The effect of dietary cholesterol consumption on health effects and serum lipids remains controversial. This study aimed to examine the association of dietary cholesterol trajectories over 14 years in China with the risk of cardio-metabolic diseases and all-cause mortality and serum lipids.
This study used weighted longitudinal data of 8952 adults from the China Health and Nutrition Survey, and subgroup analyses included 5466 adults who provided blood samples. Latent class trajectory modelling was performed to examine cholesterol trajectories. Cox regression models and general linear regressions were performed to examine the association between trajectories and outcomes.
Compared to the participants with persistently low dietary cholesterol intake, participants with gradually increasing cholesterol intake throughout adulthood were more likely to have hypertension (HR = 1.14, 95% CI: 1.03, 1.28) and to die due to all causes (HR = 2.19, 95% CI: 1.57, 3.05). Moreover, participants with persistently high cholesterol intake were more likely to die due to all causes (HR = 2.26, 95% CI 1.47, 3.47). The total cholesterol (TC):HDL-cholesterol (HDL-C) ratio and apolipoprotein B (ApoB) in these two groups were also significantly elevated compared to the group with persistently low dietary cholesterol intake (all P < 0.05). An association between trajectories of cholesterol and the incidence of diabetes was also observed; however, such an association became non significant after additional adjustment for other nutrients, food consumption and social environment.
Gradually increasing or persistently high cholesterol consumption throughout adulthood was significantly associated with an increased risk of hypertension and all-cause mortality with elevated serum lipids.
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Castelli WP. Epidemiology of coronary heart disease: the Framingham study. Am J Med. 1984;76:4–12.
Martin MJ, Hulley SB, Browner WS, Kuller LH, Wentworth D. Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361,662 men. Lancet. 1986;2:933–6.
Castelli WP, Garrison RJ, Wilson PW, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA. 1986;256:2835–8.
Klag MJ, Ford DE, Mead LA, He J, Whelton PK, Liang KY, et al. Serum cholesterol in young men and subsequent cardiovascular disease. N Engl J Med. 1993;328:313–8.
Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000;284:311–8.
Howell WH, McNamara DJ, Tosca MA, Smith BT, Gaines JA. Plasma lipid and lipoprotein responses to dietary fat and cholesterol: a meta analysis. Am J Clin Nutr. 1997;65:1747–64.
Nissinen MJ, Gylling H, Miettinen TA. Responses of surrogate markers of cholesterol absorption and synthesis to changes in cholesterol metabolism during various amounts of fat and cholesterol feeding among healthy men. Br J Nutr. 2008;99:370–8.
McGee DL, Reed DM, Yano K, Kagan A, Tillotson J. Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to nutrient intake. Am J Epidemiol. 1984;119:667–76.
Shekelle RB, Stamler J. Dietary cholesterol and ischaemic heart disease. Lancet. 1989;1:1177–9.
Posner BM, Cobb JL, Belanger AJ, Cupples LA, D’Agostino RB, Stokes J III. Dietary lipid predictors of coronary heart disease in men. The Framingham Study. Arch Intern Med. 1991;151:1181–7.
Kromhout D, Menotti A, Bloemberg B, Aravanis C, Blackburn H, Buzina R, et al. Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study. Prev Med. 1995;24:308–15.
Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ. 1997;314:112–7.
Hegsted DM, McGandy RB, Myers ML, Stare FJ. Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr. 1965;17:281–95.
Keys A, Parlin RW. Serum cholesterol response to changes in dietary lipids. Am J Clin Nutr. 1966;19:175–81.
Hu YW, Zheng L, Wang Q. Regulation of cholesterol homeostasis by liver X receptors. Clin Chim Acta. 2010;411:617–25.
Lin EC, Fernandez ML, McNamara DJ. Dietary fat type and cholesterol quantity interact to affect cholesterol metabolism in guinea pigs. J Nutr. 1992;122:2019–29.
Berger S, Raman G, Vishwanathan R, Jacques PF, Johnson EJ. Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Am J Clin Nutr. 2015;102:276–94.
Lewington S, Thomsen T, Davidsen M, Sherliker P, Clarke R. Regression dilution bias in blood total and high-density lipoprotein cholesterol and blood pressure in the Glostrup and Framingham prospective studies. J Cardiovasc Risk. 2003;10:143–8.
