The dietary index for gut microbiota and risk of advanced cardio-kidney-metabolic syndrome

As a novel dietary assessment tool, the dietary index for gut microbiota (DI-GM) measured food intake patterns that influenced GM balance. The association of DI-GM with advanced cardiovascular-kidney-metabolic syndrome (CKM) remained unclear. We aimed to explore the relationship between DI-GM and the advanced CKM risk. Participants from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018 were included. The DI-GM was defined based on intake levels of 10 beneficial and 4 unfavorable foods. To assess the association of DI-GM with advanced CKM risk, we employed multivariate logistic regression, receiver operating characteristic (ROC) analysis, and weighted quantile sum (WQS) regression. About 13,226 eligible participants were enrolled. Multivariable logistic regression showed that each 1-point increment in the DI-GM and beneficial food scores were associated with a 6% (95% CI: 0.92-0.97) and 7% (95% CI: 0.90-0.97) reduction in advanced CKM risk, respectively. Unfavorable food scores showed no significant association with advanced CKM risk. ROC analysis indicated that compared with the baseline model, the addition of the DI-GM (AUC: 0.743 vs. 0.741; P = 0.013) and the beneficial food scores (AUC: 0.743 vs. 0.741; P = 0.005) significantly improved the discriminatory ability of the baseline model for advanced CKM. WQS regression further identified broccoli, soybeans, fermented dairy products, and dietary fiber as the key dietary components strongly associated with advanced CKM. The DI-GM can function as a promising tool for assessing advanced CKM risk. For the general population, especially individuals with metabolic risk factors, increasing the intake of broccoli, soybeans, fermented dairy products, and dietary fiber may help reduce advanced CKM risk.