The associations between healthful and unhealthful plant-based dietary patterns and all-cause mortality among older Chinese adults with data-adapted early-stage cardiovascular-kidney-metabolic syndrome (stages 0-2): a prospective cohort study from the CLHLS.

Aims: To examine the associations of the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) with all-cause mortality in older Chinese adults with data-adapted early-stage cardiovascular-kidney-metabolic (CKM) syndrome (stages 0-2). Methods and results: We analyzed data from 5,872 participants aged ≥65 years from the 2008 wave of the China Longitudinal Healthy Longevity Survey (CLHLS) with data-adapted CKM stages 0-2 and no prevalent cardiovascular disease. Dietary intake was assessed using a validated food frequency questionnaire. Mortality was ascertained through March 2019. Cox proportional hazards models and restricted cubic spline analyses were used. During a median follow-up of 108 months, 2,870 deaths occurred. In multivariable-adjusted models, each 1-point increase in hPDI was associated with a 1.1% lower mortality risk (HR = 0.989, 95% CI: 0.982-0.995; Conclusion: Higher adherence to a healthful plant-based diet was associated with lower all-cause mortality, whereas higher adherence to an unhealthful plant-based diet was associated with higher mortality among older Chinese adults with data-adapted early-stage CKM syndrome. The overall PDI was not independently associated with mortality after adjustment, underscoring that plant-based dietary quality, rather than plant-based eating per se, is the relevant exposure.