Link between nutrient intake and multimorbidity risk reported in recent study, more research is needed

By Pooja Toshniwal PahariaReviewed by Danielle Ellis, B.Sc.Mar 8 2024

In a recent study published in BMC Public Health, researchers explored potential associations between nutrient intake and multimorbidities.

Background

Multimorbidity, or the presence of many chronic illnesses, is a worldwide health concern, particularly among older individuals. It raises the risk of early mortality, hospitalization, loss of physical function, depression, polypharmacy, and a decline in quality of life, inflicting a considerable cost load on healthcare systems.

Nutritional variables have a vital role in multimorbidity prevention. Unhealthy dietary habits like binge eating and excessive drinking might raise the risk. In the Netherlands, individuals with cardiometabolic multimorbidity eat more meat and snacks. Consuming fruits, vegetables, and whole grains can help reduce the risk. Mediterranean diets and increasing calcium and potassium intake are associated with decreased cardiometabolic multimorbidity. Lutein and zeaxanthin are potentially helpful nutrients. However, further study is needed to discover dietary therapies that reduce the multimorbidity burden.  

About the study

In the present prospective cohort study, researchers investigated the influence of dietary intake on multimorbidity risk.

The researchers analyzed the United Kingdom Women’s Cohort Study (UKWCS) data from 25,389 females aged between 35 and 69 years. The UKWCS dataset included food intake, anthropometric parameters, socioeconomic status, lifestyle habits, and health outcomes. The participants self-reported baseline chronic diseases such as hypertension, angina, coronary artery disease, stroke, diabetes, hyperlipidemia, gallstones, large intestinal polyps, and cancer.

The team excluded non-residents of England with multiple chronic diseases at baseline and missing covariate data. They used food frequency questionnaires (FFQs) from the UK for the European Prospective Investigation into Cancer and Nutrition (EPIC) study to estimate daily energy and nutrient intakes. They assessed multimorbidity using Charlson comorbidity index (CCI) scores electronically linked to the Hospital Episode Statistics (HES) database through March 2019, using the International Classification of Diseases, tenth edition, Australian modification (ICD-10-AM) codes. 

The researchers assessed dietary intake using McCance & Widdowson Food Composition (fifth edition) and Food Standards Agency guidelines, adjusting for total calorie intake by nutrient density. They performed Cox proportional hazards modeling to estimate hazard ratios (HRs) for the relationships between regular nutrient intake and multimorbidity risk. They used multinomial logistic regressions to evaluate the association in the sensitivity analysis and performed a stratified assessment, considering 60 years as the threshold for age. Study covariates included age, body mass index (BMI), educational level, marital status, ethnicity, socioeconomic status (SES), and physical activity.

Results

The mean participant age was 51 years, among whom 31% (n=7,799) developed multimorbidities over a 22-year follow-up (median). Individuals with multimorbidity had a higher BMI, lower educational levels, and higher SES status and showed an increased likelihood of being single or widowed compared to their counterparts.

Compared to the lowermost quintile, the uppermost quintile of regular calorie and protein intakes was related to 8.0% and 12% higher multimorbidity risks, respectively (hazard ratio, 1.1). Compared to the lowermost quintile, higher statistical quintiles of regular vitamin C consumption had a 10% lowered multimorbidity risk, while regular vitamin D consumption had a 10% increased multimorbidity risk. In comparison to the lowermost quintile of vitamin B12 consumption, multimorbidity risk was significantly higher in the topmost quintile (HR, 1.1). Compared with the lowermost quintile, higher quintiles of iron intake had marginally lowered multimorbidity risks.

In the sensitivity analysis, the significantly higher multimorbidity risks linearly related to higher statistical quintiles of B12 and D vitamin intakes were non-significant using multinomial logistic regressions. The team found evidence of age-modifying effects on vitamin B1 and iron intakes associated with multimorbidity risk. For iron intake, the team found an 11% to 13% lower multimorbidity risk among individuals below 60 years compared to those aged above 60 years.

Conclusions

The study findings highlighted a relationship between nutrient consumption and the risk of multimorbidity for developing preventive, diagnostic, treatment, and prognostic methods. The findings indicated that higher intakes of vitamin B12, vitamin D, protein, and energy may raise the risk of multimorbidity, but higher intakes of vitamin C may reduce it. It is important to note that these associations became insignificant in multinomial logistic regression. Iron consumption was adversely linked with multimorbidity risk in women aged <60 years, while there was no such association in women aged >60 years.

The study reveals that specific nutrients, notably vitamin B12, vitamin D, protein, and energy, may influence the likelihood of multimorbidity. Researchers must further investigate the optimal nutritional consumption levels for individuals with multimorbidity, and policymakers and clinical practitioners should address individualized nutrition. Additional clinical studies are necessary to determine whether dietary treatments help improve multimorbidity. More studies are needed to draw definitive conclusions.