Sex differences in association of cMIND diet with all-cause mortality in Chinese older adults: a 10-year national cohort study

BACKGROUND: The impact of diet on public health has always been a hot topic. This study first identified the association and sex differences between the modified Chinese version of the Mediterranean-DASH Intervention for Neurodegenerative Delay (cMIND) diet and all-cause mortality in Chinese older adults. METHODS: The data were obtained from the China Longitudinal Healthy Longevity Survey. The Cox regression model analyzed the association between the cMIND diet and all-cause mortality, conducted trend tests, and performed extensive subgroup and interaction analyses. Restricted cubic splines (RCS) were used to test the dose-response relationship. The random forest model ranked the importance of the components of the cMIND diet. Propensity score matching and two sensitivity analyses confirmed the robustness of the results. RESULTS: Compared to participants in Q1 of the cMIND diet, those in Q4 had a 23.3% lower risk of death (HR = 0.767, 95% CI: 0.722-0.815), with males benefiting more than females (female: HR = 0.810, 95% CI: 0.748, 0.878 vs. male: HR = 0.707, 95% CI: 0.643-0.778). The RCS results indicated a significant dose-response relationship between the above associations. The interaction analyses identified significant moderating effects of ethnic group, marital status, years of schooling, exercise, BMI, diabetes, and residence. The random forest analyses' results showed that the amount of staple food is the most important dietary factor influencing all-cause mortality. CONCLUSION: The identification of associations and the manifestation of sex differences in this study provided evidence in support of the optimization of dietary structure and precision dietary interventions for Chinese older adults.