{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:56:59Z","timestamp":1787846219839,"version":"build-2784847793"},"reference-count":45,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:00:00Z","timestamp":1644883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Special Funding for the Construction of Innovative Provinces in Hunan","award":["No.2020SK2091"],"award-info":[{"award-number":["No.2020SK2091"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Carotid atherosclerosis is a common arterial wall lesion that causes narrowing and occlusion of the arteries and is the basis of cardiovascular events. Dietary habits, lifestyle, and lipid metabolism should be considered integrally in the context of carotid atherosclerosis (CAS). However, this area has been investigated less often in China. To understand the prevalence of CAS in China and the impact of dietary diversity and habits, lifestyle, and lipid metabolism on CAS as well as its predictive factors, a cross-sectional study was performed in two northern and southern Chinese tertiary hospitals from 2017 to 2019. Included participants underwent carotid artery color Doppler ultrasonography, blood lipid examination and dietary evaluation. In total, 11,601 CAS patients and 27,041 individuals without carotid artery lesions were included. The prevalence of CAS was 30.0% in this group. High BMI (OR: 1.685, 95% CI [1.315\u20132.160]), current (1.148 [1.077\u20131.224]) or ex-smoking (1.349 [1.190\u20131.529]), abstinence from alcohol ((1.223 [1.026\u20131.459]), social engagement (1.122 [1.050\u20131.198]), hypertension (1.828 [1.718\u20131.945]), and total cholesterol (1.438 [1.298\u20131.594]) were risk factors for CAS, while higher dietary diversity according to DDS-2 (0.891 [0.805\u20130.989]), HDL-C (0.558 [0.487\u20130.639]), sugar-sweetened beverages (0.734 [0.696\u20130.774]), and no midnight snack consumption (0.846 [0.792\u20130.903]) were protective factors. This current study demonstrated that higher dietary diversity was a protective factor against CAS in a healthy population. In addition, current recommendations of healthy lifestyle and dietary habits for preventing CAS should be strengthened. In addition, dietary diversity should concentrate on food attributes and dietary balance, rather than increased quantities.<\/jats:p>","DOI":"10.3390\/nu14040815","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T22:44:47Z","timestamp":1644965087000},"page":"815","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["The Impact of Dietary Diversity, Lifestyle, and Blood Lipids on Carotid Atherosclerosis: A Cross-Sectional Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Yaqin","family":"Wang","sequence":"first","affiliation":[{"name":"Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2166-6429","authenticated-orcid":false,"given":"Lijun","family":"Li","sequence":"additional","affiliation":[{"name":"Xiangya Nursing School, Central South University, Changsha 410017, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Liu","sequence":"additional","affiliation":[{"name":"Nursing Department, The Third Xiangya Hospital of Central South University, Changsha 410013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Gan","sequence":"additional","affiliation":[{"name":"Xiangya Nursing School, Central South University, Changsha 410017, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4809-0749","authenticated-orcid":false,"given":"Yi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Xiangya Nursing School, Central South University, Changsha 410017, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8343-8611","authenticated-orcid":false,"given":"Xiaofei","family":"Luo","sequence":"additional","affiliation":[{"name":"Xiangya Nursing School, Central South University, Changsha 410017, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Xiangya Nursing School, Central South University, Changsha 410017, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianfei","family":"Xie","sequence":"additional","affiliation":[{"name":"Nursing Department, The Third Xiangya Hospital of Central South University, Changsha 410013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7126-2479","authenticated-orcid":false,"given":"Yinglong","family":"Duan","sequence":"additional","affiliation":[{"name":"Nursing Department, The Third Xiangya Hospital of Central South University, Changsha 410013, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7503-5273","authenticated-orcid":false,"given":"(Andy) S. K.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1161\/CIR.0000000000000950","article-title":"Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association","volume":"143","author":"Virani","year":"2021","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Acosta, S., Johansson, A., and Drake, I. (2021). Diet and Lifestyle Factors and Risk of Atherosclerotic Cardiovascular Disease-A Prospective Cohort Study. Nutrients, 13.","DOI":"10.3390\/nu13113822"},{"key":"ref_3","first-page":"40","article-title":"Angiographically evident atherosclerotic stenosis associated with myocardial bridging and risk factors for the artery stenosis located proximally to myocardial bridging","volume":"14","author":"Hong","year":"2014","journal-title":"Anadolu Kardiyol. Derg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1056\/NEJMoa1605086","article-title":"Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease","volume":"375","author":"Khera","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Dimovski, K., Orho-Melander, M., and Drake, I. (2019). A favorable lifestyle lowers the risk of coronary artery disease consistently across strata of non-modifiable risk factors in a population-based cohort. