Link between nutrient intake and multimorbidity risk reported in recent study, more research is needed

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In a recent study published in BMC Public Health, researchers explored potential associations between nutrient intake and multimorbidities.

Study: Nutrient intake and risk of multimorbidity: a prospective cohort study of 25,389 women. Image Credit: Saowanee K/
Study: Nutrient intake and risk of multimorbidity: a prospective cohort study of 25,389 women. Image Credit: Saowanee K/


Multimorbidity, or the presence of many chronic illnesses, is a worldwide health concern, particularly among older individuals. It raises the risk of early mortality, hospitalization, loss of physical function, depression, polypharmacy, and a decline in quality of life, inflicting a considerable cost load on healthcare systems.

Nutritional variables have a vital role in multimorbidity prevention. Unhealthy dietary habits like binge eating and excessive drinking might raise the risk. In the Netherlands, individuals with cardiometabolic multimorbidity eat more meat and snacks. Consuming fruits, vegetables, and whole grains can help reduce the risk. Mediterranean diets and increasing calcium and potassium intake are associated with decreased cardiometabolic multimorbidity. Lutein and zeaxanthin are potentially helpful nutrients. However, further study is needed to discover dietary therapies that reduce the multimorbidity burden.  

About the study

In the present prospective cohort study, researchers investigated the influence of dietary intake on multimorbidity risk.

The researchers analyzed the United Kingdom Women’s Cohort Study (UKWCS) data from 25,389 females aged between 35 and 69 years. The UKWCS dataset included food intake, anthropometric parameters, socioeconomic status, lifestyle habits, and health outcomes. The participants self-reported baseline chronic diseases such as hypertension, angina, coronary artery disease, stroke, diabetes, hyperlipidemia, gallstones, large intestinal polyps, and cancer.

The team excluded non-residents of England with multiple chronic diseases at baseline and missing covariate data. They used food frequency questionnaires (FFQs) from the UK for the European Prospective Investigation into Cancer and Nutrition (EPIC) study to estimate daily energy and nutrient intakes. They assessed multimorbidity using Charlson comorbidity index (CCI) scores electronically linked to the Hospital Episode Statistics (HES) database through March 2019, using the International Classification of Diseases, tenth edition, Australian modification (ICD-10-AM) codes. 

The researchers assessed dietary intake using McCance & Widdowson Food Composition (fifth edition) and Food Standards Agency guidelines, adjusting for total calorie intake by nutrient density. They performed Cox proportional hazards modeling to estimate hazard ratios (HRs) for the relationships between regular nutrient intake and multimorbidity risk. They used multinomial logistic regressions to evaluate the association in the sensitivity analysis and performed a stratified assessment, considering 60 years as the threshold for age. Study covariates included age, body mass index (BMI), educational level, marital status, ethnicity, socioeconomic status (SES), and physical activity.


The mean participant age was 51 years, among whom 31% (n=7,799) developed multimorbidities over a 22-year follow-up (median). Individuals with multimorbidity had a higher BMI, lower educational levels, and higher SES status and showed an increased likelihood of being single or widowed compared to their counterparts.

Compared to the lowermost quintile, the uppermost quintile of regular calorie and protein intakes was related to 8.0% and 12% higher multimorbidity risks, respectively (hazard ratio, 1.1). Compared to the lowermost quintile, higher statistical quintiles of regular vitamin C consumption had a 10% lowered multimorbidity risk, while regular vitamin D consumption had a 10% increased multimorbidity risk. In comparison to the lowermost quintile of vitamin B12 consumption, multimorbidity risk was significantly higher in the topmost quintile (HR, 1.1). Compared with the lowermost quintile, higher quintiles of iron intake had marginally lowered multimorbidity risks.

In the sensitivity analysis, the significantly higher multimorbidity risks linearly related to higher statistical quintiles of B12 and D vitamin intakes were non-significant using multinomial logistic regressions. The team found evidence of age-modifying effects on vitamin B1 and iron intakes associated with multimorbidity risk. For iron intake, the team found an 11% to 13% lower multimorbidity risk among individuals below 60 years compared to those aged above 60 years.


