Adherence to a traditional Chinese diet and its association with non-communicable diseases and mortality: results from the China Health and Nutrition Survey

Background and objectives:
Two-thirds of deaths were related to non-communicable diseases (NCDs).
Traditional diets may reduce the risk of NCDs. This study aimed to firstly
investigate the impact of adherence to the traditional Chinese diet (TCD) on NCDs and all-cause mortality.

Methods:
This study utilised data from the China Health and Nutrition Survey, a prospective cohort study conducted across multiple waves, with data collected between 1997 and 2011 selected for analysis. Eligible participants were aged 18 to 74 years, had participated in at least two survey waves, and had no known NCDs at baseline. Adherence to the TCD was assessed using a recently developed TCD index, based on three 24-hour recall data collected within this cohort. Outcomes included obesity, central obesity, hypertension, diabetes, cancers, cardiovascular diseases (CVDs), and all-cause mortality. Multilevel logistic regression models were used to analyse the longitudinal associations between TCD adherence and NCD-related outcomes; multivariable Cox regression was utilised to assess the relationship between TCD adherence and all-cause mortality.

Results:
A total of 11,158 adults were followed for a median of nine years. In the fully adjusted analysis, high TCD adherence, compared to the low adherence group, was associated with higher odds of obesity (OR:1.19, 95%CI:1.08-1.38) and central obesity (OR:1.19, 95%CI:1.12-1.26), but lower odds of CVDs (OR:0.73, 95%CI:0.91-0.87). Additionally, in the adjusted multivariable model, high, compared to low, TCD adherence was associated with a reduced risk of all-cause mortality (HR:0.73, 95%CI:0.63-0.87).

Conclusions:
High TCD adherence was associated with reduced risk of CVDs and all-cause mortality, but with higher odds of obesity and central obesity.