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7948-x"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yoon, S.J., Jung, J.G., Lee, S., Kim, J.S., Ahn, S.K., Shin, E.S., Jang, J.E., and Lim, S.H. (2020). The protective effect of alcohol consumption on the incidence of cardiovascular diseases: Is it real? A systematic review and meta-analysis of studies conducted in community settings. BMC Public Health, 20.","DOI":"10.1186\/s12889-019-7820-z"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1177\/1358863X19867393","article-title":"Healthy diet and fiber intake are associated with decreased risk of incident symptomatic peripheral artery disease\u2014A prospective cohort study","volume":"24","author":"Kulezic","year":"2019","journal-title":"Vasc. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.nut.2010.05.013","article-title":"Dietary diversity and adequacy of women caregivers in a peri-urban informal settlement in South Africa","volume":"27","author":"Kruger","year":"2011","journal-title":"Nutrition"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1017\/S1368980010001606","article-title":"Overall and within-food group diversity are associated with dietary quality in Belgium","volume":"13","author":"Vandevijvere","year":"2010","journal-title":"Public Health Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1007\/s00394-016-1167-3","article-title":"Associations of dietary diversity scores and micronutrient status in adolescent Mozambican girls","volume":"56","author":"Korkalo","year":"2017","journal-title":"Eur. J. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.atherosclerosis.2013.11.072","article-title":"Overall diet quality and risk of stroke: A prospective cohort study in women","volume":"233","author":"Larsson","year":"2014","journal-title":"Atherosclerosis"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fanelli Kuczmarski, M., Brewer, B.C., Rawal, R., Pohlig, R.T., Zonderman, A.B., and Evans, M.K. (2019). Aspects of Dietary Diversity Differ in Their Association with Atherosclerotic Cardiovascular Risk in a Racially Diverse US Adult Population. Nutrients, 11.","DOI":"10.3390\/nu11051034"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1194\/jlr.M053017","article-title":"The glycosylation-dependent interaction of perlecan core protein with LDL: Implications for atherosclerosis","volume":"56","author":"Xu","year":"2015","journal-title":"J. Lipid Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1161\/CIRCULATIONAHA.115.016960","article-title":"Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population","volume":"133","author":"Mannsverk","year":"2016","journal-title":"Circulation"},{"key":"ref_15","first-page":"43","article-title":"Evaluation of Dietary Diversity during the Second Trimester of Pregnancy and Its Influencing Factors","volume":"2016","author":"Peicheng","year":"2016","journal-title":"Mod. Prev. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1016\/j.amjcard.2009.12.051","article-title":"Relation of different measures of low-density lipoprotein cholesterol to risk of coronary artery disease and death in a meta-regression analysis of large-scale trials of statin therapy","volume":"105","author":"Kizer","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1161\/CIRCULATIONAHA.106.621417","article-title":"Healthy lifestyle factors in the primary prevention of coronary heart disease among men: Benefits among users and nonusers of lipid-lowering and antihypertensive medications","volume":"114","author":"Chiuve","year":"2006","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"(2002). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 106, 3143\u20133421.","DOI":"10.1161\/circ.106.25.3143"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1212\/WNL.0000000000004056","article-title":"Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013","volume":"89","author":"Guan","year":"2017","journal-title":"Neurology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1177\/2047487319869400","article-title":"Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors","volume":"27","author":"Lechner","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1038\/oby.2011.245","article-title":"Visceral Fat Thickness Is Associated With Carotid Atherosclerosis in Peritoneal Dialysis Patients","volume":"20","author":"Lee","year":"2012","journal-title":"Obesity"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Moshe, C.B., Haratz, S., Ravona-Springer, R., Heymann, A., Lin, H.M., Beeri, M.S., and Tanne, D. (2020). Long-term trajectories of BMI predict carotid stiffness and plaque volume in type 2 diabetes older adults: A cohort study. Cardiovasc. Diabetol., 19.","DOI":"10.21203\/rs.3.rs-20601\/v1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ypmed.2009.05.006","article-title":"Cross-sectional and longitudinal association of cigarette smoking with carotid atherosclerosis in Chinese adults","volume":"49","author":"Liang","year":"2009","journal-title":"Prev. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.atherosclerosis.2020.11.010","article-title":"Longitudinal effects of smoking cessation on carotid artery atherosclerosis in contemporary smokers: The Wisconsin Smokers Health Study","volume":"315","author":"Stein","year":"2020","journal-title":"Atherosclerosis"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1136\/jech.2009.092718","article-title":"Smoking cessation and carotid atherosclerosis: The Guangzhou Biobank Cohort Study--CVD","volume":"64","author":"Jiang","year":"2010","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1253\/circj.CJ-11-1353","article-title":"Effects of Cumulative Smoking Exposure and Duration of Smoking Cessation on Carotid Artery Structure","volume":"76","author":"Kweon","year":"2012","journal-title":"Circ. