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A prospective cohort study of starchy and non-starchy vegetable intake and mortality risk

Published online by Cambridge University Press:  24 October 2022

Tengfei Zhang
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, Anhui, People’s Republic of China NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People’s Republic of China Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, People’s Republic of China
Zhaohong Peng
Affiliation:
Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
Hairong Li
Affiliation:
Huangpu District Center for Disease Control and Prevention, Guangzhou, Guangdong, People’s Republic of China
Shaoxian Liang
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China
Mengfei Liu
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China
Shu Ye
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China
Yong Huang
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China
Yu Zhu
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China
Xiude Li
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China
Danni Wang
Affiliation:
Teaching Center for Preventive Medicine, School of Public Health, Anhui, Medical University, Hefei, People’s Republic of China
Wanshui Yang*
Affiliation:
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, Anhui, People’s Republic of China NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People’s Republic of China Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, People’s Republic of China
*
*Corresponding author: Wanshui Yang, email wanshuiyang@gmail.com
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Abstract

Whether starchy and non-starchy vegetables have distinct impacts on health remains unknown. We prospectively investigated the intake of starchy and non-starchy vegetables in relation to mortality risk in a nationwide cohort. Diet was assessed using 24-h dietary recalls. Deaths were identified via the record linkage to the National Death Index. Hazard ratios (HR) and 95 % CI were calculated using Cox regression. During a median follow-up of 7·8 years, 4904 deaths were documented among 40 074 participants aged 18 years or older. Compared to those with no consumption, participants with daily consumption of ≥ 1 serving of non-starchy vegetables had a lower risk of mortality (HR = 0·76, 95 % CI 0·66, 0·88, Ptrend = 0·001). Dark-green and deep-yellow vegetables (HR = 0·79, 95 % CI 0·63, 0·99, Ptrend = 0·023) and other non-starchy vegetables (HR = 0·80, 95 % CI 0·70, 0·92, Ptrend = 0·004) showed similar results. Total starchy vegetable intake exhibited a marginally weak inverse association with mortality risk (HR = 0·89, 95 % CI 0·80, 1·00, Ptrend = 0·048), while potatoes showed a null association (HR = 0·93, 95 % CI 0·82, 1·06, Ptrend = 0·186). Restricted cubic spline analysis suggested a linear dose–response relationship between vegetable intake and death risk, with a plateau at over 300 and 200 g/d for total and non-starchy vegetables, respectively. Compared with starchy vegetables, non-starchy vegetables might be more beneficial to health, although both showed a protective association with mortality risk. The risk reduction in mortality plateaued at approximately 200 g/d for non-starchy vegetables and 300 g/d for total vegetables.

Information

Type
Research Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society
Figure 0

Table 1. Age-adjusted characteristics of participants according to individual vegetable intake in NHANES (1999–2014)*(Mean values and standard deviations; numbers)

Figure 1

Table 2. All-cause mortality according to starchy and non-starchy vegetable intake in NHANES (1999–2014)(Hazard ratios and 95 % confidence intervals)

Figure 2

Fig. 1. Dose–response relationship between total vegetables, total starchy vegetables, total non-starchy vegetables and all-cause mortality in NHANES (1999–2014)a. HR, hazard ratio; NHANES, National Health and Nutrition Examination Survey. a Adjusted for sex (male, female), age (18–45, 46–65, ≥ 66 years), total energy intake (kcal/d, tertile), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic or other race), education (≤ 12th grade, high school graduate/GED or equivalent or more than high school), marital status (married, widowed/divorced/separated or never married), ratio of family income to poverty (< 1·30, 1·30–3·49 or ≥ 3·50), physical activity (< 8·3, 8·3–16·7 or > 16·7 METS-h/week), smoking (never smokers, former smokers or current smokers), drinking (never drinking, low to moderate drinking, heavy drinking), BMI (< 18·5, 18·5–24·9, 25·0–29·9 and ≥ 30·0), diabetes (no, yes), hypertension (no, yes), other CVD (no, yes), cancer (no, yes), HEI-2015 (tertile) and starchy and non-starchy vegetables were mutually adjusted. Of note, the dotted line represents the 95 % CI.

Figure 3

Fig. 2. HR of all-cause mortality per 1-sd increase in total starchy vegetables and non-starchy vegetables by subgroups in NHANES (1999–2014)a. HR, hazard ratios; METS, metabolic equivalent tasks; NHANES, National Health and Nutrition Examination Survey. a Adjusted for sex (male, female), age (18–45, 46–65, ≥ 66 years), total energy intake (kcal/d, tertile), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic or other race), education (≤ 12th grade, high school graduate/GED or equivalent, or more than high school), marital status (married, widowed/divorced/separated, or never married), ratio of family income to poverty (< 1·30, 1·30–3·49 or ≥ 3·50), physical activity (< 8·3, 8·3–16·7 or > 16·7 METS-h/week), smoking (never smokers, former smokers or current smokers), drinking (never drinking, low to moderate drinking, heavy drinking), BMI (< 18·5, 18·5–24·9, 25·0–29·9, and ≥ 30·0), diabetes (no, yes), hypertension (no, yes), other CVD (no, yes), cancer (no, yes), HEI-2015 (tertile) and starchy and non-starchy vegetables were mutually adjusted. Of note, each stratified variable was removed from the corresponding model. Light physical activity was defined as participants with physical activity less than 8·3 METS-h per week, and moderate and vigorous activity was defined as participants who had physical activity of 8·3 METS-h per week or more.

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