The associations between healthful and unhealthful plant-based dietary patterns and all-cause mortality among older Chinese adults with data-adapted early-stage cardiovascular-kidney-metabolic syndrome (stages 0–2): a prospective cohort study from the CLHLS

@article{zhang2026associations,
  title = {{The associations between healthful and unhealthful plant-based dietary patterns and all-cause mortality among older Chinese adults with data-adapted early-stage cardiovascular-kidney-metabolic syndrome (stages 0–2): a prospective cohort study from the CLHLS}},
  author = {Shipeng Zhang and Enjie Tang and Yanjie Jiang and Kun Zhu and Xiulian Zhuang and Hanyu Wang and Xingyi He and Yan Lu and Qinxiu Zhang and Xueying Li and Jiaqing Song},
  journal = {Frontiers in nutrition},
  year = {2026},
  month = oct,
  doi = {10.3389/fnut.2026.1915953},
  url = {https://europepmc.org/article/PMC/PMC13721378},
  note = {CC BY},
}

TY  - JOUR
TI  - The associations between healthful and unhealthful plant-based dietary patterns and all-cause mortality among older Chinese adults with data-adapted early-stage cardiovascular-kidney-metabolic syndrome (stages 0–2): a prospective cohort study from the CLHLS
AU  - Shipeng Zhang
AU  - Enjie Tang
AU  - Yanjie Jiang
AU  - Kun Zhu
AU  - Xiulian Zhuang
AU  - Hanyu Wang
AU  - Xingyi He
AU  - Yan Lu
AU  - Qinxiu Zhang
AU  - Xueying Li
AU  - Jiaqing Song
PY  - 2026
DA  - 2026/10/16
JO  - Frontiers in nutrition
DO  - 10.3389/fnut.2026.1915953
UR  - https://europepmc.org/article/PMC/PMC13721378
AB  - Aims: To examine the associations of the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) with all-cause mortality in older Chinese adults with data-adapted early-stage cardiovascular-kidney-metabolic (CKM) syndrome (stages 0–2).  Methods and results: We analyzed data from 5,872 participants aged ≥65 years from the 2008 wave of the China Longitudinal Healthy Longevity Survey (CLHLS) with data-adapted CKM stages 0–2 and no prevalent cardiovascular disease. Dietary intake was assessed using a validated food frequency questionnaire. Mortality was ascertained through March 2019. Cox proportional hazards models and restricted cubic spline analyses were used. During a median follow-up of 108 months, 2,870 deaths occurred. In multivariable-adjusted models, each 1-point increase in hPDI was associated with a 1.1% lower mortality risk (HR = 0.989, 95% CI: 0.982–0.995; p < 0.001), whereas each 1-point increase in uPDI was associated with a 1.2% higher mortality risk (HR = 1.012, 95% CI: 1.006–1.019; p < 0.001). Compared with the lowest quartile, the highest hPDI quartile had a 13.2% lower mortality risk (HR = 0.868, 95% CI: 0.783–0.961), and the highest uPDI quartile had a 19.2% higher risk (HR = 1.192, 95% CI: 1.060–1.340). Stratified estimates suggested numerically stronger associations in CKM stages 1–2 than in stage 0; however, formal interaction tests did not reach statistical significance (p = 0.062 for hPDI and p = 0.824 for uPDI), indicating limited evidence of effect modification.  Conclusion: Higher adherence to a healthful plant-based diet was associated with lower all-cause mortality, whereas higher adherence to an unhealthful plant-based diet was associated with higher mortality among older Chinese adults with data-adapted early-stage CKM syndrome. The overall PDI was not independently associated with mortality after adjustment, underscoring that plant-based dietary quality, rather than plant-based eating per se, is the relevant exposure.
SN  - 2296-861X
ER  -