中国中老年人群膳食多样性评分与心血管代谢性共病关系研究

doi:10.12183/j.scjpm.2026.0791

摘要/Abstract

摘要： 目的基于中国健康与养老追踪调查（CHARLS）探讨中国中老年人群膳食多样性评分与心血管代谢性共病（CMM）的关系。方法基于CHARLS 2020年数据,采用横断面研究设计,纳入8 174名中老年人,依据CMM发生情况分为CMM组（n=3 268）和非CMM组（n=4 906）。通过多因素logistic回归、限制性立方样条（RCS）及城乡分层回归分析膳食多样性评分与CMM的关联。结果 8 174名中老年人膳食多样性评分为（8.50±4.56）分,其中低评分2 297人（28.10%）、中等4 165人（50.95%）、高1 712人（20.94%）。多因素logistic回归分析结果显示,年龄、性别、受教育程度、生活模式、体力活动水平、心血管疾病家族史、夜间睡眠时间及膳食多样性评分与CMM显著相关（均P<0.01）。RCS分析显示膳食多样性评分与CMM呈非线性剂量-反应关系。城乡分层分析显示,农村人群中低膳食多样性评分可增加CMM风险（OR=1.144,95% CI：1.014~1.290,P=0.029）;城市人群中二者关联强度减弱,仅高评分表现出轻微保护作用（OR=1.151,95% CI：1.003~1.321,P=0.046）。结论中国中老年人群膳食多样性评分与CMM显著相关,呈非线性关系,且存在城乡异质性,农村低膳食多样性人群CMM风险尤为突出。

关键词: 心血管代谢性共病, 中老年, 膳食多样性, 中国健康与养老追踪调查, 关系, 城乡差异

Abstract: Objective To investigate the association between the dietary diversity score (DDS) and cardiometabolic multimorbidity (CMM) among middle-aged and older populations in China, utilizing data from the China Health and Retirement Longitudinal Study (CHARLS). Methods A cross-sectional study design was employed using data from the 2020 wave of CHARLS. A total of 8 174 middle-aged and older adults were included and subsequently categorized into a CMM group (n=3 268) and a non-CMM group (n=4 906) based on the presence of cardiometabolic multimorbidity. The association between DDS and CMM was evaluated using multivariable logistic regression, restricted cubic splines (RCS), and urban-rural stratified regression analyses. Results The mean DDS among the 8 174 participants was 8.50 ± 4.56. The cohort was stratified by DDS into low (2 297 individuals, 28.10%), moderate (4 165 individuals, 50.95%), and high (1 712 individuals, 20.94%) dietary diversity categories. Multivariable logistic regression analysis demonstrated that age, sex, educational attainment, lifestyle patterns, physical activity levels, family history of cardiovascular disease, nocturnal sleep duration, and DDS were significantly associated with the prevalence of CMM (all P<0.01). RCS analysis revealed a nonlinear dose-response relationship between DDS and the risk of CMM. Urban-rural stratified analyses indicated that a low DDS was associated with an elevated risk of CMM among rural populations (OR=1.144, 95% CI: 1.014-1.290, P=0.029). Conversely, this association was attenuated in urban populations, where only a high DDS exhibited a marginal protective effect (OR=1.151, 95% CI: 1.003-1.321, P=0.046). Conclusion The dietary diversity score is significantly and nonlinearly associated with cardiometabolic multimorbidity among middle-aged and older adults in China. Furthermore, substantial urban-rural heterogeneity exists in this association, with the risk of CMM being particularly pronounced among rural populations exhibiting low dietary diversity.

Key words: Cardiometabolic multimorbidity, Middle aged and elderly, Dietary diversity, China Health and Retirement Longitudinal Study, Association, Urban-rural disparities

中图分类号:

R151.4

李青青, 雷浩浩, 吴冠吉, 麻强强. 中国中老年人群膳食多样性评分与心血管代谢性共病关系研究[J]. 华南预防医学, 2026, 52(7): 791-795.

Li Qingqing, Lei Haohao, Wu Guanji, Ma Qiangqiang. Association between dietary diversity score and cardiometabolic multimorbidity in Chinese middle aged and older adults[J]. South China Journal of Preventive Medicine, 2026, 52(7): 791-795.