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e4439","DOI":"10.1136\/bmj.e4439","article-title":"Weight gain in smokers after quitting cigarettes: Meta-analysis","volume":"345","author":"Aubin","year":"2012","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.atherosclerosis.2013.03.036","article-title":"Cigarette-smoke-induced atherogenic lipid profiles in plasma and vascular tissue of apolipoprotein E-deficient mice are attenuated by smoking cessation","volume":"229","author":"Lietz","year":"2013","journal-title":"Atherosclerosis"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.drugalcdep.2017.09.034","article-title":"The impact of long-term moderate and heavy alcohol consumption on incident atherosclerosis among persons living with HIV","volume":"181","author":"Plankey","year":"2017","journal-title":"Drug Alcohol. Depend."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.numecd.2013.02.007","article-title":"Moderate alcohol use and health: A consensus document","volume":"23","author":"Poli","year":"2013","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/ane.12671","article-title":"Alcohol withdrawal syndrome: Mechanisms, manifestations, and management","volume":"135","author":"Jesse","year":"2017","journal-title":"Acta Neurol. Scand."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/j.1360-0443.1991.tb03098.x","article-title":"Increased severity of alcohol withdrawal in in-patient alcoholics with a co-existing anxiety diagnosis","volume":"86","author":"Johnston","year":"1991","journal-title":"Br. J. Addict."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e12838","DOI":"10.1111\/adb.12838","article-title":"TSPO polymorphism in individuals with alcohol use disorder: Association with cholesterol levels and withdrawal severity","volume":"26","author":"Wiers","year":"2021","journal-title":"Addict. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1038\/ejcn.2010.286","article-title":"The relationship between diet and subclinical atherosclerosis: Results from the Asklepios Study","volume":"65","author":"Hoebeeck","year":"2011","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1017\/S1368980010000522","article-title":"Dietary diversity score is related to obesity and abdominal adiposity among Iranian female youth","volume":"14","author":"Azadbakht","year":"2011","journal-title":"Public Health Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1093\/jn\/136.11.2921","article-title":"A more diversified diet among Mexican men may also be more atherogenic","volume":"136","author":"Ponce","year":"2006","journal-title":"J. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ahj.2016.03.018","article-title":"Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women","volume":"177","author":"Chun","year":"2016","journal-title":"Am. Heart J."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Kurniawan, A.L., Hsu, C.Y., Rau, H.H., Lin, L.Y., and Chao, J.C.J. (2019). Inflammatory Dietary Pattern Predicts Dyslipidemia and Anemia in Middle-Aged and Older Taiwanese Adults with Declined Kidney Function: A Cross-Sectional Population Study from 2008 to 2010. Nutrients, 11.","DOI":"10.3390\/nu11092052"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1159\/000515025","article-title":"The Psychology of Desire and Implications for Healthy Hydration","volume":"76","author":"Papies","year":"2020","journal-title":"Ann. Nutr. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mita, T., Osonoi, Y., Osonoi, T., Saito, M., Nakayama, S., Someya, Y., Ishida, H., Gosho, M., and Watada, H. (2020). Breakfast skipping is associated with persistently increased arterial stiffness in patients with type 2 diabetes. BMJ Open Diabetes Res. Care, 8.","DOI":"10.1136\/bmjdrc-2019-001162"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1097\/00004872-200409000-00013","article-title":"Hypertension and subclinical carotid atherosclerosis in a suburban general population in China","volume":"22","author":"Lu","year":"2004","journal-title":"J. Hypertens."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e721","DOI":"10.1016\/S2214-109X(20)30117-0","article-title":"Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: A systematic review, meta-analysis, and modelling study","volume":"8","author":"Song","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1093\/eurheartj\/ehw106","article-title":"2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)","volume":"37","author":"Piepoli","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"554778","DOI":"10.3389\/fneur.2020.554778","article-title":"Comparison of the Characteristics and Risk Factors of Carotid Atherosclerosis in High Stroke Risk Populations Between Urban and Rural Areas in North China","volume":"11","author":"Zhang","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.atherosclerosis.2007.07.033","article-title":"High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: A systematic review","volume":"196","author":"Amarenco","year":"2008","journal-title":"Atherosclerosis"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/4\/815\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:20:07Z","timestamp":1760134807000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/4\/815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,15]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["nu14040815"],"URL":"https:\/\/doi.org\/10.3390\/nu14040815","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,15]]}}}