A hypothetical intervention analysis for the effects of healthy dietary patterns on reducing major chronic diseases and mortality associated with air pollutant mixtures.

Abstract

Randomized trials have not assessed how changing dietary patterns affects air pollution-related chronic diseases and mortality. We estimated these risks under hypothetical dietary interventions. 17,254 UK Biobank adults with repeated 24-h dietary assessments (2009-2012) were included. Exposures to six air pollutants (PM_2.5, PM₁₀, NO₂, NO_X, SO₂, and benzene) were estimated using the bilinear interpolation algorithm. Outcomes included incident cardiovascular disease (CVD), diabetes, cancer, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dementia, and all-cause mortality. Eleven dietary patterns were calculated. Using the parametric g-formula, we simulated interventions increasing dietary scores (75th/90th percentiles, optimal adherence), estimating 13-year cumulative risks and risk difference (RD) for outcomes associated with air pollutant mixtures. Over 12.9 median follow-up years, 2295 CVD, 475 diabetes, 1912 cancer, 969 CKD, 395 COPD, 405 dementia cases, and 814 deaths occurred. Increased adherence to ten dietary patterns (excluding the healthy low-carbohydrate diet) reduced air pollution-related disease risks, with maximal benefit at optimal adherence. For example, comparing interventions targeting dietary diversity score with non-intervention, the 13-year RD (per 1000 population) ranged from - 0.48 to - 2.14 for CVD, - 2.85 to - 10.16 for diabetes, - 0.65 to - 2.95 for cancer, - 4.26 to - 16.22 for CKD, - 2.79 to - 9.60 for COPD, - 3.64 to - 12.12 for dementia, and - 2.54 to - 9.84 for death. Interventions optimizing dietary patterns could mitigate the 13-year risks of major chronic diseases and mortality linked to air pollutant mixtures. Adherence to healthy dietary patterns holds significant public health potential for preventing air pollution-related morbidity and premature death.