Aims: Patients with chronic kidney disease (CKD) are at an increased risk of developing heart failure. The American Heart Association recently released a new metric, Life’s Essential 8 (LE8), for health promotion. However, evidence regarding associations between LE8 and heart failure risk among patients with CKD is scarce. Methods and results: A total of 16 190 patients with CKD (mean age 55.9 years), free of cardiovascular disease at recruitment from the Kailuan Study, were included. Cardiovascular health was assessed using the LE8 score. Incident heart failure events were ascertained via linkage of electronic health record data. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs). There were 814 (5.0%) patients in the high LE8 criteria, with 13 180 (81.4%) in the moderate, and 2196 (13.6%) in the low LE8 category, respectively. During a median follow-up of 13.7 years, 724 incident heart failure cases were documented. Compared with the low LE8 category, the HRs (95% CIs) for heart failure were 0.58 (0.48, 0.71) for the moderate LE8 category and 0.32 (0.19, 0.54) for the high LE8 category (P for trend <0.001). In addition, the association was stronger in patients aged ≤65 years compared with their older counterparts (P for interaction = 0.01). Conclusion: Our data showed a strong graded inverse association between the LE8-defined cardiovascular health and the risk of heart failure among patients with CKD. Our findings support the importance of adopting the LE8 among patients with CKD to prevent heart failure.

Inadequate calcium intake is common in the US. Trends in calcium intake among the US population have been less studied, especially in more recent years. We used data from the National Health and Nutrition Examination Survey (NHANES) 1999–2000 to 2017–2018 to study trends in calcium derived from diet and dietary supplements among the US population aged 2 years, stratified by sex, age group, race, and ethnicity. Among the 80,880 participants included in our study, a substantial portion consistently lacked sufficient calcium intake, even when considering calcium from supplements. Concerning trends were observed over the more recent ten years (2009–2018), with decreased dietary calcium intake and no significant improvement in the prevalence of dietary calcium intake < Estimated Average Requirement (EAR) or the prevalence of taking calcium-containing dietary supplements among them. Decreasing trends in dietary calcium intake were more concerning among men, children, and non-Hispanic Whites. Attention should be given to subgroups with higher calcium intake requirements (e.g., 9–18 years and 60+ years), and subgroups with low levels of dietary calcium and a low prevalence of obtaining calcium from dietary supplements (e.g., the non-Hispanic Black subgroup). Concerning trends of calcium intake were observed among the US population from 2009 to 2018. Tailored guidance on dietary choices and dietary supplement use is required to change consumers’ behaviors.

Although dietary patterns rich in plant-based food have been linked to lower frailty risk in older adults, the relationship between vegetarian diet and incident frailty has been understudied. Therefore, this study aimed to investigate the association between vegetarian diet and risk of frailty in a nationwide representative cohort of Chinese community-dwelling older adults (≥ 65 years old). Included were 27,917 participants (age range: 65–122 years; mean age: 86.9 ± 11.0 years) free of frailty at study entry, from the Chinese Longitudinal Healthy Longevity Survey initiated in 1998. According to the consumption of meat, fish, eggs, and milk products assessed by the food frequency questionnaire at each survey, participants were categorized as omnivores (n = 23,541) or vegetarians (n = 4376), among which were further classified as pesco-vegetarians (n = 1547), ovo-lacto-vegetarians (n = 1745), and vegans (n = 1084). Diet trajectory (from baseline to the first follow-up survey, median interval: 2.8 years) categories included Stick-To-Omnivorous, Stick-To-Vegetarian, Omnivorous-To-Vegetarian, and Vegetarian-To-Omnivorous. Frailty was defined by a frailty index > 0.25 based on 40 variables reflecting health deficits. We used multivariable time-varying Cox proportional hazard models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of frailty risk according to different diet groups and diet trajectories. During a median follow-up of 3.0 (IQR: 1.83–5.33) years, vegetarians showed a higher risk of incident frailty (HR [95% CI]: 1.13 [1.07, 1.20]) compared to omnivores. Similar patterns were observed across subgroups of vegetarian diet, including pesco-vegetarians (HR [95% CI]: 1.15 [1.05, 1.26]), ovo-lacto-vegetarians (HR [95% CI]: 1.11 [1.02, 1.20]), and vegans (HR [95% CI]: 1.12 [1.01, 1.25]). In terms of diet trajectory, maintaining vegetarian diets (HR [95% CI]: 1.19 [1.03, 1.38]), transition from the omnivorous diet to vegetarian diets (HR [95% CI]: 1.16 [1.04, 1.30]), and transition from vegetarian diets to the omnivorous diet (HR [95% CI]: 1.14 [1.02, 1.27]) were all associated with higher risks of frailty, compared with maintaining an omnivorous diet. In this prospective study, vegetarian diets were observed to be associated with higher frailty risk, compared to the omnivorous diet in Chinese older adults. Future research is needed to confirm our observations.

Vegetarian diets are increasingly popular worldwide, but their impact on healthy aging in older adults remains unclear. This study examined the association between vegetarian diets and healthy aging among 2,888 healthy older Chinese adults from the Chinese Longitudinal Healthy Longevity Survey. Dietary patterns (vegan, ovo-vegetarian, pesco-vegetarian, omnivorous) were derived from a simplified non-quantitative food frequency questionnaire. Over a median follow-up of 6 years, after accounting for sociodemographic and lifestyle factors, vegetarians had lower odds of achieving healthy aging compared to omnivores (adjusted OR = 0.65, 95% CI: 0.47-0.89), with consistent results across sensitivity analyses and individual health components. Additionally, the health effects of vegetarian diets may vary depending on diet quality, with vegetarians of higher diet quality not significantly differing in terms of overall healthy aging and individual outcomes when compared to omnivores. Accordingly, this finding highlights modest inclusion of animal-based foods may improve the overall health status of healthy older adults.