Abstract
No previous study has assessed the relationship between overall macronutrient quality and all-cause mortality. We aimed to prospectively examine the association between a multidimensional macronutrient quality index (MQI) and all-cause mortality in the SUN (Seguimiento Universidad de Navarra) (University of Navarra Follow-Up) study, a Mediterranean cohort of middle-aged adults. Dietary intake information was obtained from a validated 136-item semi-quantitative food-frequency questionnaire. We calculated the MQI (categorized in quartiles) based on three quality indexes: the carbohydrate quality index (CQI), the fat quality index (FQI), and the healthy plate protein source quality index (HPPQI). Among 19,083 participants (mean age 38.4, 59.9% female), 440 deaths from all causes were observed during a median follow-up of 12.2 years (IQR, 8.3–14.9). No significant association was found between the MQI and mortality risk with multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest quartile of 0.79 (95% CI, 0.59–1.06; Ptrend = 0.199). The CQI was the only component of the MQI associated with mortality showing a significant inverse relationship, with HR between extreme quartiles of 0.64 (95% CI, 0.45–0.90; Ptrend = 0.021). In this Mediterranean cohort, a new and multidimensional MQI defined a priori was not associated with all-cause mortality. Among its three sub-indexes, only the CQI showed a significant inverse relationship with the risk of all-cause mortality.
Highlights
Healthy eating results essential to reduce the risk of developing non-communicable diseases and increases the number of years lived with good health [1]
We described the baseline characteristics of participants adjusted for age and sex using the inverse probability weighting method, using proportions and means according to quartiles of the macronutrient quality index (MQI)
We calculated hazard ratios (HRs) with their 95 % confidence interval (CIs) and we considered always the lowest quartile as the reference category
Summary
Healthy eating results essential to reduce the risk of developing non-communicable diseases and increases the number of years lived with good health [1]. Diet quality is a complex concept that is difficult to measure, general recommendations for a healthy eating include fostering bioactive-rich foods (vegetables, fruits, seeds, whole grains, nuts, plant oils, fish, and yogurt), selecting non-processed or minimally-processed foods and avoiding ultra-processed products, which are important sources of sugars, refined starch, and industrial additives such as trans fatty acids and sodium [3]. In this context, multiple dietary indices have gained attention to measure diet quality.
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