Varied Diet Linked to Lower Peptic Ulcer Risk in Older Chinese Adults

Older adults in China who ate a more varied diet developed peptic ulcers at a lower rate than those with narrower diets, according to a prospective cohort study drawing on nearly a decade of data from the Chinese Longitudinal Healthy Longevity Survey. The researchers, Kai Wang of Heping Hospital Affiliated to Changzhi Medical College and Xiaodan Li of Zhangzi County Maternal and Child Health Family Planning Service Center, analyzed four survey waves collected between 2008 and 2018, following 13,274 ulcer-free adults aged 65 and older who had complete covariate data.

The exposure of interest was the dietary diversity score, or DDS, a measure ranging from 0 to 9 that was derived from a nine-item food frequency questionnaire. The outcome was incident gastric or duodenal ulcer, meaning ulcers newly reported during follow-up among people who started the study without one.

To estimate the association, the team used Cox proportional hazards models, the standard survival-analysis approach for time-to-event data, and complemented them with restricted cubic splines to characterize the shape of any dose–response relationship. Sensitivity analyses included competing-risk models that account for death as an alternative event, lagged exposure updates, analyses restricted to hospital-confirmed diagnoses, and multiple imputation to handle missing data.

In the fully adjusted models, each one-point increase in dietary diversity score was associated with a lower risk of incident ulcer, with a hazard ratio of 0.944 (95% confidence interval 0.904–0.986; p = 0.009). In practical terms, a two-point difference in diet variety corresponded to roughly an 11% lower hazard of developing an ulcer over follow-up, holding the adjusted covariates constant. When participants were grouped into tertiles of dietary diversity, those in the highest tertile had a 24% lower risk than those in the lowest tertile (hazard ratio 0.757, 95% confidence interval 0.618–0.927; p = 0.007).

The restricted cubic spline analysis pointed to an approximately linear dose–response relationship, with a p-value for nonlinearity of 0.655. That statistical result suggests the data did not detect a threshold or curved pattern; instead, the estimated benefit accumulated steadily across the observed range of scores. Because hazard ratios from observational models describe associations rather than experimentally assigned effects, the finding indicates that greater dietary variety and lower ulcer incidence traveled together in this population, not that prescribing dietary diversity would prevent ulcers.

Subgroup analyses added an important nuance. The association was consistent across most of the population examined, but it was absent among participants with disability in activities of daily living, and the interaction test reached statistical significance (p for interaction = 0.004). The authors’ conclusion emphasizes that the relationship was particularly evident among functionally independent individuals.

Timing mattered as well. Although the findings were robust across the battery of sensitivity analyses, the association attenuated to null after three years of follow-up and in a six-year landmark analysis, suggesting that the protective association was mainly evident during early follow-up. The lagged exposure updates and competing-risk models were designed partly to probe such vulnerabilities, and the core association survived them.

The study's strengths include its prospective design, a large cohort of 13,274 older adults, and repeated measurement waves spanning 2008 to 2018. Its limitations are those inherent to observational cohort research: diet was self-reported through a food frequency questionnaire, ulcer ascertainment depended in part on participant report despite the hospital-confirmed sensitivity analysis, and residual confounding cannot be excluded. The authors themselves state that randomized trials are needed to confirm causality and to evaluate whether dietary diversity has intervention potential.

The headline numbers, a 5.6% lower hazard per point of diversity and a 24% lower hazard for the highest versus lowest tertile, are modest but internally consistent, and the linear dose–response pattern gives the association a coherent shape. Whether encouraging older adults to broaden their diets would actually reduce ulcer incidence remains an open question that only experimental evidence can answer.

Subject of Research: The association between dietary diversity and incident peptic ulcer risk among older Chinese adults

Article Title: Dietary diversity score and incident peptic ulcer in Chinese older adults: a prospective cohort study

Article References: Wang, K., & Li, X. (2026). Dietary diversity score and incident peptic ulcer in Chinese older adults: a prospective cohort study. Frontiers in Nutrition, 13, Article 1984205. https://doi.org/10.3389/fnut.2026.1984205

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1984205

Keywords: dietary diversity, peptic ulcer, older adults, cohort study, CLHLS, nutritional epidemiology, hazard ratio, China, gastric ulcer, duodenal ulcer, food frequency questionnaire, Dietary