参考文献

[1] 金奕辰, 程杨杨, 周亚冠, 等. 中国中老年人群4种血脂标志物与心血管代谢性共病进展的关联研究[J]. 中华流行病学杂志, 2024, 45(7): 923-931.
[2] Jin Y, Liang J, Hong C, et al.Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: A multicohort study[J]. Lancet Healthy Longev, 2023, 4(6): 265-273.
[3] 梅竹, 刘子齐, 刘晶, 等. 我国中老年人心血管代谢性多病危险因素分析[J]. 临床军医杂志, 2025, 53(6): 569-573.
[4] 冯文婷, 潘晔, 史威力, 等. 中老年人群CMM患病情况调查及CMM患者认知功能的关联因素分析[J]. 中华全科医师杂志, 2025, 24(1): 62-69.
[5] Lai H, Tu Y, Liao C, et al.Joint assessment of abdominal obesity and non-traditional lipid parameters for primary prevention of cardiometabolic multimorbidity: Insights from the China health and retirement longitudinal study 2011-2018[J]. Cardiovasc Diabetol, 2025, 24(1): 109.
[6] Mao D, He L, Li Y, et al.Study on the association between dietary patterns and cardiometabolic multimorbidities among adults[J]. J Health Popul Nutr, 2025, 44(1): 345.
[7] 吴元婧, 白明, 吴岳. 膳食-肠道菌群轴:心血管代谢性疾病的干预新视角[J]. 中国实用内科杂志, 2025, 45(11): 899-903.
[8] Liu F, Meng Y, Wang R, et al.Combined influence of depression symptoms and ratio of triglyceride to high-density lipoprotein cholesterol on cardiometabolic multimorbidity: Findings from the China Health and Retirement Longitudinal Study 2011-2018[J]. J Affect Disord, 2024, 46(360): 242-248.
[9] 崔晴梅, 李建新, 曹杰, 等. 中国不同风险人群心血管疾病的膳食和体力活动状况[J]. 中华疾病控制杂志, 2022, 26(3): 251-256.
[10] 王嘉慧. 中国老年人膳食多样性评分变化与认知功能受损及日常生活自理能力失能的队列研究[D]. 广州: 南方医科大学, 2022.
[11] 吴佳玉, 孟德涛, 梁潇潇. 体力活动水平对帕金森病发病风险的影响: 基于CHARLS数据的横断面分析[J]. 中国康复理论与实践, 2023, 29(10): 1135-1139.
[12] 杨婷婷, 李新颖, 夏璐, 等. 膳食脂肪酸摄入与心血管疾病患者死亡风险的关联研究[J]. 营养学报, 2022, 44(5): 463-472.
[13] Tang Y, Xiao Y, Yang F, et al.Association between dietary vitamin A intake and risk of cardiometabolic multimorbidity[J]. Sci Rep, 2024, 14(1): 16656.
[14] Li J, Yang M, Huang W, et al.The mediating role of inflammatory factors in the association between dietary index for gut microbiota and hypertension[J]. Sci Rep, 2025, 15(1): 36099.
[15] 许珊, 张书迎, 谢文涵, 等. 生活方式与心血管代谢性共病发生发展轨迹的关联研究[J]. 现代预防医学, 2024, 51(12): 2113-2120.
[16] Wiese ML, Frost F, Bahls M, et al.Dietary diversity, rather than quality, parallels a reduction in metabolic syndrome and a favorable gut microbiome: The dietary diversity score[J]. J Am Nutr Assoc, 2025, 44(3): 256-266.
[17] Zhang Y, Cen Y, Li X, et al.Vitamin E and fatty acid intake and cardiometabolic multimorbidity risk: The mediating role of plasma lipid metabolites[J]. Int J Mol Sci, 2025, 26(23): 11477.
[18] Sakakibara BM, Obembe AO, Eng JJ.The prevalence of cardiometabolic multimorbidity and its association with physical activity, diet, and stress in Canada: Evidence from a population-based cross-sectional study[J]. BMC Public Health, 2019, 19(1): 1361.
[19] Córdova R, Kim J, Thompson AS, et al.Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: A prospective analysis[J]. Lancet Healthy Longev, 2025, 6(8): 100742.
[20] 沈倩, 吴碧容, 周蓉, 等. 上海新泾镇老年人膳食模式与高血压、糖尿病及其共病的关联研究[J]. 中国慢性病预防与控制, 2025, 33(10): 781-785.
[21] Zhang X, Wang H, He Y, et al.Chinese healthy diet and cardiometabolic multimorbidity risks: A prospective cohort study from the China Health and Nutrition Survey[J]. Br J Nutr, 2025, 134(6): 487-496.
[22] Zhang H, Dou B, Chen X, et al.Obesity, composite dietary antioxidant index, and their interactive association with the risk of cardiometabolic multimorbidity in the elderly from a large national survey[J]. Lipids Health Dis, 2025, 24(1): 132.
[23] Caballero FF, Lana A, Struijk EA, et al.Multimorbidity patterns in older adults: The role of social variables and lifestyle behaviors[J]. Gerontology, 2023, 69(6): 716-727.
[24] 陈占超, 刘岩, 房绍红, 等. 生命八要素评分与心血管代谢疾病发病风险相关性的城乡差异[J]. 中国循环杂志, 2025, 40(3): 269-276.
[25] Sharafi M, Baeradeh N, Mohsenpour MA, et al.Investigating multimorbidity patterns and associated risk factors in the fasa adults cohort study (FACS): A latent class analysis[J]. PLoS One, 2025, 20(11): 335177.