years was associated with a 17-year mortality risk in older adults. Participants were 1664 community-dwelling adults aged ≥65 years in the longitudinal Enquete de Sante’ Psychologique-Risques, Incidence et Traitement (ESPRIT) study. Outcomes were all-cause mortality, cardiovascular disease (CVD) and cancer mortality. Weight change was defined as difference between weight at baseline and 4 years, categorised into: weight stable (±<5% weight change), weight loss (≥5%) and weight gain (≥5%). Association between weight change and mortality risk was evaluated using Cox proportional hazards models. Over 17 years of follow-up (median 15 years), 565 participants died. Compared to stable weight participants, those with ≥ 5% weight loss had an increased risk of all-cause mortality (HR: 1.24, 95% CI: 1.00–1.56, p = 0.05) and CVD mortality (HR: 1.53, 95% CI: 1.10–2.14, p = 0.01), but not cancer mortality (HR: 0.83, 95% CI: 0.50–1.39, p = 0.49). Weight gain of ≥5% was not associated with increased mortality (HR: 1.05, 95% CI: 0.76–1.45, p = 0.74). Weight monitoring in older adults could help identify weight loss at its early stages to better target interventions to maintain nutritional reserve and prevent premature mortality.     

Intakes of Folate,Vitamin B6, and Vitamin B12 in Relation to All-Cause and Cause-Specific Mortality: A National Population-Based Cohort

The evidence regarding the intake of dietary folate, vitamin B6, and vitamin B12 in relation to mortality in the general population is limited. This study aimed to examine the relationship between dietary intakes of folate, vitamin B6, and vitamin B12 in relation to all-cause and cause-specific mortality in a large U.S. cohort. This study included a total of 55,569 adults from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999–2014. Vital data were determined by linking with the National Death Index records through 31 December 2015. Cox proportional hazards models were used to investigate the relationships of all-cause and cause-specific mortality with dietary folate, vitamin B6, and vitamin B12 intake. Dietary intakes of folate and vitamin B6 were inversely associated with mortality from all-cause, cardiovascular disease, and cancer for men and with mortality from all-cause and cardiovascular disease for women. In men, the multivariable hazard ratios (95% confidence intervals) for the highest versus lowest quintiles of folate and vitamin B6 were 0.77 (0.71–0.85) and 0.79 (0.71–0.86) for all-cause mortality, 0.59 (0.48–0.72) and 0.69 (0.56–0.85) for CVD mortality, and 0.68 (0.56–0.84) and 0.73 (0.60–0.90) for cancer mortality, respectively. Among women, the multivariable hazard ratios (95% confidence intervals) for the highest versus lowest quintiles of folate and vitamin B6 were 0.86 (0.78–0.95) and 0.88 (0.80–0.97) for all-cause mortality and 0.53 (0.41–0.69) and 0.56 (0.44–0.73) for CVD mortality, respectively. No significant associations between dietary vitamin B12 and all-cause and cause-specific mortality were observed. In conclusion, higher dietary intakes of folate and vitamin B6 were significantly associated with lower all-cause and cardiovascular mortality. Our findings suggest that increasing the intake of folate and vitamin B6 may lower the mortality risk among U.S. adults.     

Association of Adherence to the Mediterranean Diet with All-Cause Mortality in Subjects with Heart Failure

We investigated the associations of adherence to the Mediterranean diet with all-cause and cardiovascular mortality in patients with heart failure. We analyzed the National Health and Nutrition Examination Survey (NHANES) participants from 1999 to 2010, with their vital status confirmed through to the end of 2011. The alternate Mediterranean Diet Index (aMED) was used to assess study participants’ adherence to the Mediterranean diet according to information on dietary questionnaires. We conducted weighted Cox proportional hazards regression models to determine the associations of adherence to the Mediterranean diet (aMED ≥ median vs. <median) with all-cause and cardiovascular mortality in participants with a history of heart failure. A total of 832 participants were analyzed, and the median aMED was 3. After a median follow-up of 4.7 years, 319 participants had died. aMED ≥ 3 (vs. <3) was not associated with a lower risk of all-cause (adjusted HR 0.797, 95% CI 0.599–1.059, p = 0.116) and cardiovascular (adjusted HR 0.911, 95% CI 0.539–1.538, p = 0.724) mortality. The findings were consistent across several subgroup populations. Among the components of aMED, a lower intake of red/processed meat was associated with a higher risk of mortality (adjusted HR 1.406, 95% CI 1.011–1.955, p = 0.043). We concluded that adherence to the Mediterranean diet was not associated with a lower risk of all-cause and cardiovascular mortality in participants with a history of heart failure. The higher risk of mortality associated with a lower intake of red/processed meat deserves further investigation.     

