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