The Healthy Taiwanese Eating Approach is inversely associated with all-cause and cause-specific mortality: A prospective study on the Nutrition and Health Survey in Taiwan, 1993-1996
Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan. The study population included 2475 y...
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| Published in | PloS one Vol. 16; no. 5; p. e0251189 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
06.05.2021
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0251189 |
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| Abstract | Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan.
The study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged≥65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis.
A total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities.
Consuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan. |
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| AbstractList | Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan. The study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged[greater than or equal to]65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis. A total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities. Consuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan. BackgroundFew longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan.MethodsThe study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged≥65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis.ResultsA total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities.ConclusionConsuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan. Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan.BACKGROUNDFew longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan.The study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged≥65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis.METHODSThe study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged≥65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis.A total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities.RESULTSA total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities.Consuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan.CONCLUSIONConsuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan. About the Authors: Shao-Yuan Chuang Roles Conceptualization, Formal analysis, Funding acquisition, Methodology, Writing – original draft, Writing – review & editing * E-mail: chuangsy@nhri.org.tw (SYC); pan@ibms.sinica.edu.tw (WHP) Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C ORCID logo https://orcid.org/0000-0003-2138-4771 Hsing-Yi Chang Roles Conceptualization, Methodology, Writing – review & editing Affiliations Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C, Institute of Public Health, National Yang Ming University, Taipei, Taiwan, R.O.C Hsin-Ling Fang Roles Data curation, Formal analysis, Methodology Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C Shu-Chen Lee Roles Conceptualization, Data curation, Resources Affiliation: Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C Yueh-Ying Hsu Roles Data curation, Resources, Software Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C Wen-Ting Yeh Roles Data curation, Formal analysis, Software Affiliation: Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C Wen-Ling Liu Roles Data curation, Formal analysis, Software Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C Wen-Harn Pan Roles Conceptualization, Data curation, Investigation, Methodology, Writing – review & editing * E-mail: chuangsy@nhri.org.tw (SYC); pan@ibms.sinica.edu.tw (WHP) Affiliations Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C, Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C Introduction Cardiovascular diseases (CVDs) are the most common cause of death globally [1], and most CVDs can be prevented by changing behavioral risk factors such as tobacco use, unhealthy diet, and physical inactivity. [...]Asian populations consume less beef, dairy products, olive oil, butter, and coffee, but more vegetables, soy-products, rice, and tea. [...]food choices for achieving good health in Asia may differ from those espoused in the Mediterranean or European regions. Studies investigating the association between diet and longevity in Asian populations have been rare and inconclusive, especially concerning which foods or dietary patterns lead to better health outcomes [16–18]. [...]we carried out a prospective study in young and middle-aged adults to investigate the relationship between foods/dietary patterns and mortality with respect to all cause, CVD, cancer, and other causes in Taiwan. Food items assessed in the questionnaire included freshwater fish, poultry (chicken, duck), lean meat (pork), high-fat meat (marbled red meats with skins or high fat beef), animal liver, other organ meats, eggs, deep-ocean fish (with rich OMGEA-3), shellfish, other seafood [shrimp or crab], soy products (tofu and its products), soy milk, whole milk, skim milk, vegetables as a whole, carrots, melons, mushrooms, bamboo shoots, beans, dark-colored vegetables, seaweed, pickled/fermented vegetables, fruits as a whole, 100% fruit juice, soft drinks, tea, coffee and fermented foods. Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan. The study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged≥65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis. A total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities. Consuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan. Background Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan. Methods The study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged[greater than or equal to]65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis. Results A total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities. Conclusion Consuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan. About the Authors: Shao-Yuan Chuang Roles Conceptualization, Formal analysis, Funding acquisition, Methodology, Writing – original draft, Writing – review & editing * E-mail: chuangsy@nhri.org.tw (SYC); pan@ibms.sinica.edu.tw (WHP) Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C ORCID logo https://orcid.org/0000-0003-2138-4771 Hsing-Yi Chang Roles Conceptualization, Methodology, Writing – review & editing Affiliations Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C, Institute of Public Health, National Yang Ming University, Taipei, Taiwan, R.O.C Hsin-Ling Fang Roles Data curation, Formal analysis, Methodology Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C Shu-Chen Lee Roles Conceptualization, Data curation, Resources Affiliation: Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C Yueh-Ying Hsu Roles Data curation, Resources, Software Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C Wen-Ting Yeh Roles Data curation, Formal analysis, Software Affiliation: Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C Wen-Ling Liu Roles Data curation, Formal analysis, Software Affiliation: Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C Wen-Harn Pan Roles Conceptualization, Data curation, Investigation, Methodology, Writing – review & editing * E-mail: chuangsy@nhri.org.tw (SYC); pan@ibms.sinica.edu.tw (WHP) Affiliations Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C, Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C Introduction Cardiovascular diseases (CVDs) are the most common cause of death globally [1], and most CVDs can be prevented by changing behavioral risk factors such as tobacco use, unhealthy diet, and physical inactivity. [...]Asian populations consume less beef, dairy products, olive oil, butter, and coffee, but more vegetables, soy-products, rice, and tea. [...]food choices for achieving good health in Asia may differ from those espoused in the Mediterranean or European regions. Studies investigating the association between diet and longevity in Asian populations have been rare and inconclusive, especially concerning which foods or dietary patterns lead to better health outcomes [16–18]. [...]we carried out a prospective study in young and middle-aged adults to investigate the relationship between foods/dietary patterns and mortality with respect to all cause, CVD, cancer, and other causes in Taiwan. Food items assessed in the questionnaire included freshwater fish, poultry (chicken, duck), lean meat (pork), high-fat meat (marbled red meats with skins or high fat beef), animal liver, other organ meats, eggs, deep-ocean fish (with rich OMGEA-3), shellfish, other seafood [shrimp or crab], soy products (tofu and its products), soy milk, whole milk, skim milk, vegetables as a whole, carrots, melons, mushrooms, bamboo shoots, beans, dark-colored vegetables, seaweed, pickled/fermented vegetables, fruits as a whole, 100% fruit juice, soft drinks, tea, coffee and fermented foods. |
| Audience | Academic |
| Author | Chang, Hsing-Yi Pan, Wen-Harn Chuang, Shao-Yuan Lee, Shu-Chen Hsu, Yueh-Ying Yeh, Wen-Ting Fang, Hsin-Ling Liu, Wen-Ling |
| AuthorAffiliation | 3 Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C 2 Institute of Public Health, National Yang Ming University, Taipei, Taiwan, R.O.C 1 Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C University of Hong Kong, HONG KONG |
| AuthorAffiliation_xml | – name: 3 Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C – name: 1 Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C – name: 2 Institute of Public Health, National Yang Ming University, Taipei, Taiwan, R.O.C – name: University of Hong Kong, HONG KONG |
| Author_xml | – sequence: 1 givenname: Shao-Yuan orcidid: 0000-0003-2138-4771 surname: Chuang fullname: Chuang, Shao-Yuan – sequence: 2 givenname: Hsing-Yi surname: Chang fullname: Chang, Hsing-Yi – sequence: 3 givenname: Hsin-Ling surname: Fang fullname: Fang, Hsin-Ling – sequence: 4 givenname: Shu-Chen surname: Lee fullname: Lee, Shu-Chen – sequence: 5 givenname: Yueh-Ying surname: Hsu fullname: Hsu, Yueh-Ying – sequence: 6 givenname: Wen-Ting surname: Yeh fullname: Yeh, Wen-Ting – sequence: 7 givenname: Wen-Ling surname: Liu fullname: Liu, Wen-Ling – sequence: 8 givenname: Wen-Harn surname: Pan fullname: Pan, Wen-Harn |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33956833$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2021 Public Library of Science 2021 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2021 Chuang et al 2021 Chuang et al |
| Copyright_xml | – notice: COPYRIGHT 2021 Public Library of Science – notice: 2021 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2021 Chuang et al 2021 Chuang et al |
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| DOI | 10.1371/journal.pone.0251189 |
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| Snippet | Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the... Background Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated... About the Authors: Shao-Yuan Chuang Roles Conceptualization, Formal analysis, Funding acquisition, Methodology, Writing – original draft, Writing – review &... BackgroundFew longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated... |
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| Title | The Healthy Taiwanese Eating Approach is inversely associated with all-cause and cause-specific mortality: A prospective study on the Nutrition and Health Survey in Taiwan, 1993-1996 |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/33956833 https://www.proquest.com/docview/2522651054 https://www.proquest.com/docview/2524351361 https://pubmed.ncbi.nlm.nih.gov/PMC8101962 https://doaj.org/article/efddf897a9f8432db4f65b3d54177d63 http://dx.doi.org/10.1371/journal.pone.0251189 |
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