Abstract P359: Dietary Patterns and Risk of All-Cause and Cause-Specific Mortality in Chinese Men and Women: The Singapore Chinese Health Study
Authors: Odegaard Andrew O , Koh Woon Puay , Yuan Jian-Min , Gross Myron D , Pereira Mark A 
Published: July 2021

Over the last half century dietary composition has been shown to have a clear role in the development of cardiovascular disease (CVD) and other conditions. Yet, research is limited on overall dietary patterns in relation to all-cause and cause-specific mortality, especially in non-western populations. We aimed to empirically derive dietary patterns and examine their association with all-cause and cause-specific mortality in men and women aged 45-74 enrolled in the Singapore Chinese Health Study from 1993 - 1998. We excluded those with a history of cancer, CVD and diabetes, as well as extreme caloric intakes, leaving 52,584 participants. Participants were followed through December 31, 2009 and 8,359 deaths were identified. Follow-up for mortality is considered virtually complete due to linkage with the national birth and death registry. Included in the baseline assessment was a 165-item food frequency questionnaire specifically developed for and validated in the study population. Two major dietary patterns were identified using principal components analysis; a vegetable, fruit, and soy rich pattern (VFS) and a dim sum and meat rich pattern (DSM). Pattern scores for each participant were calculated and examined with risk of mortality using Cox regression. The VFS dietary pattern with higher intake of vegetables, fruits, and soy foods was inversely associated with risk of death from CVD, cancer, respiratory diseases, and all-causes. The DSM dietary pattern with higher intake of dim sum, meat and processed meat, sweetened foods and beverages and fried foods was associated with a significantly increased risk of death from all causes as well as cause-specific deaths. There was no evidence these results differed by age, sex, education, smoking status, physical activity or BMI. These findings suggest population level shifts towards a more traditional and prudent dietary pattern would have significant impact on not only CVD mortality rates, but also mortality from cancer, respiratory diseases, and possibly other causes.

Hazard ratios and 95% confidence intervals of mortality due to cardiovascular disease, cancer, respiratory, and all causes in Chinese men and women according to quintile of dietary pattern score

Vegetable, fruit, and soy rich pattern

Q1

Q2

Q3

Q4

Q5

Type of Death

HR (95% CI)
HR (95% CI)
HR (95% CI)
HR (95% CI)

P Trend

All Cause
1.0
0.88 (0.83-0.93)
0.79 (0.74-0.85)
0.79 (0.74-0.85)
0.75 (0.70-0.81)
&#60;0.0001

CVD
1.0
0.86 (0.77-0.95)
0.73 (0.64-0.82)
0.78 (0.69-0.88)
0.67 (0.58-0.77)
&#60;0.0001

Cancer
1.0
0.96 (0.86-1.06)
0.87 (0.78-0.96)
0.88 (0.79-0.99)
0.84 (0.74-0.95)
0.001

Respiratory
1.0
0.74 (0.63-0.87)
0.75 (0.64-0.89)
0.68 (0.56-0.81)
0.66 (0.54-0.80)
&#60;0.0001

Dim sum and meat rich pattern

Type of Death

Q1

Q2

Q3

Q4

Q5

P Trend

All Cause
1.0
0.98 (0.92-1.04)
1.03 (0.96-1.10)
1.06 (0.99-1.14)
1.16 (1.07-1.26)
&#60;0.0001

CVD
1.0
0.99 (0.88-1.11)
1.04 (0.92-1.17)
1.10 (0.97-1.25)
1.23 (1.06-1.42)
0.003

Cancer
1.0
0.97 (0.87-1.08)
1.00 (0.90-1.12)
1.09 (0.98-1.23)
1.14 (1.00-1.29)
0.01

Respiratory
1.0
1.04 (0.88-1.22)
1.06 (0.89-1.26)
0.88 (0.72-1.06)
1.21 (0.99-1.49)
0.23

-Models adjusted for age, sex, dialect, education, marital status, smoking, physical activity, sleep, BMI and energy intake.

-Definition of outcomes: CVD (ICD-9 =394-459, N=2,626), Cancer (ICD-9=140-239, N=3,279), Respiratory (e.g. Influenza, pneumonia, COPD) (ICD-9=480-488, 490-96, N=1,289)