In a recent publication in BMC Public Health, researchers delved into potential connections between nutrient intake and multimorbidity.

Background: Multimorbidity, or the presence of numerous chronic illnesses, poses a global health concern, particularly among the elderly population. It amplifies the risk of premature mortality, hospitalization, decline in physical function, depression, polypharmacy, and deterioration in quality of life, placing significant strain on healthcare systems.

Nutritional factors play a crucial role in preventing multimorbidity. Unhealthy dietary patterns such as binge eating and excessive alcohol consumption may elevate the risk. In the Netherlands, individuals with cardiometabolic multimorbidity tend to consume more meat and snacks. Conversely, incorporating fruits, vegetables, and whole grains into one’s diet can help mitigate this risk. Mediterranean diets and increased intake of calcium and potassium have been associated with reduced cardiometabolic multimorbidity. Additionally, nutrients like lutein and zeaxanthin show promise. However, further research is needed to explore dietary interventions that alleviate the burden of this condition.

About the study

In this prospective cohort study, researchers examined the impact of dietary intake on multimorbidity risk.

They analyzed data from the United Kingdom Women’s Cohort Study (UKWCS), comprising 25,389 females aged 35 to 69 years. The dataset included information on food consumption, anthropometric measurements, socioeconomic status, lifestyle behaviors, and health outcomes. Participants self-reported baseline chronic conditions such as hypertension, angina, coronary artery disease, stroke, diabetes, hyperlipidemia, gallstones, large intestinal polyps, and cancer.

The team excluded non-residents of England with pre-existing multiple chronic conditions and incomplete covariate data. They utilized food frequency questionnaires (FFQs) from the UK arm of the European Prospective Investigation into Cancer and Nutrition (EPIC) study to estimate daily nutrient and energy intake. Multimorbidity was assessed using Charlson comorbidity index (CCI) scores linked electronically to the Hospital Episode Statistics (HES) database until March 2019, employing the International Classification of Diseases, tenth edition, Australian modification (ICD-10-AM) codes.

Dietary intake was evaluated based on McCance & Widdowson Food Composition (fifth edition) and Food Standards Agency guidelines, adjusting for nutrient density relative to total calorie intake. Cox proportional hazards modeling was employed to determine hazard ratios (HRs) for the associations between regular nutrient consumption and multimorbidity risk. Multinomial logistic regressions were used in sensitivity analyses, and a stratified analysis was conducted using 60 years as the age threshold. Covariates included age, body mass index (BMI), education level, marital status, ethnicity, socioeconomic status (SES), and physical activity.

Results

The average participant age was 51 years, with 31% (n=7,799) developing multimorbidities over a median 22-year follow-up period. Individuals with multimorbidity exhibited higher BMIs, lower educational attainment, and higher socioeconomic status, and were more likely to be single or widowed compared to their counterparts. Compared to the lowest quintile, higher quintiles of regular calorie and protein intake were associated with an 8.0% and 12% increase in multimorbidity risk, respectively (HR, 1.1). Conversely, higher quintiles of regular vitamin C consumption were linked to a 10% decrease in multimorbidity risk, while increased vitamin D intake was associated with a 10% rise in multimorbidity risk. Moreover, the topmost quintile of vitamin B12 intake demonstrated a significantly higher multimorbidity risk compared to the lowest quintile (HR, 1.1). Marginally lower the risk of these chronic conditions were observed with higher quintiles of iron intake compared to the lowest quintile.

In sensitivity analyses, the significant associations between higher quintiles of B12 and D vitamin intake and increased multimorbidity risk were rendered non-significant using multinomial logistic regressions. Age-related modifying effects were observed for vitamin B1 and iron intakes regarding multimorbidity risk. Specifically, individuals below 60 years exhibited an 11% to 13% lower multimorbidity risk with higher iron intake compared to those aged above 60 years.

Conclusions

The study underscores the interplay between nutrient intake and multimorbidity risk, urging the development of preventive, diagnostic, therapeutic, and prognostic strategies. It suggests that elevated levels of vitamin B12, vitamin D, protein, and energy may heighten multimorbidity risk, while higher vitamin C intake may mitigate it. Iron consumption was found to be adversely associated with multimorbidity risk in women aged under 60 years, with no such correlation observed in those aged over 60 years.

The research underscores the potential influence of specific nutrients, particularly vitamin B12, vitamin D, protein, and energy, on multimorbidity likelihood. Further investigation is warranted to ascertain optimal nutritional intake levels for individuals with this condition, with a call for tailored nutritional guidance from policymakers and clinical practitioners. Additional clinical trials are imperative to determine the efficacy of dietary interventions in ameliorating multimorbidity. Further studies are needed to draw definitive conclusions.

For more information: Nutrient intake and risk of multimorbidity: a prospective cohort study of 25,389 women, BMC Health, https://doi.org/10.1186/s12889-024-18191-9