Fudan/Harvard study of nearly 200,000 people: 8 dietary patterns can reduce the risk of cardiovascular disease, cancer, and diabetes

Chronic non-communicable diseases (NCDs), referred to as "chronic diseases" or " chronic diseases ", refer to a class of diseases with complex causes, long courses of illness, and prolonged illnesses, mostly represented by malignant tumors, cardiovascular diseases, chronic obstructive pulmonary disease, diabetes , etc. In 2022, the World Health Organization (WHO) released the report "Invisible Numbers: The Real Situation and Countermeasures of Non-communicable Diseases", which showed that chronic diseases are the "world's number one killer", and one person under the age of 70 dies from chronic diseases every two seconds.

A healthy diet may be a potential measure to reduce the risk of chronic diseases , but current research on diet and chronic diseases mostly focuses on a specific type of food and may not provide a more comprehensive ideal diet.

Recently, Nature Medicine published a result from research institutions including Fudan University and Harvard University, showing that maintaining a healthy eating pattern is related to reducing the risk of chronic diseases. Among the eight eating patterns, a low-insulin diet, a low-inflammatory diet, and a diet that reduces the risk of diabetes are more likely to reduce the risks of various chronic diseases.

This study evaluated the association between eight dietary patterns and major chronic diseases (major cardiovascular diseases (such as coronary heart disease, stroke, etc.), type 2 diabetes and cancer) by using 32 years of follow-up data from nearly 200,000 people (from three cohorts: the Health Professionals Follow-up Study (HPFS ), the Nurses' Health Study (NHS) and NHS II) . The eight dietary patterns are:

1. DASH diet : Developed from a large-scale hypertension prevention program in the United States in 1997, it is a dietary pattern that can lower blood pressure. It advocates low fat, low salt, and low sugar, and provides balanced nutrition. Lean meat, poultry, and fish are the main sources of protein, and vegetables, fruits, dairy products, grains, soy products, nuts, a small amount of fat and sweets are consumed in a balanced manner; at the same time, the intake of salt and saturated fat is reduced, such as drinking low-fat milk and not eating or eating less fatty meat.

2. Mediterranean diet (AMED) : It is generally believed that people living along the Mediterranean coast have a longer life expectancy and a lower risk of cancer and cardiovascular disease. It mainly includes: vegetables and fruits (these two types of food occupy a very important position in the Mediterranean diet pyramid); olive oil; whole grain staples, bean products; fish and seafood at least twice a week; moderate amounts of red wine and water. In addition, the Mediterranean diet restricts sweets and red meat.

3~4. Low insulin diet (rEDIH) and low inflammation diet (rEDIP) : Systemic inflammation and hyperinsulinemia are thought to be associated with type 2 diabetes, cardiovascular disease, and cancer. These two dietary patterns are based on the association of specific foods with insulinemia and inflammatory biomarkers.

5. World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) : The World Cancer Research Fund/American Institute for Cancer Research proposes the role of diet, nutrition and exercise in preventing cancer.

6. Healthy Plant-Based Diet (hPDI) : Emphasizes natural plant-based foods and a small amount of animal-based foods to reduce the risks of hypertension, type 2 diabetes, cardiovascular diseases, etc.

7. Diabetes Risk Diet (DRRD) : A dietary pattern that reduces the risk of diabetes by increasing the intake of cereal fiber, coffee, fruits and nuts, and reducing the intake of red meat, processed meat, sugary drinks, etc.

8. Alternative Healthy Eating Initiative 2010 (AHEI-2010) : A dietary pattern developed based on the prediction of chronic diseases, emphasizing the consumption of more vegetables, fruits, whole grains, nuts/legumes, omega-3 fatty acids, polyunsaturated fatty acids, and discouraging the consumption of sugary drinks and juices, red meat and processed meat, sodium and trans fatty acids, but allowing appropriate alcohol intake.

Seven dietary patterns are negatively correlated with the risk of major chronic diseases

After comparing the correlation between high and low compliance of each diet pattern and the risk of chronic diseases, it was found that high compliance with low insulin diet, low inflammation diet, diabetes risk reduction diet , 2010 alternative healthy diet, Mediterranean diet, healthy plant-based diet, and DASH diet were negatively correlated with the risk of major chronic diseases , and the first three diet patterns had the strongest correlation ( HR = 0.58~0.80), that is, maintaining these 7 diets, the risk of chronic diseases is lower. World Cancer Research Fund/American Institute for Cancer Research diet is not correlated with chronic diseases.

