Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition?

Sander Biesbroek,W M Monique Verschuren,Anouk Geelen,Yvonne T Van Der Schouw,Mirjam E Van De Kamp,Jolanda M A Boer,Elisabeth H M Temme,Moniek Looman

doi:10.1017/s0007114517001878

Abstract

Guidelines for a healthy diet aim to decrease the risk of chronic diseases. It is unclear as to what extent a healthy diet is also an environmentally friendly diet. In the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition, the diet was assessed with a 178-item FFQ of 40 011 participants aged 20-70 years between 1993 and 1997. The WHO's Healthy Diet Indicator (HDI), the Dietary Approaches to Stop Hypertension (DASH) score and the Dutch Healthy Diet index 2015 (DHD15-index) were investigated in relation to greenhouse gas (GHG) emissions, land use and all-cause mortality risk. GHG emissions were associated with HDI scores (-3·7 % per sd increase (95 % CI -3·4, -4·0) for men and -1·9 % (95 % CI -0·4, -3·4) for women), with DASH scores in women only (1·1 % per sd increase, 95 % CI 0·9, 1·3) and with DHD15-index scores (-2·5 % per sd increase (95 % CI -2·2, -2·8) for men and -2·0 % (95 % CI -1·9, -2·2) for women). For all indices, higher scores were associated with less land use (ranging from -1·3 to -3·1 %). Mortality risk decreased with increasing scores for all indices. Per sd increase of the indices, hazard ratios for mortality ranged from 0·88 (95 % CI 0·82, 0·95) to 0·96 (95 % CI 0·92, 0·99). Our results showed that adhering to the WHO and Dutch dietary guidelines will lower the risk of all-cause mortality and moderately lower the environmental impact. The DASH diet was associated with lower mortality and land use, but because of high dairy product consumption in the Netherlands it was also associated with higher GHG emissions.

Highlights

Global warming has led to an increased interest in environmentally friendly dietary patterns
Greater adherence to the WHO guidelines for a healthy diet (HDI) has been associated with increased longevity in European and American elderly[19], whereas the Dietary Approaches to Stop Hypertension (DASH) diet but not the Healthy Diet Indicator (HDI) was significantly associated with a lower risk of developing CVD, CHD and stroke in the European Prospective Investigation into Cancer and Nutrition – Dutch cohort (EPICNL) study[20]
Alcohol intake is lower with higher dietary index scores, with the exception of women for whom alcohol intake remains constant across tertiles of the DASH score

Summary

Introduction

Global warming has led to an increased interest in environmentally friendly dietary patterns. A typical Western dietary pattern high in animal products, soft drinks and processed foods is reported to have a large environmental impact[4] and is associated with a higher risk of diseases compared with diets rich in vegetables, fruit and fibre-rich cereals[5,6,7]. A Mediterranean dietary pattern high in fruit and vegetables, legumes, wine, fish and oils and low in meats, dairy products and processed foods is found to be healthier[8], and adherence to the Mediterranean guidelines is more environmentally friendly[9]. In a Dutch setting, substituting meat with vegetables, fruit–nuts–seeds, fish or pasta–rice–couscous was associated with both a lower mortality risk (6 to 19 %) and a reduced environmental burden, measured as GHG emissions (4–11 %) and land use (10–12 %)(10). The previous DHD-index was not associated with disease burden (disability-adjusted life years) or CVD risk in one Dutch cohort[20,21] but was associated with decreased risk of all-cause mortality and CVD mortality in another[22]

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Results

Conclusion