Objective: to map and identify evidence on the relationship between diet and multimorbidity of chronic non-communicable diseases (NCDs) among adults. Methods: a scoping review was conducted in the electronic Virtual Health Library (VHL), EMBASE, PubMed, Scientific Electronic Library Online (SciELO), Science Direct and Scopus databases. The inclusion criteria admitted quantitative studies published between 2000 and 2023 whose title and abstract mentioned multimorbidity and diet or used similar words. Results: the search retrieved 37 articles, 17 of which were included for analysis using the PRISMA-ScR protocol. Diets rich in fruit and vegetables were associated with decreased risk of multimorbidity, while the main dietary risk factor for multimorbidity was diets rich in red meat and chicken, possibly influenced by dietary patterns and lifestyle factors. Conclusion: this review summarised the findings of studies describing the evidence of association between diet and multimorbidity, which has important public health implications.
KeywordsMultimorbidityDietAdultReview
World Health Organization (WHO) (2016) Multimorbidity: Technical Series on Safer Primary Care. Geneva: World Health Organization.
Skou, S.T., Mair, F.S., Fortin, M., Guthrie, B., Nunes, B.P., Miranda, J.J., et al . (2022) Multimorbidity. Nature Reviews Disease Primers , 8, Article No. 48. https://doi.org/10.1038/s41572-022-00376-4
Xu, X., Mishra, G.D. and Jones, M. (2017) Evidence on Multimorbidity from Definition to Intervention: An Overview of Systematic Reviews. Ageing Research Reviews , 37, 53-68. https://doi.org/10.1016/j.arr.2017.05.003
Koyanagi, A., Lara, E., Stubbs, B., Carvalho, A.F., Oh, H., Stickley, A., et al . (2018) Chronic Physical Conditions, Multimorbidity, and Mild Cognitive Impairment in Low‐ and Middle‐Income Countries. Journal of the American Geriatrics Society , 66, 721-727. https://doi.org/10.1111/jgs.15288
Nguyen, H., Manolova, G., Daskalopoulou, C., Vitoratou, S., Prince, M. and Prina, A.M. (2019) Prevalence of Multimorbidity in Community Settings: A Systematic Review and Meta-Analysis of Observational Studies. Journal of Comorbidity , 9. https://doi.org/10.1177/2235042x19870934
Carvalho, J.N.d., Roncalli, Â.G., Cancela, M.d.C. and Souza, D.L.B.d. (2017) Prevalence of Multimorbidity in the Brazilian Adult Population According to Socioeconomic and Demographic Characteristics. PLOS ONE , 12, e0174322. https://doi.org/10.1371/journal.pone.0174322
Rzewuska, M., de Azevedo-Marques, J.M., Coxon, D., Zanetti, M.L., Zanetti, A.C.G., Franco, L.J., et al . (2017) Epidemiology of Multimorbidity within the Brazilian Adult General Population: Evidence from the 2013 National Health Survey (PNS 2013). PLOS ONE , 12, e0171813. https://doi.org/10.1371/journal.pone.0171813
Souza, A.C.D.d., Barbosa, I.R. and Souza, D.L.B.d. (2020) Prevalence of Multimorbidity and Associated Factors in the Brazilian Working Population. Revista Brasileira de Medicina do Trabalho , 18, 302-311. https://doi.org/10.47626/1679-4435-2020-568
Oliveira, A.P.F., Maciel, G.F., Trigueiro, G.M., Xavier, J.A., Pires, A.C., Ribeiro, L.M., et al . (2021) Risk Factors for Chronic Non-Communicable Diseases in Brazil. Brazilian Journal of Development , 7, 17242-17245.
Cena, H. and Calder, P.C. (2020) Defining a Healthy Diet: Evidence for the Role of Contemporary Dietary Patterns in Health and Disease. Nutrients , 12, Article No. 334. https://doi.org/10.3390/nu12020334
The Joanna Briggs Institute (2015) Joanna Briggs Institute reviewers’ Manual: 2015 Edition/Supplement. Adelaide (AU): The Joanna Briggs Institute, The University of Adelaide. Methodology for JBI Scoping Reviews.
