Association between nutrition and the evolution of multimorbidity: the importance of fruits and vegetables and whole grain products.
OBJECTIVE
Multimorbidity is a common health status. The impact of nutrition on the development of multimorbidity remains to be determined. The aim of this study is to determine the association between foods, macronutrients and micronutrients and the evolution of multimorbidity.


METHODS
Data from 1020 Chinese who participated in the Jiangsu longitudinal Nutrition Study (JIN) were collected in 2002 (baseline) and 2007 (follow-up). Three-day weighted food records and status for 11 chronic diseases was determined using biomedical measures (hypertension, diabetes, hypercholesterolemia and anemia) or self-reports (coronary heart disease, asthma, stroke, cancer, fracture, arthritis and hepatitis). Participants were divided in six categories of stage of evolution of multimorbidity. Association of foods, macronutrients and micronutrients at baseline with stages in the evolution of multimorbidity were determined. Data were adjusted for age, sex, BMI, marital status, sedentary lifestyle, smoking status, annual income, education and energy intake.


RESULTS
The prevalence of multimorbidity increased from 14% to 34%. A high consumption of fruit and vegetables (p < 0.05) and grain products other than rice and wheat (p < 0.001) were associated with healthier stages in the evolution of multimorbidity. The consumption of grain products other than rice and wheat was highly correlated with dietary fibers (r = 0.77, p < 0.0001), iron (r = 0.46, p < 0.0001), magnesium (r = 0.49, p < 0.0001) and phosphorus (r = 0.57, p < 0.0001) intake which were also associated with healthier stages.


CONCLUSIONS
This study provides the first evidence of an association between nutrition and evolution towards multimorbidity. More precisely, greater consumption of fruits and vegetable and whole grain products consumption appear to lower the risk of multimorbidity.
Institut national de santé publique du Québec, Québec, Canada; Population Research and Outcome Studies, University of Adelaide, South Australia, Australia. Electronic address: guillaumeruel4@hotmail.com.
Guillaume
G
Ruel
Population Research and Outcome Studies, University of Adelaide, South Australia, Australia; Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
Zumin
Z
Shi
Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
Shiqi
S
Zhen
Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
Hui
H
Zuo
Institut national de santé publique du Québec, Québec, Canada; Centre d'excellence sur le vieillissement de Québec, Université Laval, Québec, Canada.
Edeltraut
E
Kröger
Institut national de santé publique du Québec, Québec, Canada; Université du Québec à Rimouski, Canada.
Caroline
C
Sirois
Institut national de santé publique du Québec, Québec, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada.
Jean-Frédéric
JF
Lévesque
Population Research and Outcome Studies, University of Adelaide, South Australia, Australia.
Anne W
AW
Taylor
D000328:Adult; D015992:Body Mass Index; D002681:China; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002523:Edible Grain; D002149:Energy Intake; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008875:Middle Aged; D009017:Morbidity; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies; D057185:Sedentary Behavior; D012959:Socioeconomic Factors; D014675:Vegetables; D055815:Young Adult
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D004044:Dietary Proteins; D018977:Micronutrients
Chronic diseases and fruits and vegetables; Comorbidity; Multimorbidity; Nutrition