Health Benefits of Daily Walking on Mortality Among Younger-Elderly Men With or Without Major Critical Diseases in the New Integrated Suburban Seniority Investigation Project: A Prospective Cohort Study

Background

Regular physical activity contributes to the prevention of cancer, cardiovascular disease, and other chronic diseases. However, the frequency of physical activity often declines with age, particularly among the elderly. Thus, we investigated the effects of daily walking on mortality among younger-elderly men (65–74 years) with or without major critical diseases (heart disease, cerebrovascular disease, or cancer).

Methods

We assessed 1239 community-dwelling men aged 64/65 years from the New Integrated Suburban Seniority Investigation Project. We estimated hazard ratios (HRs) of all-cause mortality and 95% confidence intervals (CIs) according to daily walking duration and adjusted for potential confounders, including survey year, marital status, work status, education, smoking and drinking status, BMI, regular exercise, regular sports, sleeping time, medical status, disease history, and functional capacity.

Results

For men without critical diseases, mortality risk declined linearly with increased walking time after adjustment for confounders (P _trend = 0.018). Walking ≥2 hours/day was significantly associated with lower all-cause mortality (HR 0.49; 95% CI, 0.27–0.90). For men with critical diseases, walking 1–2 hours/day showed a protective effect on mortality compared with walking <0.5 hours/day after adjustment for confounders (HR 0.29; 95% CI, 0.06–1.20). Walking ≥2 hours/day showed no benefit on mortality in men with critical diseases, even after adjustment for confounders.

Conclusions

Different duration of daily walking was associated with decreased mortality for younger-elderly men with or without critical diseases, independent of sociodemographic and lifestyle factors, BMI, medical status, disease history, and functional capacity. Incorporating regular walking into daily lives of younger-elderly men may improve longevity and successful aging.Key words: walking, mortality, younger elderly, secondary prevention     

Ultra-Processed Food Consumption and Adult Mortality Risk: A Systematic Review and Dose–Response Meta-Analysis of 207,291 Participants

We performed a systematic review and dose–response meta-analysis of observational studies assessing the association between UPF consumption and adult mortality risk. A systematic search was conducted using ISI Web of Science, PubMed/MEDLINE, and Scopus electronic databases from inception to August 2021. Data were extracted from seven cohort studies (totaling 207,291 adults from four countries). Using a random-effects model, hazard ratios (HR) of pooled outcomes were estimated. Our results showed that UPF consumption was related to an enhanced risk of all-cause mortality (HR = 1.21; 95% CI: 1.13, 1.30; I² = 21.9%; p < 0.001), cardiovascular diseases (CVDs)-cause mortality (HR = 1.50; 95% CI: 1.37, 1.63; I² = 0.0%; p < 0.001), and heart-cause mortality (HR = 1.66; 95% CI: 1.50, 1.85; I² = 0.0%; p = 0.022), but not cancer-cause mortality. Furthermore, our findings revealed that each 10% increase in UPF consumption in daily calorie intake was associated with a 15% higher risk of all-cause mortality (OR = 1.15; 95% CI: 1.09, 1.21; I² = 0.0%; p < 0.001). The dose–response analysis revealed a positive linear association between UPF consumption and all-cause mortality (P_nonlinearity = 0.879, P_{dose–response} = p < 0.001), CVDs-cause mortality (P_nonlinearity = 0.868, P_{dose–response} = p < 0.001), and heart-cause mortality (P_nonlinearity = 0.774, P_{dose–response} = p < 0.001). It seems that higher consumption of UPF is significantly associated with an enhanced risk of adult mortality. Despite this, further experimental studies are necessary to draw a more definite conclusion.     

Higher Intakes of Potassium and Magnesium,but Not Lower Sodium,Reduce Cardiovascular Risk in the Framingham Offspring Study

We explored the dose-response relations of sodium, potassium, magnesium and calcium with cardiovascular disease (CVD) risk in the Framingham Offspring Study, as well as the combined effects of these minerals. Analyses included 2362 30–64 year-old men and women free of CVD at baseline. Cox proportional-hazards models were used estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for mineral intakes and incident CVD. Cox models with restricted cubic spline functions were used to examine dose-response relations, adjusting for confounding by age, sex, body mass index, dietary fiber intake, and time-varying occurrence of hypertension. Lower sodium intake (<2500 vs. ≥3500 mg/d) was not associated with a lower risk of CVD. In contrast, potassium intake ≥3000 (vs. <2500) mg/d was associated with a 25% lower risk (95% CI: 0.59, 0.95), while magnesium intake ≥320 (vs. <240) mg/d led to a 34% lower risk (95% CI: 0.51, 0.87) of CVD. Calcium intake ≥700 (vs. <500) mg/d was associated with a non-statistically significant 19% lower risk. Restricted cubic spline curves showed inverse dose-response relations of potassium and magnesium with CVD risk, but no such associations were observed for sodium or calcium. These results highlight the importance of potassium and magnesium to cardiovascular health.     

