The association of multimorbidity within cardio-metabolic disease domains with dietary patterns: A cross-sectional study in 129 369 men and women from the Lifelines cohort

Background Multimorbidity is considered a major challenge for current health care. Lifestyle interventions, as a broad and generic approach, may have the potential to improve the management of care among patients with multimorbidity. The objective of this study was to evaluate the association of multimorbidity defined within the cardiometabolic disease domains with dietary patterns, representing habitual dietary intake. Design We studied 129 369 participants from the Lifelines Cohort study (42% male, 45 +/- 13 years (range 18-93)) in which diet was assessed using a 110-item food frequency questionnaire. A composite morbidity score was applied in multivariable ordered logistic regression to test the association with dietary patterns derived by principal components analysis, based on sex-specific dietary pattern scores. Results Four dietary patterns were retained, accounting for 26.6% of the variation in overall diet. After control for potential confounders, men and women in the highest quintile of meat, alcohol and potato pattern and snack pattern had a higher likelihood of having higher morbidity scores than those in the lowest quintile (e.g. men: OR = 1.83(95% CI: 1.71-1.97), OR = 1.18(95% CI 1.11-1.27 respectively). The opposite was observed with respect to the bread and sweets pattern and vegetable, fish and fruit pattern (e.g. women: OR = 0.88 (95% CI: 0.81-0.96), OR = 0.86(95% CI 0.81-0.92 respectively). The association partially attenuated after adjusting for BMI, but the associations remained significant among men. Conclusions Robust associations between dietary patterns and multimorbidity within the cardiometabolic domain, in particular a meat, alcohol and potato pattern, suggest an important opportunity of dietary interventions in multimobidity prevention. Generic prevention strategies based on population derived dietary patterns may have the potential to enhance lifestyle management among people with multimorbidity.