Tricco, A.C., Lillie, E., Zarin, W., O’Brien, K.K., Colquhoun, H., Levac, D., et al . (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine , 169, 467-473. https://doi.org/10.7326/m18-0850
Arksey, H. and O’Malley, L. (2005) Scoping Studies: Towards a Methodological Framework. International Journal of Social Research Methodology , 8, 19-32. https://doi.org/10.1080/1364557032000119616
Tricco, A.C., Lillie, E., Zarin, W., O’Brien, K., Colquhoun, H., Kastner, M., et al . (2016) A Scoping Review on the Conduct and Reporting of Scoping Reviews. BMC Medical Research Methodology , 16, Article No. 15. https://doi.org/10.1186/s12874-016-0116-4
Peters, M., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. and Khalil, H. (2019) Chapter 11. Scoping Reviews. In: JBI Reviewer ’ s Manual , JBI. https://doi.org/10.46658/jbirm-20-01
Levac, D., Colquhoun, H. and O’Brien, K.K. (2010) Scoping Studies: Advancing the Methodology. Implementation Science , 5, Article No. 69. https://doi.org/10.1186/1748-5908-5-69
Ruel, G., Shi, Z., Zhen, S., Zuo, H., Kröger, E., Sirois, C., et al . (2014) Association between Nutrition and the Evolution of Multimorbidity: The Importance of Fruits and Vegetables and Whole Grain Products. Clinical Nutrition , 33, 513-520. https://doi.org/10.1016/j.clnu.2013.07.009
Fortin, M., Haggerty, J., Almirall, J., Bouhali, T., Sasseville, M. and Lemieux, M. (2014) Lifestyle Factors and Multimorbidity: A Cross Sectional Study. BMC Public Health , 14, Article No. 686. https://doi.org/10.1186/1471-2458-14-686
Pereira, B.P., Bortolotto, C.C., Tomasi, E., Gonzalez, M.C., Gomes, A.P. and Bielemann, R.M. (2020) Food Consumption and Multimorbidity among Non-Institutionalized Elderly People in Pelotas, 2014: A Cross-Sectional Study. Epidemiologia e Serviços de Saude , 2, e2019050.
Olivares, D.E.V., Chambi, F.R.V., Chañi, E.M.M., Craig, W.J., Pacheco, S.O.S. and Pacheco, F.J. (2017) Risk Factors for Chronic Diseases and Multimorbidity in a Primary Care Context of Central Argentina: A Web-Based Interactive and Cross-Sectional Study. International Journal of Environmental Research and Public Health , 14, Article No. 251. https://doi.org/10.3390/ijerph14030251
Katikireddi, S.V., Skivington, K., Leyland, A.H., Hunt, K. and Mercer, S.W. (2017) The Contribution of Risk Factors to Socioeconomic Inequalities in Multimorbidity across the Lifecourse: A Longitudinal Analysis of the Twenty-07 Cohort. BMC Medicine , 15, Article No. 152. https://doi.org/10.1186/s12916-017-0913-6
Rodrigues, A.M., Gregório, M.J., Sousa, R.D., Dias, S.S., Santos, M.J., Mendes, J.M., et al . (2018) Challenges of Ageing in Portugal: Data from the EpiDoC Cohort. Acta Médica Portuguesa , 31, 80-93. https://doi.org/10.20344/amp.9817
Dekker, L.H., de Borst, M.H., Meems, L.M.G., de Boer, R.A., Bakker, S.J.L. and Navis, G.J. (2019) The Association of Multimorbidity within Cardio-Metabolic Disease Domains with Dietary Patterns: A Cross-Sectional Study in 129 369 Men and Women from the Lifelines Cohort. PLOS ONE , 14, e0220368. https://doi.org/10.1371/journal.pone.0220368
Sakakibara, B.M., Obembe, A.O. and Eng, J.J. (2019) The Prevalence of Cardiometabolic Multimorbidity and Its Association with Physical Activity, Diet, and Stress in Canada: Evidence from a Population-Based Cross-Sectional Study. BMC Public Health , 19, Article No. 1361. https://doi.org/10.1186/s12889-019-7682-4
Olaya, B., Essau, C.A., Moneta, M.V., Lara, E., Miret, M., Martín-María, N., et al . (2019) Fruit and Vegetable Consumption and Potential Moderators Associated with All-Cause Mortality in a Representative Sample of Spanish Older Adults. Nutrients , 11, Article No. 1794. https://doi.org/10.3390/nu11081794
Ng, R., Sutradhar, R., Yao, Z., Wodchis, W.P. and Rosella, L.C. (2019) Smoking, Drinking, Diet and Physical Activity—Modifiable Lifestyle Risk Factors and Their Associations with Age to First Chronic Disease. International Journal of Epidemiology , 49, 113-130. https://doi.org/10.1093/ije/dyz078
