Dietary patterns and cardiovascular disease risk among Chinese adults: a prospective cohort study

Background and objective We aimed to examine the prospective association between dietary patterns and cardiovascular disease (CVD) risk in Chinese adults. Methods Adults aged >= 20 years in the China Health and Nutrition Survey (open cohort) were followed between 1991 and 2011. Participants may enter the cohort at any wave. Dietary intakes were obtained from a 3-day, 24-h recall combined with household weighing for oil and condiments. CVD was defined as having either myocardial infarction or stroke. Two sets of dietary patterns were derived using reduced rank regression and factor analysis. Iron-related dietary pattern (IDP) was generated using iron intake as a response variable. Multivariable Cox regression was used to analyse the relation between dietary patterns and CVD risk. Results In total, 13,055 adults were followed for a median of 9 years. During 115,368 person years of follow-up, 502 participants developed CVD. Two dietary patterns were derived and labeled as traditional dietary pattern (high intake of rice, pork, fish, poultry, and fresh vegetable but low intake of wheat) and modern dietary pattern (high intake of fruit, soymilk, and fast food). Across the quartiles of intake, the hazard ratio (95% CI) for CVD were 1.0, 0.84 (0.64-1.10), 0.57 (0.42-0.77), and 0.58 (0.42-0.79) for traditional pattern (p for trend <0.001) and 1.0, 1.56 (1.16-2.09), 1.56 (1.13-2.14), and 1.68 (1.16-2.44) (p for trend = 0.118) for modern pattern. IDP was characterised by high intake of fresh vegetable, wheat, legume, beverage, offal, rice, and whole grain. IDP intake was not associated CVD. Comparing extreme quartiles, high rice intake was associated with halved while wheat intake was associated with a doubled risk of CVD. Conclusions Traditional dietary pattern and rice intake are inversely but modern dietary pattern and wheat is directly associated with CVD risk. IDP is not related to CVD in Chinese adults.