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Associations of Dietary Patterns and Micronutrients With Major Adverse Cardiovascular Events and Mortality Among

Yingqi Hou1,2,3, Kaixin Yuan4, Yadan Xu5

  • 1Clinical Research Unit, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China.

Food Science & Nutrition
|July 3, 2026
PubMed

Insights

Plant-based diets like the alternative Mediterranean diet (AMED) and healthful plant-based diet index (HPDI) are linked to lower major adverse cardiovascular events (MACE) and mortality in cardiovascular-kidney-metabolic (CKM) syndrome. Adequate micronutrient intake also shows protective effects.

Area of Science:

  • Cardiovascular epidemiology
  • Nutritional science
  • Metabolic syndrome research

Background:

  • Cardiovascular-kidney-metabolic (CKM) syndrome is a recently proposed condition requiring further understanding of dietary impacts.
  • Associations between plant-based diets, inflammatory diets, and micronutrient intake with major adverse cardiovascular events (MACE) and mortality in CKM syndrome stages 0-3 are not well-established.

Purpose of the Study:

  • To investigate the association of plant-based diets, inflammatory diets, and micronutrient intake with MACE and mortality in patients with CKM syndrome stages 0-3.
  • To explore potential mediating pathways including oxidative stress, phenotypic aging, and inflammatory markers.

Main Methods:

  • Utilized data from the National Health and Nutrition Examination Survey (NHANES) and UK Biobank (UKB) cohort studies (total N=99,064).
  • Calculated dietary scores including alternative Mediterranean diet (AMED), Healthful Plant-Based Diet Index (HPDI), and Dietary Inflammatory Index (DII).
  • Employed multivariate Cox Regression models, restricted cubic spline analyses, and mediation analyses.

Main Results:

  • Higher adherence to AMED and HPDI was significantly associated with reduced MACE and all-cause mortality.
  • Each standard deviation increase in AMED and HPDI scores correlated with a 5%-7% decrease in MACE incidence.
  • Increased intake of specific vitamins (Alpha/Beta-carotene, Vitamin C) and minerals (copper, iron, magnesium) showed potential benefits for reducing MACE and mortality.
  • Oxidative stress, phenotypic aging, and inflammatory markers partially mediated these dietary associations.

Conclusions:

  • Adherence to plant-based dietary patterns (HPDI, AMED) and adequate micronutrient intake may improve cardiovascular and metabolic health in individuals with CKM syndrome.
  • Reducing pro-inflammatory diets, particularly red meat-based ones, is advisable.
  • Dietary interventions targeting plant-based nutrition and micronutrients show promise for managing CKM syndrome.

Keywords:
MACENHANESUK Biobankcardiovascular‐kidney‐metabolic syndromeinflammatory dietsmicronutrientsplant‐based diets

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