The association between four dietary indices and mortality risk in cardiovascular disease patients

Mengshan Pan; Tongle Yin; Ying Yang; Feiyun Zhu; Jiamin Xu; Rucheng Chen; Weijun Zheng

doi:10.1186/s12986-025-00966-5

The association between four dietary indices and mortality risk in cardiovascular disease patients

Nutr Metab (Lond). 2025 Jul 1;22(1):67. doi: 10.1186/s12986-025-00966-5.

Authors

Mengshan Pan^#¹, Tongle Yin^#¹, Ying Yang¹, Feiyun Zhu¹, Jiamin Xu¹, Rucheng Chen¹, Weijun Zheng²

Affiliations

¹ School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou City, 310053, Zhejiang Province, China.
² School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou City, 310053, Zhejiang Province, China. 20111042@zcmu.edu.cn.

^# Contributed equally.

Abstract

Background: The Planetary Healthy Diet Index-United States, the Healthy Diet Index, the Mediterranean Diet, and the Dietary Inflammation Index were linked to mortality rates in cardiovascular patients. This study investigated the relationship between these dietary patterns and all-cause mortality risk in U.S. cardiovascular patients from 2005 to 2006 to 2017-2018.

Methods: Data were collected from adults aged 19 years and older participating in the National Health and Nutrition Examination Survey from 2005 to 2006 to 2017-2018. Dietary patterns were assessed for each survey cycle using 24-hour dietary recalls, and scores for the four dietary indices were calculated. Survey-weighted multivariable Cox proportional hazards regression models evaluated associations between these indices and all-cause and cause-specific mortality among patients with cardiovascular disease, using hazard ratios across quartiles and per 1-SD increment.

Results: This study included 3,088 patients with cardiovascular disease. In the partially adjusted model, the Planetary Healthy Diet Index-United States (HR = 0.81; 95% CI: 0.75-0.87; P < 0.001), Healthy Eating Index (HR = 0.85; 95% CI: 0.78-0.93; P < 0.001), and the Mediterranean Diet (HR = 0.82; 95% CI: 0.75-0.90; P < 0.001) were each associated with a reduced risk of all-cause mortality. In contrast, the Dietary Inflammatory Index was associated with an increased risk of all-cause mortality (HR = 1.25; 95% CI: 1.14-1.37; P < 0.001). In the fully adjusted model, the Planetary Healthy Diet Index-United States (HR = 0.89; 95% CI: 0.81-0.97; P = 0.005) remained significantly associated with a lower risk of all-cause mortality, whereas the Dietary Inflammation Index (HR = 1.20; 95% CI: 1.07-1.34; P = 0.002) continued to show a significant association with increased mortality risk.

Conclusions: Among cardiovascular disease patients, higher adherence to the Healthy Eating Index, Mediterranean Diet, and Planetary Healthy Diet Index-United States was linked to lower all-cause mortality, while higher Dietary Inflammation Index scores were linked to increased mortality. The Mediterranean Diet and Planetary Healthy Diet Index-United States were inversely associated with mortality in congestive heart failure patients, whereas Dietary Inflammation Index was positively associated with mortality in this group and in those with angina pectoris.

Keywords: Cardiovascular disease; Diet quality; Dietary inflammatory index; Healthy eating Index-2020; Mediterranean diet score; Mortality; Planetary healthy diet Index-United States.