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It is generally believed that greater dietary diversity is associated with better health status. Individuals’ dietary diversity can change with age; however, evidence on the trajectory of long-term change and whether it is related to all-cause mortality is still scarce. In this study, we used data from the China Health and Nutrition Survey (CHNS) collected in five follow-ups between 2004 and 2015 to explore the association between changes in dietary diversity scores (DDS) and all-cause mortality, as well as the dynamic change in DDS with age.
In total, 6,737 individuals (aged 30–60 years at enrollment) were included in the analysis. Latent Class Trajectory Modeling (LCTM) was used to explore different trajectories of DDS changes among participants. Four classes were identified: class 1 with the lowest mean DDS (3.0) which showed a gradual decline during follow-ups; class 2 with relatively low DDS (4.0) which experienced slight growth; class 3 with medium DDS (5.2) which also demonstrated a similar growth rate to class 2; and class 4 with the highest DDS (6.7) maintained at a high level. Cox proportional hazards regression models were applied to investigate the association between DDS trajectories and the risk of death. Only class 4, which was characterized by the highest and stable DDS, had a significantly reduced risk of all-cause mortality by 71.0% (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.10–0.83), 68% (HR: 0.32; 95% CI: 0.11–0.89), and 66.0% (HR: 0.34; 95% CI: 0.12–0.94), compared to classes 1, 2, and 3, respectively, while the first three classes showed no significant differences between classes. When considering the average DDS during the study period, each one-point increase in DDS corresponded to a 22% reduction in mortality risk (HR: 0.78; 95% CI: 0.69–0.89). In summary, achieving and maintaining a higher DDS was associated with a reduction in the risk of all-cause mortality. Therefore, promoting a diverse diet and increasing the accessibility of food varieties should receive more attention from policymakers and be further emphasized in dietary guidelines.
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