Type 2 diabetes is most strongly associated with dietary patterns, and a varied diet may reduce cancer risk

Type 2 diabetes was most strongly associated with dietary patterns, especially low-insulin diet, low-inflammatory diet, and reduced diabetes risk diet ( HR = 0.35-0.56), suggesting a possible link between dietary patterns and the pathophysiology of insulin resistance and type 2 diabetes. These three dietary patterns were also strongly associated with cardiovascular disease outcomes ( HR = 0.63-0.77), mainly affecting coronary heart disease and stroke.

Participants with high adherence to a low-insulin diet, a low-inflammatory diet, or a reduced-risk-diabetes diet had a reduced risk of all types of cancer, obesity-related cancers, and smoking-related cancers ( HR = 0.83-0.92). The World Cancer Research Fund/American Institute for Cancer Research diet was positively associated with the risk of type 2 diabetes, but not with coronary heart disease, stroke, obesity, and smoking-related cancers.

The article states that there are many causes of cancer, such as smoking, obesity, lack of exercise, etc. Some cancers (such as colorectal cancer) may be related to diet, while others are not. Considering the heterogeneity of cancer, based on existing research alone, if diet alone can reduce the risk of cancer by about 10%, it would be very good.

Specific food: 3 foods are positively correlated with chronic diseases, and 6 foods are negatively correlated with chronic diseases

Looking at specific foods, coffee, whole grains, and desserts are negatively correlated with chronic diseases, meaning the more these foods are eaten, the lower the risk of chronic diseases . Processed meat, low-energy drinks, red meat, French fries, high-energy drinks, and eggs are positively correlated with chronic diseases, meaning the more these foods are eaten, the higher the risk of chronic diseases . It is somewhat surprising that desserts can reduce the risk of chronic diseases. The article suggests that this may be because desserts are negatively correlated with certain foods that are not conducive to metabolism, such as tomatoes and eggs, and flavonoids in chocolate.

After removing coffee, the association between low insulin diet, low inflammation diet, and reduced diabetes risk diet and chronic disease risk weakened, but the overall trend was similar , because these three dietary patterns believe that coffee is associated with a lower risk of cardiometabolic disease.

Compared with other dietary patterns, low-insulin diets, low-inflammatory diets, and diets that reduce the risk of diabetes contain more foods related to the above-mentioned chronic disease risks, such as coffee, wine, processed meat, red meat, French fries, and sugary drinks, and low-insulin diets and low-inflammatory diets contain fewer fruits and vegetables (except green vegetables). This shows that the metabolic effects of diet occur cumulatively, reflecting the overall diet rather than the dominant effects of certain foods or the accumulation of individual foods.

Dietary patterns in different subgroups of the population were associated with the risk of chronic diseases, but no association was observed in all cancers

Different subgroups were defined by age, body mass index (BMI), gender, smoking status, and drinking. The results showed that the dietary patterns of each subgroup were correlated with the risk of chronic diseases, especially the dietary patterns of young people, overweight or obese people, and women. The negative correlation between dietary patterns and chronic disease risk was stronger . No correlation was observed between dietary patterns and cancer risk in all different subgroups.

summary

In summary, adhering to a healthy diet is associated with a reduced risk of chronic diseases, especially a low-insulin diet, a low-inflammatory diet, and a diet that reduces the risk of diabetes.

The purpose of formulating dietary guidelines for adults is to provide food-related choices and suggestions to meet the nutritional needs of the human body and help prevent diet-related chronic diseases. The pathophysiological process of chronic diseases is inseparable from factors such as lipids, blood pressure, blood sugar, insulinemia and inflammation. From the results of this study, hyperinsulinemia and inflammation are most affected by dietary factors and are reflected in many diseases. Considering that low-insulin diets and low-inflammatory diets are based on the association between specific foods and insulinemia and inflammatory biomarkers, these two dietary patterns may provide a reference for dietary guidelines for the prevention of chronic diseases . In the future, we need to continue to explore more specific association mechanisms between diet and overall health.