The double-edged chopstick: how dietary pattern shapes multimorbidity among older adults in China

Culture has been increasingly emphasized for its role diet-related health risks and outcomes globally, including multimorbidity among older people. China’s Eight Major Cuisines (CEMC) is one of the well-known cultural classifications that captures the country’s rich and diverse dietary pattern. This study compiles an ingredient dataset from 461 representative dishes of the CEMC to measure regional dietary patterns that reflect these cultural characteristics. Using data from the 2011–2020 China Health and Retirement Longitudinal Study, the 2017 China Migrants Dynamic Survey, and the 2015 National 1% Population Sample Survey, the study conducts fixed effects and quantile regression models to examine the impact of dietary pattern on multimorbidity among older adults. The results show that: (1) Among the CEMC, Su Cuisine ranks highest in seafood proportion and energy from protein. Lu Cuisine has the highest red meat percentage and energy from fat. Min Cuisine contains the highest cholesterol. Chuan Cuisine has the highest sodium, while Yue Cuisine has the lowest sodium. (2) Preference for red meat, energy from fat, and sodium, as reflected in dietary pattern, increases the risk of multimorbidity among older adults by 16.50%, 30.30%, and 15.22%, respectively. (3) The role of regional dietary patterns in multimorbidity is more pronounced among rural and younger-old adults. (4) Dietary pattern worsens inequalities in multimorbidity distribution. Specifically, older adults with multiple chronic conditions who adhere to culturally influenced diets characterized by high intakes in red meat, fat, and sodium face greater health risks.