Chudasama, Y.V., Khunti, K., Gillies, C.L., Dhalwani, N.N., Davies, M.J., Yates, T., et al . (2020) Healthy Lifestyle and Life Expectancy in People with Multimorbidity in the UK Biobank: A Longitudinal Cohort Study. PLOS Medicine , 17, e1003332. https://doi.org/10.1371/journal.pmed.1003332
Jeong, D., Kim, J., Lee, H., Kim, D. and Lim, H. (2020) Association of Cardiometabolic Multimorbidity Pattern with Dietary Factors among Adults in South Korea. Nutrients , 12, Article No. 2730. https://doi.org/10.3390/nu12092730
Espeland, M.A., Gaussoin, S.A., Bahnson, J., Vaughan, E.M., Knowler, W.C., Simpson, F.R., et al . (2020) Impact of an 8‐Year Intensive Lifestyle Intervention on an Index of Multimorbidity. Journal of the American Geriatrics Society , 68, 2249-2256. https://doi.org/10.1111/jgs.16672
Shang, X., Peng, W., Wu, J., He, M. and Zhang, L. (2020) Leading Determinants for Multimorbidity in Middle-Aged Australian Men and Women: A Nine-Year Follow-Up Cohort Study. Preventive Medicine , 141, Article ID: 106260. https://doi.org/10.1016/j.ypmed.2020.106260
Bishop, N.J., Ullevig, S.L., Wang, K. and Zuniga, K.E. (2021) Dietary Quality Modifies the Association between Multimorbidity and Change in Mobility Limitations among Older Americans. Preventive Medicine , 153, Article ID: 106721. https://doi.org/10.1016/j.ypmed.2021.106721
Zhang, Y., Chen, H., Carrillo-Larco, R.M., Lim, C.C.W., Mishra, S.R., Yuan, C., et al . (2022) Association of Dietary Patterns and Food Groups Intake with Multimorbidity: A Prospective Cohort Study. Clinical Nutrition ESPEN , 51, 359-366. https://doi.org/10.1016/j.clnesp.2022.07.019
Sturmer, J., Franken, D.L., Ternus, D.L., Henn, R.L., Dias-da-Costa, J.S., Olinto, M.T.A., et al . (2022) Dietary Pattern as a Predictor of Multimorbidity Patterns: A Population-Based Cross-Sectional Study with Women. Clinical Nutrition ESPEN , 51, 452-460. https://doi.org/10.1016/j.clnesp.2022.06.105
World Health Organization (WHO) (2003) Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. WHO. https://www.who.int/publications/i/item/924120916X
Wadden, T.A., West, D.S., Neiberg, R.H., Wing, R.R., Ryan, D.H., Johnson, K.C., et al . (2009) One‐Year Weight Losses in the Look AHEAD Study: Factors Associated with Success. Obesity , 17, 713-722. https://doi.org/10.1038/oby.2008.637
Raynor, H.A., Anderson, A.M., Miller, G.D., Reeves, R., Delahanty, L.M., Vitolins, M.Z., et al . (2015) Partial Meal Replacement Plan and Quality of the Diet at 1 Year: Action for Health in Diabetes (Look AHEAD) Trial. Journal of the Academy of Nutrition and Dietetics , 115, 731-742. https://doi.org/10.1016/j.jand.2014.11.003
Honorato, M.M., Amorim, S.O.d., Honorato, L.G.F., Oliveira, S.M.S.d., Cremaschi, R.M.d.C. and Coelho, F.M.S. (2024) A importância da análise de sobrevida para os estudos epidemiológicos e de saúde. Revista Ibero - Americana de Humanidades , Ciências e Educação , 10, 1880-1888. https://doi.org/10.51891/rease.v10i4.13697
Vega-Cabello, V., Struijk, E.A., Caballero, F.F., Yévenes-Briones, H., Ortolá, R., Calderón-Larrañaga, A., et al . (2023) Diet Quality and Multimorbidity in Older Adults: A Prospective Cohort Study. The Journals of Gerontology , Series A : Biological Sciences and Medical Sciences , 79, glad285. https://doi.org/10.1093/gerona/glad285
Ioannidis, J.P.A. (2005) Why Most Published Research Findings Are False. PLOS Medicine , 2, e124. https://doi.org/10.1371/journal.pmed.0020124
Afshar, S., Roderick, P.J., Kowal, P., Dimitrov, B.D. and Hill, A.G. (2015) Multimorbidity and the Inequalities of Global Ageing: A Cross-Sectional Study of 28 Countries Using the World Health Surveys. BMC Public Health , 15, Article No. 776. https://doi.org/10.1186/s12889-015-2008-7