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The association of 14-year dietary cholesterol trajectories with the risk of cardio-metabolic diseases, all-cause mortality and serum lipids



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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Fig. 1: Trajectories of cholesterol consumption in CHNS (n = 8952).


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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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All authors made a significant contribution to this article. CHS and YL planned the work. WYH and XXF carried out the statistical analysis. WYH, HYL, XYY and IS wrote and reported the work. ZHJ, YW and YZ played a critical role in revising the paper. All authors critically assessed and reviewed the paper and approved the version to be published. CHS and YL are responsible for the overall content as guarantors.

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Correspondence to Changhao Sun or Ying Li.

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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).

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