Importance Clonal hematopoiesis of indeterminate potential (CHIP), the expansion of somatic leukemogenic variations in hematopoietic stem cells, has been associated with atherosclerotic cardiovascular disease. Because the inherited risk of developing CHIP is low, lifestyle elements such as dietary factors may be associated with the development and outcomes of CHIP.

Objective To examine whether there is an association between diet quality and the prevalence of CHIP.

Design, Setting, and Participants This retrospective cohort study used data from participants in the UK Biobank, an ongoing population-based study in the United Kingdom that examines whole-exome sequencing data and survey-based information on health-associated behaviors. Individuals from the UK Biobank were recruited between 2006 and 2010 and followed up prospectively with linkage to health data records through May 2020. The present study included 44 111 participants in the UK Biobank who were age 40 to 70 years, had data available from whole-exome sequencing of blood DNA, and were free of coronary artery disease (CAD) or hematologic cancer at baseline.

Exposures Diet quality was categorized as unhealthy if the intake of healthy elements (fruits and vegetables) was lower than the median of all survey responses, and the intake of unhealthy elements (red meat, processed food, and added salt) was higher than the median. Diets were classified as healthy if the intake of healthy elements was higher than the median, and the intake of unhealthy elements was lower than the median. The presence of CHIP was detected by data from whole-exome sequencing of blood DNA.

Main Outcomes and Measures The primary outcome was CHIP prevalence. Multivariable logistic regression analysis was used to examine the association between diet quality and the presence of CHIP. Multivariable Cox proportional hazards models were used to assess the association of incident events (acute coronary syndromes, coronary revascularization, or death) in each diet quality category stratified by the presence of CHIP.

Results Among 44 111 participants (mean [SD] age at time of blood sample collection, 56.3 [8.0] years; 24 507 women [55.6%]), 2271 individuals (5.1%) had an unhealthy diet, 38 552 individuals (87.4%) had an intermediate diet, and 3288 individuals (7.5%) had a healthy diet. A total of 2507 individuals (5.7%) had CHIP, and the prevalence of CHIP decreased as diet quality improved from unhealthy (162 of 2271 participants [7.1%]) to intermediate (2177 of 38 552 participants [5.7%]) to healthy (168 of 3288 participants [5.1%]; P = .003 for trend). Compared with individuals without CHIP who had an intermediate diet, the rates of incident cardiovascular events progressively decreased among those with CHIP who had an unhealthy diet (hazard ratio [HR], 1.52; 95% CI, 1.04-2.22) and those with CHIP who had a healthy diet (HR, 0.99; 95% CI, 0.62-1.58) over a median of 10.0 years (interquartile range, 9.6-10.4 years) of follow-up.

Conclusions and Relevance This cohort study suggests that an unhealthy diet quality may be associated with a higher prevalence of CHIP and higher rates of adverse cardiovascular events and death independent of CHIP status.

重要性 不确定潜能的克隆性造血 (CHIP)，即造血干细胞中体细胞白血病变异的扩展，与动脉粥样硬化性心血管疾病有关。由于发生 CHIP 的遗传风险较低，因此饮食因素等生活方式因素可能与 CHIP 的发生和结果有关。

目的 探讨膳食质量与 CHIP 患病率之间是否存在关联。

设计、设置和参与者 这项回顾性队列研究使用了来自英国生物银行参与者的数据，这是一项在英国进行的基于人群的研究，检查全外显子组测序数据和基于调查的健康相关行为信息。在 2006 年至 2010 年期间招募了来自英国生物银行的个人，并在 2020 年 5 月之前通过与健康数据记录的关联进行了前瞻性随访。本研究包括英国生物银行的 44111 名年龄在 40 至 70 岁之间的参与者，其数据来自整个-血液 DNA 的外显子组测序，并且在基线时没有冠状动脉疾病 (CAD) 或血液系统癌症。

如果健康元素（水果和蔬菜）的摄入量低于所有调查答复的中位数，并且不健康元素（红肉、加工食品和添加的盐）的摄入量高于中位数，则饮食质量被归类为不健康. 如果健康元素的摄入量高于中位数，并且不健康元素的摄入量低于中位数，则饮食被归类为健康。通过血液 DNA 的全外显子组测序数据检测到 CHIP 的存在。

主要结果和测量 主要结果是 CHIP 患病率。多变量逻辑回归分析用于检查饮食质量与 CHIP 存在之间的关联。多变量 Cox 比例风险模型用于评估按 CHIP 存在分层的每个饮食质量类别中事件事件（急性冠状动脉综合征、冠状动脉血运重建或死亡）的关联。

结果 在 44 111 名参与者中（采集血液样本时的平均年龄 [SD]，56.3 [8.0] 岁；24 507 名女性 [55.6%]），2271 人（5.1%）的饮食不健康，38552 人（87.4%） ) 有中等饮食，3288 人 (7.5%) 有健康饮食。共有 2507 人 (5.7%) 患有 CHIP，随着饮食质量从不健康（2271 名参与者中的 162 名 [7.1%]）提高到中等（38 552 名参与者中的 2177 名 [5.7%]）到健康（ 3288 名参与者中的 168 名 [5.1%]；P = .003 表示趋势）。与没有 CHIP 且进行中等饮食的个体相比，CHIP 患者的不健康饮食（风险比 [HR]，1.52；95% CI，1.04-2.22）和 CHIP 患者的心血管事件发生率逐渐降低。在中位 10.0 年（四分位间距，9.6-10.4 年）的随访中，他们有健康的饮食（HR，0.99；95% CI，0.62-1.58）。

结论和相关性 该队列研究表明，不健康的饮食质量可能与较高的 CHIP 患病率以及较高的心血管不良事件和死亡发生率相关，而与 CHIP 状态无关。