Abstract
Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72–0.79) to 0.88 (0.84–0.92) for all-cause, 0.76 (0.69–0.83) to 0.84 (0.76–0.92) for CVD and 0.78 (0.73–0.83) to 0.91 (0.85–0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.
Highlights
Poor diet is a leading risk factor for all-cause mortality and mortality due to major non-communicable diseases including cardiovascular disease (CVD) and several cancers [1,2]
We present the first comparative examination of the association and predictive performance of 10 different diet quality scores for 10-year risk of all-cause, CVD and cancer mortality across 10 countries with over 450,000 participants without previous diagnosis of major diseases
We have shown that various dietary scores are associated with all-cause mortality, as well as cause-specific (CVD and cancer) mortality, with stronger associations with CVD compared to cancer
Summary
Poor diet is a leading risk factor for all-cause mortality and mortality due to major non-communicable diseases including cardiovascular disease (CVD) and several cancers [1,2]. Numerous a priori diet quality scores have been developed in the medical literature ranging from regional/national dietary patterns, such as the Mediterranean diet [4], to indices based on national/international guidelines such as those from the World Health Organization (WHO) [5]. These scores have been thoroughly studied as etiological risk factors for all-cause or cause-specific mortality [6,7,8,9,10,11,12,13]. A secondary objective was to examine the variability in their predictive performance between different countries
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