The study findings highlighted a relationship between nutrient consumption and the risk of multimorbidity for developing preventive, diagnostic, treatment, and prognostic methods. The findings indicated that higher intakes of vitamin B12, vitamin D, protein, and energy may raise the risk of multimorbidity, but higher intakes of vitamin C may reduce it. It is important to note that these associations became insignificant in multinomial logistic regression. Iron consumption was adversely linked with multimorbidity risk in women aged <60 years, while there was no such association in women aged >60 years.

The study reveals that specific nutrients, notably vitamin B12, vitamin D, protein, and energy, may influence the likelihood of multimorbidity. Researchers must further investigate the optimal nutritional consumption levels for individuals with multimorbidity, and policymakers and clinical practitioners should address individualized nutrition. Additional clinical studies are necessary to determine whether dietary treatments help improve multimorbidity. More studies are needed to draw definitive conclusions.

Journal reference:

Article Revisions

  • Mar 11 2024 - Further information added to the conclusion to explain the associations found in the study
  • Mar 11 2024 - Title changed to better represent the findings of the study in response to public discourse
  • Mar 9 2024 - Title changed to reflect the study was only conducted on women
Pooja Toshniwal Paharia

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Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.


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  1. Chuck Silva Chuck Silva United States says:

    This was a study done exclusively in women, which is an important point that we don't find about until we wade through two big paragraphs.

  2. Melissa Harrison Melissa Harrison United States says:

    I would like to raise the point that this study may demonstrate correlation rather than causation. I supplement with a B complex and vitamin D because of low test results for vitamins B12 and D. I wouldn’t have known of my low levels if I weren’t already being seen by an endocrinologist and gastroenterologist for (multimorbid) chronic conditions.

    • Judy Liu Judy Liu United States says:

      This is 100% correlation. Low vit B12 causes numbness and tingling and muscle aches and pains and vit d deficiency causes SAD in certain people. So what happens when people with muscle aches, tingling, depression look up 'natural' fixes? They just take more vitamins.

      This result is due to correlation, NOT causation. People with more comorbid conditions are more likely to take extra vitamins.

  3. Debora Garcia Debora Garcia United States says:

    How is it exactly that we consume energy?

  4. Amun Fangsrud Amun Fangsrud United States says:

    The article picks out vitamin use as the possible culprit in the conclusion, yet totally ignores the fact that higher BMI and other factors were also correlated with higher multi morbidities, conditions that have been proven to cause health problems in patients. People who have more health problems are more likely to start taking various supplements in an attempt to alleviate these problems.

  5. Jo Breeze Jo Breeze United States says:

    I ain't ever heard of energy being in my food. I've heard of things being in the food that can help produce natural energy. But putting energy in the same catagory as b12, D and protein is plain dumb. You didn't think before you wrote that?

  6. Janine Prukop Janine Prukop United States says:

    As a woman with a chronic health condition, this conclusion seems like it was reached by those who are generally considered healthy. Some of the most common dietary changes for people who suffer from a chronic health condition are to increase your vitamin D and B12 intake, and to consider a higher protein/low sugar diet. Especially since this study looked at multimorbidity, I think the Occam's razor argument would be: get diagnosis 1, make recommended dietary changes given to you by your doctor, get diagnosis 2 because these conditions tend to run in packs.

    This was a good idea for something to study, but I wish it had been presented as "here are things that are highly correlated" rather than "this is caused by X", because it shows a blind spot from either the researchers or the writer.

  7. Janine Prukop Janine Prukop United States says:

    Well, just re-read the article, and I realize that it did present the conclusions as a strong correlation in most places. I blame daylight savings time in the states.

    That said, I wish there was more of a breakdown regarding which conditions had the strongest correlations, etc. though I realize that would probably result in sample sizes that were too small to be statistically significant. It just feels like they are going to reach a dangerous conclusion, because those dietary changes have been shown to be beneficial for individuals with certain conditions, and avoiding them would potentially lead to a worsening of symptoms...

  8. Jayne PP Jayne PP United States says:

    It seems odd they don't separate nutrients by vitamin vs food. It makes sense that higher b12 and d intake *in food* would have these results as they are primarily consumed in meat and dairy. However many people supplement these vitamins precisely because they eat plant based. While the image used is presumably of vitamin supplements, they only mention dietary intake ias a whole.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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