Abstract
Serum uric acid (SUA) and apolipoprotein B (apoB) are markers of the risk of morbidity and mortality. However, no study has investigated their role, simultaneously with nutritional factors, on the risk of mortality. We calculated the dietary uricaemia score (DUS) and the dietary atherogenic score (DAS) and evaluated their associations with the risk of all-cause and cause-specific mortality. Data from the NHANES 1999–2010 study were used. Vital status through the 31 December 2011 was ascertained. Reduced rank regression models followed by stepwise linear regression analyses were applied on 39 macro/micronutrients to identify a dietary pattern most predictive of SUA (DUS) and apoB (DAS). Overall, 20,256 participants were included (mean age: 47.5 years; 48.7% men). DUS consists of 14 contributors (eight positive, six negative), whereas DAS consists of 23 contributors (six positive, 17 negative). An increasing risk of cause-specific mortality was found across the quartiles (Q) of DUS, i.e., participants with the highest score of DUS (Q4) had a greater risk of all-cause (hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.07–1.30), cardiovascular disease (CVD) (HR: 1.36, 95%CI: 1.21–1.59) and cancer (HR: 1.06, 95%CI: 1.01–1.14) mortality compared with Q1. Similarly, participants at the highest DAS quartile had 25, 40 and 11% greater risk of all-cause, CVD and cancer mortality, respectively, compared with Q1. For the first time, we reported an underlying shared link between two atherosclerosis factors (SUA and apoB) and nutrients, as well as their joint adverse impact on all-cause and cause-specific mortality.
Highlights
Non-communicable diseases (NCDs), mainly cardiovascular disease (CVD), stroke, cancer, diabetes and chronic respiratory disease, are an increasing cause of morbidity and mortality worldwide [1].Worldwide, regardless of gender, age or membership of social group, the spread of NCDs is a globalNutrients 2019, 11, 2323; doi:10.3390/nu11102323 www.mdpi.com/journal/nutrientsNutrients 2019, 11, 2323 crisis [2]
In 2017, in papers authored by Jannasch et al and Perez-Martinez et al, have shown that the Mediterranean diet reduces the risk of type 2 diabetes, cancer incidence, as well as CVD [5,6]
Using data from the National Health and Nutrition Examination Survey (NHANES) database, we prospectively evaluated the associations of two empirical hypothesis-oriented dietary indices that represent diets with increased uricaemia and atherogenic risk, with all-cause/cause-specific mortality
Summary
Non-communicable diseases (NCDs), mainly cardiovascular disease (CVD), stroke, cancer, diabetes and chronic respiratory disease, are an increasing cause of morbidity and mortality worldwide [1].Worldwide, regardless of gender, age or membership of social group, the spread of NCDs is a globalNutrients 2019, 11, 2323; doi:10.3390/nu11102323 www.mdpi.com/journal/nutrientsNutrients 2019, 11, 2323 crisis [2]. Non-communicable diseases (NCDs), mainly cardiovascular disease (CVD), stroke, cancer, diabetes and chronic respiratory disease, are an increasing cause of morbidity and mortality worldwide [1]. According to the World Health Organization (WHO), 71% of deaths worldwide are caused by NCDs annually (approximately 41 million) of which >43% (17.9 million people) are caused by CVD. It is worth adding that, according to the WHO, nine million people die from cancer every year, respiratory diseases contribute 3.9 million deaths, and diabetes 1.6 million deaths annually [3]. Dietary risk factors contribute to mortality and morbidity from NCDs [4]; food consumption in developed countries is dominated by unhealthy diets [2]. In 2017, in papers authored by Jannasch et al and Perez-Martinez et al, have shown that the Mediterranean diet reduces the risk of type 2 diabetes, cancer incidence, as well as CVD [5,6]
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