High-quality dietary patterns reduce risk of advanced cardiovascular-kidney-metabolic syndrome: A cross-sectional NHANES study in US adults.

Evidence-based dietary strategies for mitigating Cardiovascular-kidney-metabolic (CKM) syndrome progression remain limited; therefore, we hypothesized that higher dietary quality indices would be inversely associated with advanced CKM risk, while a higher pro-inflammatory dietary index (DII) would increase risk. To test this, we analyzed cross-sectional data from 21,908 US adults (NHANES), classifying participants into early or advanced CKM stages. Associations between 5 dietary indices (Healthy Eating Index-2020 [HEI-2020], Alternative Healthy Eating Index [AHEI], Dietary Approaches to Stop Hypertension [DASH], Dietary Inflammatory Index [DII], Mediterranean Diet [MED]) and advanced CKM risk were assessed via multivariable logistic regression and sensitivity analyses, while predictive performance and feature importance were evaluated using generalized Weighted Quantile Sum (gWQS) regression and XGBoost machine learning models. Consequently, higher scores for HEI-2020, AHEI, DASH, and MED were significantly inversely associated with advanced CKM risk, whereas higher (pro-inflammatory) DII scores showed a positive association. Notably, both gWQS and XGBoost models demonstrated robust predictive accuracy, identifying HEI-2020 and DII as the strongest dietary contributors to risk. Collectively, these results demonstrate that high-quality dietary patterns protect against advanced CKM risk, while pro-inflammatory diets increase risk, with effects varying by sex and obesity status. The predictive importance of HEI-2020 and DII, along with subgroup variations, strongly supports developing personalized dietary interventions for CKM syndrome management.