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Plant-based dietary patterns in relation to mortality among older adults in China

Nature Aging volume 2, pages 224–230 (2022)Cite this article

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Abstract

A plant-based dietary pattern has been recommended for its potential health and environmental benefits, but its relation to mortality warrants further exploration1. We examined this association among 13,154 adults aged 65 years and older (57.4% female) in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The overall plant-based diet index (PDI), healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI) were calculated using dietary data collected by a simplified food frequency questionnaire (FFQ). Compared with the lowest quintile, participants in the highest quintile of PDI and hPDI had a decreased risk of all-cause mortality (hazard ratio (HR) = 0.92; 95% confidence interval (CI) 0.86, 0.98 for PDI; HR = 0.81, 95% CI, 0.76, 0.87 for hPDI), whereas participants with the highest uPDI scores had a 17% (95% CI, 9%, 26%) increased risk. Among plant foods, fresh fruits, fresh vegetables, legumes, garlic, nuts and tea were the main protective contributors, whereas preserved vegetables and sugar were associated with a higher risk of mortality. These findings support the beneficial roles of overall and healthful plant-based dietary patterns. The quality, and not only quantity, of plant foods should be emphasized in relevant public health recommendations.

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Fig. 1: HRs and 95% CIs for all-cause mortality, according to continuous plant-based diet indices (n = 13,154).
Fig. 2: HRs and 95% CI for all-cause mortality per 10-unit increment in adherence to plant-based diet indices, stratified by selected characteristics (n = 13,154).

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Data availability

Data described in this paper are stored in the Peking University Open Research Data Platform, a public data repository (https://opendata.pku.edu.cn/dataset.xhtml?persistentId=doi:10.18170/DVN/WBO7LK).

Code availability

The code scripts used in this analysis are available from the corresponding authors upon reasonable request.

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Acknowledgements

This work was supported by Fundamental Research Funds from the Central Universities of Zhejiang University (X.W. and C. Y.). The collection of the CLHLS datasets analyzed in this paper was jointly supported by the National Key R&D Program of China (2018YFC2000400), the National Natural Sciences Foundation of China (72061137004), the National Institute on Aging of the National Institutes of Health (P01AG031719) and Duke/Duke-NUS (grant RECA(Pilot)/2019/0051 to Y. Z.). The funders had no role in study design, data collection, analysis, decision to publish or manuscript preparation. We are grateful to all cooperating organizations and their staff during the CLHLS, whose hard work made this study possible. We thank the interviewees and their families for their voluntary participation in the CLHLS.

Author information

Author notes

  1. These authors contributed equally: Hui Chen, Jie Shen.

Authors and Affiliations

  1. School of Public Health, Zhejiang University School of Medicine, Hangzhou, China

    Hui Chen, Jie Shen & Changzheng Yuan

  2. China Academy for Rural Development, Department of Agricultural Economics and Management, Zhejiang University, Hangzhou, China

    Jiaqi Xuan & Xiaoxi Wang

  3. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany

    Anna Zhu

  4. Medical Faculty, Heidelberg University, Heidelberg, Germany

    Anna Zhu

  5. Vanke School of Public Health, Tsinghua University, Beijing, China

    John S. Ji

  6. Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, USA

    Xiaoran Liu

  7. CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China

    Yaying Cao & Geng Zong

  8. Center for Healthy Aging and Development Studies, Raissun Institute for Advanced Studies, National School of Development, Peking University, Beijing, China

    Yi Zeng

  9. Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, USA

    Yi Zeng

  10. Potsdam Institute for Climate Impact Research, Potsdam, Germany

    Xiaoxi Wang

  11. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Changzheng Yuan

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Contributions

C.Y., J.S.J., X.W., and H.C. designed the analysis; H.C. and A.Z. performed the statistical analyses; J.S., J.X., X.W., and X.L. interpreted the data; J.S. and H.C. drafted the manuscript; X.L., Y.C., X.W. and G.Z. critically reviewed and revised the manuscript; Y.Z. designed and administered the original CLHLS; C.Y. and X.W. supervised the data analysis and interpretation; and C.Y. had primary responsibility for the final content. All authors approved the final draft.

Corresponding authors

Correspondence to Xiaoxi Wang or Changzheng Yuan.

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The authors have no competing interests.

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Nature Aging thanks Zhangling Chen, Shankar Viswanathan and Paul Jacques for their contribution to the peer review of this work.

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Extended data figures and tables

Extended Data Fig. 1 The pairwise Spearman correlation coefficient between different food groups.

Pairwise Spearman correlation coefficients were presented.

Source data

Extended Data Fig. 2 Flow chart of participant inclusion.

Of a total of 16954 participants, 13154 eligible participants were included in the final analysis.

Supplementary information

Source data

Source Data Fig. 1

Source data for Fig. 1.

Source Data Fig. 2

Source data for Fig. 2.

Extended Data Fig. 1

Source data for Extended Data Fig. 1.

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Chen, H., Shen, J., Xuan, J. et al. Plant-based dietary patterns in relation to mortality among older adults in China. Nat Aging 2, 224–230 (2022). https://doi.org/10.1038/s43587-022-00180-5

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