ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Epidemiology
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1535174
This article is part of the Research TopicThe Impact of Dietary Patterns and Nutrients on Cardiometabolic DiseasesView all articles
Impact of Dietary Patterns on the Survival Outcomes of Patients with Cardiovascular Disease
Provisionally accepted
- 1Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
- 2First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Background: This study examines the association between dietary patterns and survival outcomes in patients with cardiovascular disease (CVD).: A total of 9,101 adults with CVD from the 2005-2018 National Health and Nutrition Examination Survey were included. Dietary patterns were evaluated using five indices: the Alternative Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension (DASH), Dietary Inflammatory Index (DII), Healthy Eating Index-2020 (HEI-2020), and the Alternative Mediterranean Diet Score (aMED). Associations between dietary indices and all-cause mortality were assessed using Kaplan-Meier survival analysis, weighted Cox regression models, and restricted cubic spline analyses. Predictive performance was evaluated using time-dependent receiver operating characteristic (Time-ROC) curves.Results: After a median follow-up of 7 years, 1,225 deaths were recorded. Survivors had higher AHEI, DASH scores, and lower DII scores. Kaplan-Meier analysis suggested better survival outcomes associated with higher adherence to healthier dietary patterns (AHEI, DASH, HEI-2020, aMED) and lower adherence to proinflammatory diets (DII). Weighted Cox regression revealed significant associations between higher scores on AHEI, DASH, HEI-2020, and aMED and reduced mortality risk (highest vs. lowest tertile HRs: 0.59, 0.73, 0.65, and 0.75, respectively; all P < 0.05). Conversely, higher DII scores were associated with increased mortality risk, with the highest tertile showing significantly elevated risk compared to the lowest tertile (HR = 1.58, 95% CI: 1.21-2.06; P < 0.001). Restricted cubic spline analyses identified a significant nonlinear relationship between AHEI scores and mortality (P for nonlinearity = 0.036), while other indices exhibited linear associations. Time-ROC analysis indicated that dietary indices maintain relatively consistent predictive effectiveness for mortality risk over time.Improved healthy dietary patterns could potentially reduce mortality risk in CVD patients, underscoring the need for dietary quality enhancement in managing CVD.
Keywords: Dietary patterns, cardiovascular disease, Survival outcomes, weighted Cox regression, 54 Predictive ability
Received: 27 Nov 2024; Accepted: 30 Jun 2025.
Copyright: © 2025 Sun, Jiang and Shen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xingyu Jiang, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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