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Background <p>We aimed to examine whether dietary iron intake is associated with cardiometabolic multimorbidity (CMM) incidence and the potential role of biological age in mediating this association.</p> Methods <p>Based on data from the 2009 China Nutrition and Health Survey (CHNS), a national prospective cohort study of the Chinese population. Dietary intake was calculated from three consecutive 24-hour dietary recalls and household food stocks. CMM was defined as the presence of at least two cardiometabolic diseases (hypertension, diabetes, stroke, and myocardial infarction). Biological aging indicators included Klemera–Doubal method (KDM), phenotypic age (PA), homeostatic dysregulation (HD), and adaptive load (AL). Data were analyzed using COX risk regression, restricted cubic spline method (RCS) analysis and subgroup analysis. Mediation analysis was used to explore the mediating role of biological aging.</p> Results <p>High total iron intake (HR<sub>Q1 vs. Q5</sub>: 0.74, 95%CI: 0.57–0.97) and nonheme iron intake (HR<sub>Q1 vs. Q5</sub>: 0.69, 95%CI: 0.53–0.90) were associated with a lower risk of developing CMM. Compared to the age deceleration group, all age acceleration groups were associated with a significantly higher incidence of CMM, with hazard ratios of 3.41 (95% CI: 2.95–3.95) for KDM, 3.36 (95% CI: 2.88–3.92) for PA, 4.33 (95% CI: 3.55–5.28) for HD, and 3.42 (95% CI: 2.91–4.03) for AL. Total dietary iron intake and dietary non-heme iron intake were U-shapedly correlated with biological age (<i>P</i> for nonlinearity &lt; 0.001). In the total population, significant indirect effects average causal mediation effects of total iron 0.03% (95% CI: 0.01%–0.04%) and non-heme iron 0.02% (95% CI: 0.01%–0.03%) were exhibited via the KDM algorithm, while heme iron 0.24%–0.45% (95% CI: 0.06%–1.07%) demonstrated significant indirect effects through all four biological age algorithms.</p> Conclusion <p>High dietary iron intake is associated with a lower risk of CMM, partially mediated by biological aging. Appropriate intake of total dietary iron and non-heme iron may be associated with a slowed biological aging process and a lower risk of CMM.</p>

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The association between dietary iron intake and the incidence of cardiometabolic multimorbidity: the mediating role of biological age

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月10日

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  • Ningbo Chen,
  • Dan Yang,
  • Guiyuan Qiao,
  • Zhilan Ke,
  • Yudi Tang,
  • Jing Zhou,
  • Xinhong Zhu

摘要

Background

We aimed to examine whether dietary iron intake is associated with cardiometabolic multimorbidity (CMM) incidence and the potential role of biological age in mediating this association.

Methods

Based on data from the 2009 China Nutrition and Health Survey (CHNS), a national prospective cohort study of the Chinese population. Dietary intake was calculated from three consecutive 24-hour dietary recalls and household food stocks. CMM was defined as the presence of at least two cardiometabolic diseases (hypertension, diabetes, stroke, and myocardial infarction). Biological aging indicators included Klemera–Doubal method (KDM), phenotypic age (PA), homeostatic dysregulation (HD), and adaptive load (AL). Data were analyzed using COX risk regression, restricted cubic spline method (RCS) analysis and subgroup analysis. Mediation analysis was used to explore the mediating role of biological aging.

Results

High total iron intake (HRQ1 vs. Q5: 0.74, 95%CI: 0.57–0.97) and nonheme iron intake (HRQ1 vs. Q5: 0.69, 95%CI: 0.53–0.90) were associated with a lower risk of developing CMM. Compared to the age deceleration group, all age acceleration groups were associated with a significantly higher incidence of CMM, with hazard ratios of 3.41 (95% CI: 2.95–3.95) for KDM, 3.36 (95% CI: 2.88–3.92) for PA, 4.33 (95% CI: 3.55–5.28) for HD, and 3.42 (95% CI: 2.91–4.03) for AL. Total dietary iron intake and dietary non-heme iron intake were U-shapedly correlated with biological age (P for nonlinearity < 0.001). In the total population, significant indirect effects average causal mediation effects of total iron 0.03% (95% CI: 0.01%–0.04%) and non-heme iron 0.02% (95% CI: 0.01%–0.03%) were exhibited via the KDM algorithm, while heme iron 0.24%–0.45% (95% CI: 0.06%–1.07%) demonstrated significant indirect effects through all four biological age algorithms.

Conclusion

High dietary iron intake is associated with a lower risk of CMM, partially mediated by biological aging. Appropriate intake of total dietary iron and non-heme iron may be associated with a slowed biological aging process and a lower risk of CMM.