Socioecological determinants of chronic disease multimorbidity in high-altitude Tibetan populations: a cross-sectional study

Background: Dietary patterns are closely associated with the prevention and management of chronic diseases. Although large-scale national nutrition and health surveys have been conducted in China, evidence on dietary patterns and their associations with chronic diseases remains scarce in high-altitude regions, where unique dietary habits and lifestyles are prevalent. Methods: A cross-sectional study was conducted among high-altitude residents using food frequency questionnaires (FFQs) to assess dietary intake. Principal Component Analysis(PCA) was used to extract dietary patterns, and the scores were categorized into tertiles (from low to high: T1, T2, T3). Logistic regression models were used to examine their associations with chronic diseases, smoking, alcohol use, local tea drinking, and physical exercise. Results: Five dietary patterns were identified: dry nuts and beverages, traditional Tibetan, three-high (characterized by high salt, high carbohydrate, and high fat intake), animal-predominant high protein, and high dietary fiber. Among the 606 participants, 39.9% reported having at least one chronic disease. Fully adjusted model showed that the three-high pattern (T2 vs. T1: OR = 1.81, 95% CI: 1.10–2.99; T3 vs. T1: OR = 1.90, 95% CI: 1.09–3.33), animal-predominant high protein pattern (T2 vs. T1: OR = 2.37, 95% CI: 1.42–3.94), smoking (OR = 1.88, 95% CI: 1.06–3.35), and local tea drinking (OR = 1.85, 95% CI: 1.13–3.02) were positively associated with chronic diseases. Conversely, the traditional Tibetan pattern (T2 vs. T1: OR = 0.47, 95% CI: 0.28–0.80) and physical exercise (OR = 0.62, 95% CI: 0.39–0.99) were negatively associated with chronic diseases. Conclusion: Among high-altitude populations, traditional Tibetan pattern and physical exercise appear to be protective factors against chronic diseases, while the three-high pattern, animal-predominant high protein pattern, smoking, and local tea drinking constitute potential risk factors. Modifying dietary pattern and lifestyle thus play a significant role in the prevention and management of chronic diseases in these unique environments.