Eastern Diet - A Healthful Dietary Pattern from Eastern China: Its Characteristics and Relation to Adiposity, Cardiometabolic Diseases, Mortality and Gut Microbiota

Abstract

AbstractBackgroundThe dietary pattern along the downstream of the Yangtze River in Eastern China has garnered widespread attention for its potential health benefits; however, population-based evidence is limited. This study aimed to identify and characterize this dietary pattern, develop a dietary pattern index, and evaluate its associations with adiposity, cardiometabolic diseases, mortality, and gut microbiota.MethodsThis study included 8,852 adults aged 18-80 from the WELL-China cohort in Hangzhou, Eastern China, between 2016 to 2019. Dietary intake was assessed using a validated food frequency questionnaire. We adopted K-means clustering to identify the Eastern Diet (EastDiet) pattern within the study population and developed a dietary index to quantify adherence to the EastDiet. Adiposity was characterized by total and regional fat measured via dual-energy x-ray absorptiometry. Incident cardiometabolic diseases were documented through October 2022. In addition, we extrapolated the EastDiet index to a nationwide representative cohort of old individuals, including 13,773 participants of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), followed from 2008 to 2018. Linear regression and Cox proportional models were used to assess the associations of the EastDiet index with the study outcomes.ResultsIn the WELL-China, we identified an EastDiet pattern emphasizing high consumption of plant-based foods and low consumption of refined grains and red meat, aligning with previously reported healthy eating habits in Eastern China. The EastDiet index was constructed based on intake levels of 12 food groups. Higher EastDiet adherence was significantly associated with lower level of overall adiposity (BMI and body fat percentage) and central adiposity (waist-hip ratio and android-gynoid fat ratio), reduced incident cardiometabolic diseases (HRhighv.s,low= 0.65, 95% CI: 0.43-0.97), and higher gut microbial diversity and abundance of beneficial genera. In the CLHLS, individuals living in the eastern regions had higher EastDiet index scores compared to other regions of China. Higher EastDiet adherence was also associated with decreased mortality.ConclusionHigher adherence to the EastDiet was associated with more favorable cardiometabolic outcomes, reduced mortality risk, and improved diversity and taxonomy of gut microbiota. These findings support that the EastDiet identified in this study, could be considered an important healthy dietary pattern for Chinese adults.