Association of Walnut Consumption with Total and Cause-Specific Mortality and Life Expectancy in U.S. Adults

Walnut consumption is associated with health benefits. We aimed to (1) examine the association between walnut consumption and mortality and (2) estimate life expectancy in relation to walnut consumption in U.S. adults. We included 67,014 women of the Nurses’ Health Study (1998–2018) and 26,326 men of the Health Professionals Follow-up Study (1998–2018) who were free of cancer, heart disease, and stroke at baseline. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During up to 20 years of follow-up, we documented 30,263 deaths. The hazard ratios for total mortality across categories of walnut intake (servings/week), as compared to non-consumers, were 0.95 (95% confidence interval (CI), 0.91, 0.98) for <1 serving/week, 0.94 (95% CI, 0.89, 0.99) for 1 serving/week, 0.87 (95% CI, 0.82, 0.93) for 2–4 servings/week, and 0.86 (95% CI, 0.79, 0.93) for >=5 servings/week (p for trend <0.0001). A greater life expectancy at age 60 (1.30 years in women and 1.26 years in men) was observed among those who consumed walnuts more than 5 servings/week compared to non-consumers. Higher walnut consumption was associated with a lower risk of total and CVD mortality and a greater gained life expectancy among U.S. elder adults.     

Low Circulating Concentrations of Very Long Chain Saturated Fatty Acids Are Associated with High Risk of Mortality in Kidney Transplant Recipients

Kidney transplant recipients (KTR) are at increased risk of mortality, particularly from infectious diseases, due to lifelong immunosuppression. Although very long chain saturated fatty acids (VLSFA) have been identified as crucial for phagocytosis and clearance of infections, their association with mortality in immunocompromised patient groups has not been studied. In this prospective cohort study we included 680 outpatient KTR with a functional graft ≥1 year and 193 healthy controls. Plasma VLSFA (arachidonic acid (C20:0), behenic acid (C22:0) and lignoceric acid (C24:0)) were measured by gas chromatography coupled with a flame ionization detector. Cox regression analyses was used to prospectively study the associations of VLSFA with all-cause and cause-specific mortality. All studied VLSFA were significantly lower in KTR compared to healthy controls (all p < 0.001). During a median (interquartile range) follow-up of 5.6 (5.2–6.3) years, 146 (21%) KTR died, of which 41 (28%) died due to infectious diseases. In KTR, C22:0 was inversely associated with risk of all-cause mortality, with a HR (95% CI) per 1-SD-increment of 0.79 (0.64–0.99), independent of adjustment for potential confounders. All studied VLSFA were particularly strongly associated with mortality from infectious causes, with respective HRs for C20:0, C22:0 and C24:0 of 0.53 (0.35–0.82), 0.48 (0.30–0.75), and 0.51 (0.33–0.80), independent of potential confounders. VLSFA are inversely associated with infectious disease mortality in KTR after adjustment, including HDL-cholesterol. Further studies are needed to assess the effect of VLSFA-containing foods on the risk of infectious diseases in immunocompromised patient groups.     

Association between Dietary Diversity and All-Cause Mortality: A Multivariable Model in a Mediterranean Population with 18 Years of Follow-Up

We evaluated the relationship between the dietary diversity score (DDS) and all-cause, CVD and cancer mortality in an adult Mediterranean population. We analyzed the data of 1540 participants from the Valencia Nutrition Survey. The DDS was estimated using a validated food frequency questionnaire and was categorized into quartiles (Q), where the first quartile indicates the lowest dietary diversity. Deaths were ascertained during an 18-year follow-up period. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). There were 403 deaths during the follow-up period (40% due to CVD). An inverse association was observed between the DDS and all-cause and CVD mortality. Compared with participants in the lowest DDS quartile (Q1), participants in the highest DDS quartile (Q4) showed 32% and 45% less risk of death for all-cause and CVD mortality, in sex- and age-adjusted models, respectively. Regarding the food groups in the DDS, an inverse association was identified between total vegetable consumption diversity and all-cause and CVD mortality in the highest quartiles, (Q3 vs. Q1, HR: 0.70; 95% CI: 0.50, 0.99) and (Q4 vs. Q1, HR: 0.52; 95% CI: 0.30, 0.91), respectively. This study suggests that a higher diversity in food intake, particularly in vegetables, may be associated with a lower risk of all-cause and CVD mortality. This association should be further investigated in other wider populations.     

