Association between nutrition and the evolution of multimorbidity: the importance of fruits and vegetables and whole grain products

Clin Nutr. 2014 Jun;33(3):513-20. doi: 10.1016/j.clnu.2013.07.009. Epub 2013 Jul 22.


Background & aims: Multimorbidity is a common health status. The impact of nutrition on the development of multimorbidity remains to be determined. The aim of this study is to determine the association between foods, macronutrients and micronutrients and the evolution of multimorbidity.

Methods: Data from 1020 Chinese who participated in the Jiangsu longitudinal Nutrition Study (JIN) were collected in 2002 (baseline) and 2007 (follow-up). Three-day weighted food records and status for 11 chronic diseases was determined using biomedical measures (hypertension, diabetes, hypercholesterolemia and anemia) or self-reports (coronary heart disease, asthma, stroke, cancer, fracture, arthritis and hepatitis). Participants were divided in six categories of stage of evolution of multimorbidity. Association of foods, macronutrients and micronutrients at baseline with stages in the evolution of multimorbidity were determined. Data were adjusted for age, sex, BMI, marital status, sedentary lifestyle, smoking status, annual income, education and energy intake.

Results: The prevalence of multimorbidity increased from 14% to 34%. A high consumption of fruit and vegetables (p < 0.05) and grain products other than rice and wheat (p < 0.001) were associated with healthier stages in the evolution of multimorbidity. The consumption of grain products other than rice and wheat was highly correlated with dietary fibers (r = 0.77, p < 0.0001), iron (r = 0.46, p < 0.0001), magnesium (r = 0.49, p < 0.0001) and phosphorus (r = 0.57, p < 0.0001) intake which were also associated with healthier stages.

Conclusion: This study provides the first evidence of an association between nutrition and evolution towards multimorbidity. More precisely, greater consumption of fruits and vegetable and whole grain products consumption appear to lower the risk of multimorbidity.

Keywords: Chronic diseases and fruits and vegetables; Comorbidity; Multimorbidity; Nutrition.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index
  • China
  • Chronic Disease / epidemiology*
  • Chronic Disease / therapy*
  • Dietary Carbohydrates / administration & dosage
  • Dietary Fats / administration & dosage
  • Dietary Fiber / administration & dosage
  • Dietary Proteins / administration & dosage
  • Edible Grain*
  • Energy Intake
  • Female
  • Fruit*
  • Humans
  • Male
  • Micronutrients / administration & dosage
  • Middle Aged
  • Morbidity
  • Nutrition Assessment
  • Nutritional Status*
  • Prospective Studies
  • Sedentary Behavior
  • Socioeconomic Factors
  • Vegetables*
  • Young Adult


  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Fiber
  • Dietary Proteins
  • Micronutrients