Plant-based index linked to fall risk in older Chinese adults: cross-sectional evidence from a national cohort

Abstract

Objectives: Epidemiology showed that the falling incidences increased with advanced age, and recent findings found link between nutritional intake and risk of falls. Nevertheless, the relationship between different plant-based diets and the risk of falls in older adults remains unclear. Our investigation aimed to evaluate the correlation between various plant-based diet indices and the occurrence of falls.

Design: This study is a cross-sectional and post-hoc analysis from a national cohort study.

Setting and participants: We included individuals over 65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) recruited in 2018 with information on falls and dietary assessments, finally 11,044 participants were eligible.

Measurements: Using food frequency questionnaire (FFQ), we calculated plant-based index scores categorized as unhealthy plant-based index (uPDI) and healthy plant-based index (hPDI). The primary outcome was falls obtained from questionnaire. Statistical analysis was performed utilizing logistic regression model to investigate the relationship between the plant-based diet indices and falls. We also used the subgroup analysis to investigate the interaction of falls and plant-based diet index (PDI) among different status and used the restricted cubic spline (RCS) curves to investigate the connection between the PDI scores and falls risk.

Results: Among 11,044 participants included in our study, a total of 2493 fall cases were observed. The logistic regression analysis revealed that the plant-based index related to falls. In the adjusted model, per 10-unit increment of hPDI has a significant decreased risk of falls (odd ratio [OR]: 0.85, 95% confidence interval [CI]: 0.79-0.91, P for trend < 0.001) and per 10-unit increment in uPDI increased the risk of falls (OR: 1.21, 95% CI: 1.13-1.30, P for trend < 0.001). We also revealed an interaction between smoking status and falls among the uPDI group (P_interaction = 0.012). Finally, we found that with plant-based index scores increased, the odds of falls among hPDI decreased (P for overall < 0.001, P nonlinear = 0.0239), and the odds of falls among uPDI increased (P for overall < 0.001, P nonlinear = 0.0332).

Conclusion and implications: We found significant association between the Plant-based diet index and the risk of falls, highlighting the key role of the consumption of nutritious plant-based foods on the risk of falls, which needed take into account in developing intervention and prevention strategies to decrease falls among older Chinese adults.

Keywords: Plant-based diet; Falls; Older population.

Fig. 1

Study flowchart

Fig. 2

Subgroup analysis between hPDI and falls, ORs and 95% CI for fall risk per 10-unit increment in adherence to healthy plant-based diet indices. The logistic model adjusted for age, sex, ethnicity, smoking status, residence, marital status, year of schooling, alcohol consumption, body mass index. CI: confidence interval; uPDI: unhealthy plant-based diet; hPDI: healthy plant-based diet; OR: odd ratio

Fig. 3

ORs and 95% CIs for fall risks, according to continuous plant-based diet index. The curves were multivariable adjusted for age, sex, ethnicity, smoking status, residence, year of schooling, alcohol consumption, marital status, body mass index. P_nonlinear for hPDI = 0.0239, P_nonlinear for uPDI = 0.0332. CI: confidence interval; hPDI: healthy plant-based diet; uPDI: unhealthy plant-based diet; OR: odd ratio