The Association between Dietary Purine Intake and Mortality: Evidence from the CHNS Cohort Study

Objectives: To investigate the association between dietary purine intake and mortality among Chinese adults. Methods: Based on data from the 2004–2015 China Health and Nutrition Survey (CHNS) and the corresponding edition of China Food Composition, the average purine intake per day (mg/day) from 2004 to 2011 was calculated, and the surveyed population was divided into five groups by quintiles. The outcome event and timepoint of concern were defined as death and time, respectively, as reported by family members, recorded until the 2015 survey. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) for death. The possibly nonlinear relationship between purine intake and mortality was examined with restricted cubic splines. Results: We included 17,755 subjects, and the average purine intake among them was 355.07 ± 145.32 mg/day. Purine intake was inversely associated with mortality (P_trend < 0.001). Compared with the lowest quintiles of purine intake, the highest quintiles (HR = 0.60; 95% CI: 0.46, 0.77) showed a significant association with lower mortality. The negative association with mortality was mainly found in plant-derived purine (P_trend = 0.001) and, weakly, in animal-derived purine (P_trend = 0.052). In addition, a U-shaped relationship between purine intake and mortality was observed in males; however, there was no statistically significant dose–response relationship in females. Conclusion: Considering the low-purine-intake levels of the Chinese population, we observed a U-shaped relationship between purine intake and mortality in males, but purine intake may not relate to mortality in females. Future studies should investigate the causal relationship between purine intake and disease burden in China.     

Association of Sugar-Sweetened Beverages and Cardiovascular Diseases Mortality in a Large Young Cohort of Nearly 300,000 Adults (Age 20–39)

(1) Background: The association of sugar-sweetened beverages (SSBs) with cardiovascular disease (CVD) mortality in younger adults (age 20–39) is rarely mentioned in the literature. Younger adults are less vulnerable to CVDs, but they tend to consume more SSBs. This prospective study aimed to assess the association between CVD mortality and SSBs in younger adults between 1994 and 2017. (2) Methods: The cohort enrolled 288,747 participants consisting of 139,413 men and 148,355 women, with a mean age 30.6 ± 4.8 years, from a health surveillance program. SSBs referred to any drink with real sugar added, such as fructose corn syrup or sucrose. One serving of SSB contains about 150 Kcal of sugar in 12 oz of drink. Cox models were used to estimate the mortality risk. (3) Results: There were 391 deaths from CVDs in the younger adults, and the positive association with CVD mortality started when SSB intake was ≥2 servings/day (HR: 1.59, 95% CI: 1.16–2.17). With mortalities from diabetes and kidney disease added to CVDs, the so-called expanded CVD mortality risk was 1.49 (95% CI: 1.11–2.01). By excluding CVD risk factors (hypertension, diabetes, and smoking), the CVD mortality risk increased to 2.48 (95% CI: 1.33–4.62). The dose–response relationship persisted (p < 0.05 for trend) in every model above. (4) Conclusions: Higher intake of SSBs (≥2 servings/day) was associated with increased CVD mortality in younger adults. The younger adults (age 20–39) with SSB intake ≥2 servings/day had a 50% increase in CVD mortality in our study, and the mortality risk increased up to 2.5 times for those without CVD risk factors. The dose–response relationship between the quantity of SSB intake and the mortality risk of CVD in younger adults discourages SSB intake for the prevention of CVD mortality.     

Association between Milk Intake and All-Cause Mortality among Chinese Adults: A Prospective Study

Background: Little is known about the effect of milk intake on all-cause mortality among Chinese adults. The present study aimed to explore the association between milk intake and all-cause mortality in the Chinese population. Methods: Data from 1997 to 2015 of the China Health and Nutrition Survey (CHNS) were used. A total of 14,738 participants enrolled in the study. Dietary data were obtained by three day 24-h dietary recall. All-cause mortality was assessed according to information reported. The association between milk intake and all-cause mortality were explored using Cox regression and further stratified with different levels of dietary diversity score (DDS) and energy intake. Results: 11,975 (81.25%) did not consume milk, 1341 (9.10%) and 1422 (9.65%) consumed 0.1–2 portions/week and >2 portions/week, respectively. Milk consumption of 0.1–2 portions/week was related to the decreased all-cause mortality (HR: 0.59, 95% CI: 0.41–0.85). In stratified analysis, consuming 0.1–2 portions/week was associated with decreased all-cause mortality among people with high DDS and energy intake. Conclusions: Milk intake is low among Chinese adults. Consuming 0.1–2 portions of milk/week might be associated with the reduced risk of death among Chinese adults by advocating health education. Further research is required to investigate the relationships between specific dairy products and cause-specific mortality.     

