Multidimensional links between dietary behavior and cardiometabolic comorbidities: a network analysis.

Abstract

Background: The burden of cardiometabolic comorbidities-such as hypertension, diabetes, dyslipidemia, and nonalcoholic fatty liver disease (NAFLD)-attributable to unhealthy dietary behaviors is increasing, particularly among working-age populations. This study aimed to investigate the complex interactions between dietary behaviors and cardiometabolic comorbidities using network analysis.

Methods: This cross-sectional study enrolled 1,427 corporate employees aged 18-50 years in Shanghai, China, who underwent routine health check-ups from July to December 2022. Demographic characteristics and dietary behaviors were assessed via a self-reported questionnaire, while metabolic indicators were obtained through clinical evaluations. Mixed graphical models were used to construct a network identifying associations among demographic factors, unhealthy dietary behaviors, and six cardiometabolic comorbidities: hypertension, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and NAFLD.

Results: Among participants, 49.5% had at least one cardiometabolic comorbidity. Network analyses revealed that interactions among demographic factors, various dietary behaviors, and cardiometabolic comorbidities formed a complex structure, with frequent meat consumption (2.03) and eating out (2.00) exhibiting high centrality in the network. Further sensitivity analyses indicated that eating before bedtime (2.01) emerged as a central node when modifiable demographic factors were included in the model.

Conclusions: This study identifies specific unhealthy dietary behaviors that are strongly linked to early manifestations of cardiometabolic comorbidities in working-age adults. The findings suggest that these behaviors may serve as effective targets for dietary interventions and public health strategies aimed at metabolic disease prevention.