Oza-Frank R, Cheng YJ, Narayan KM, Gregg EW. Trends in nutrient intake among adults with diabetes in the United States: 1988–2004. J Am Diet Assoc. 2009;109:1173–8.
Ramazauskiene V, Petkeviciene J, Klumbiene J, Kriaucioniene V, Sakytė E. Diet and serum lipids: changes over socio-economic transition period in Lithuanian rural population. BMC Public Health. 2011;11:447.
Su C, Jia X, Wang Z, Wang H, Zhang B. Trends in dietary cholesterol intake among Chinese adults: a longitudinal study from the China Health and Nutrition Survey, 1991–2011. BMJ Open. 2015;5:e007532.
National Bureau of Statistics of China. China Statistical Yearbook, 2012. Beijing, China: China Statistics Press; 2012.
Wang L. Summary report of China Nutrition and Health 2002. Beijing: People’s Medical Publishing House; 2005.
Ge K. The dietary and nutritional status of Chinese population (1992 National Nutrition Survey). Beijing: People’s Medical Publishing House; 1995.
Chen CM. Nutrition status of the Chinese people. Biomed Environ Sci. 1996;9:81–92.
Popkin BM, Du S, Zhai F, Zhang B. Cohort profile: The China Health and Nutrition Survey—monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol. 2010;39:1435–40.
Zhang B, Zhai FY, Du SF, Popkin BM. The China Health and Nutrition Survey, 1989–2011. Obes Rev. 2014;15:2–7.
Wang HJ, Wang ZH, Zhang JG, Du WW, Su C, Zhang J, et al. Trends in dietary fiber intake in Chinese aged 45 years and above, 1991–2011. Eur J Clin Nutr. 2014;68:619–22.
Yan S, Li J, Li S, Zhang B, Du S, Gordon-Larsen P, et al. The expanding burden of cardiometabolic risk in China: the China Health and Nutrition Survey. Obes Rev. 2012;13:810–21.
Ng SW, Howard AG, Wang HJ, Su C, Zhang B. The physical activity transition among adults in China: 1991-2011. Obes Rev. 2014;15:27–36.
Jones-Smith JC, Popkin BM. Understanding community context and adult health changes in China: development of an urbanicity scale. Soc Sci Med. 2010;71:1436–46.
Proust-Lima C, Phillips V, Liquet B. Estimation of extended mixed models using latent classes and latent processes: the R package lcmm. J Stat Softw. 2015;78:1–56.
Houston DK, Ding J, Lee JS, Garcia M, Kanaya AM, Tylavsky FA, et al. Dietary fat and cholesterol and risk of cardiovascular disease in older adults: the Health ABC Study. Nutr Metab Cardiovasc Dis. 2011;21:430–7.
Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA. 1999;281:1387–94.
Lin EC, Fernandez ML, Tosca MA, McNamara DJ. Regulation of hepatic LDL metabolism in the guinea pig by dietary fat and cholesterol. J Lipid Res. 1994;35:446–57.
Lin EC, Fernandez ML, McNamara DJ. High density lipoprotein metabolism is altered by dietary cholesterol but not fat saturation in guinea pigs. Atherosclerosis. 1995;112:161–75.
Weggemans RM, Zock PL, Katan MB. Dietary cholesterol from eggs increases the ratio of total cholesterol to high-density lipoprotein cholesterol in humans: a meta-analysis. Am J Clin Nutr. 2001;73:885–91.
Kannel WB, Castelli WP, Gordon T, McNamara PM. Serum cholesterol, lipoproteins, and the risk of coronary heart disease. The Framingham study. Ann Intern Med. 1971;74:1–12.
DIAMOND Project Group. Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Diabet Med. 2006;23:857–66.
We thank the CHNS team based in the Carolina Population Centre.
This research was supported by funds from the National Key R&D Programme of China (2017YFC1307401 to CS) and the Open Research Fund for Top Disciplines of Public Health and Preventive Medicine at Ningxia Medical University (30181302 to YL).
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The authors declare that they have no conflict of interest.
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Hou, W., Yu, X., Fan, X. et al. The association of 14-year dietary cholesterol trajectories with the risk of cardio-metabolic diseases, all-cause mortality and serum lipids. Eur J Clin Nutr 75, 283–290 (2021). https://doi.org/10.1038/s41430-020-00825-x