Association of Serum Vitamin B6 with All-Cause and Cause-Specific Mortality in a Prospective Study

There is little evidence regarding the association between serum vitamin B6 concentration and subsequent mortality. We aimed to evaluate the association of serum vitamin B6 concentration with all-cause, cardiovascular disease (CVD), and cancer mortality in the general population using data from the National Health and Nutrition Examination Survey (NHANES). Our study examined 12,190 adults participating in NHANES from 2005 to 2010 in the United States. The mortality status was linked to National Death Index (NDI) records up to 31 December 2015. Pyridoxal 5′-phosphate (PLP) is the biologically active form of vitamin B6. Vitamin B6 status was defined as deficient (PLP < 20 nmol/L), insufficient (PLP ≥ 20.0 and <30.0 nmol/L), and sufficient (PLP ≥ 30.0 nmol/L). We established Cox proportional-hazards models to estimate the associations of categorized vitamin B6 concentration and log-transformed PLP concentration with all-cause and cause-specific mortality by calculating hazard ratios (HRs) and 95% confidence intervals (95%CIs). In our study, serum vitamin B6 was sufficient in 70.6% of participants, while 12.8% of the subjects were deficient in vitamin B6. During follow-up, a total of 1244 deaths were recorded, including 294 cancer deaths and 235 CVD deaths. After multivariate adjustment in Cox regression, participants with higher serum vitamin B6 had a 15% (HR = 0.85, 95%CI = 0.77, 0.93) reduced risk of all-cause mortality and a 19% (HR = 0.81, 95%CI = 0.68, 0.98) reduced risk for CVD mortality for each unit increment in natural log-transformed PLP. A higher log-transformed PLP was not significantly associated with a lower risk for cancer mortality. Compared with sufficient vitamin B6, deficient (HR = 1.37, 95%CI = 1.17, 1.60) and insufficient (HR = 1.19, 95%CI = 1.02, 1.38) vitamin B6 level were significantly associated with a higher risk for all-cause mortality. There was no significant association for cause-specific mortality. Participants with higher levels of vitamin B6 had a lower risk for all-cause mortality. These findings suggest that maintaining a sufficient level of serum vitamin B6 may lower the all-cause mortality risk in the general population.     

Relationship Between Non-fasting Triglycerides and Cardiovascular Disease Mortality in a 20-year Follow-up Study of a Japanese General Population: NIPPON DATA90

BackgroundNon-fasting triglycerides (TG) are considered a better predictor of cardiovascular disease (CVD) than fasting TG. However, the effect of non-fasting TG on fatal CVD events remains unclear. In the present study, we aimed to explore the relationship between non-fasting TG and CVD mortality in a Japanese general population.MethodsA total of 6,831 participants without a history of CVD, in which those who had a blood sampling over 8 hours or more after a meal were excluded, were followed for 18.0 years. We divided participants into seven groups according to non-fasting TG levels: ≤59 mg/dL, 60–89 mg/dL, 90–119 mg/dL, 120–149 mg/dL, 150–179 mg/dL, 180–209 mg/dL, and ≥210 mg/dL, and estimated the multivariable-adjusted hazard ratios (HRs) of each TG group for CVD mortality after adjusting for potential confounders, including high density lipoprotein cholesterol. Additionally, we performed analysis stratified by age <65 and ≥65 years.ResultsDuring the follow-up period, 433 deaths due to CVD were detected. Compared with a non-fasting TG of 150–179 mg/dL, non-fasting TG ≥210 mg/dL was significantly associated with increased risk for CVD mortality (HR 1.56: 95% CI, 1.01–2.41). Additionally, lower levels of non-fasting TG were also significantly associated with increased risk for fatal CVD. In participants aged ≥65 years, lower levels of non-fasting TG had a stronger impact on increased risk for CVD mortality, while higher levels of non-fasting TG had a stronger impact in those aged <65 years.ConclusionIn a general Japanese population, we observed a U-shaped association between non-fasting TG and fatal CVD events.Key words: non-fasting triglyceride, cardiovascular disease, mortality, general population, Japan