Healthy Diet Indicator Research Articles

Abstract A100: Adherence to the WHO's Healthy Diet Indicator and overall cancer risk in the Dutch part of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) cohort

Abstract Background: A healthy dietary pattern defined by international recommendations of the World Health Organization (WHO) for the prevention of chronic diseases has been shown to reduce overall mortality risk. It is unknown whether this healthy dietary pattern is related to the incidence of cancer. We investigated the association between adherence to the WHO guidelines and overall, nutrition-related and smoking related cancer risk. Methods: 36,683 men and women (aged 20-70 years) participating in the Dutch part of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) were included in the present study. At recruitment (1993-1997), diet was assessed through a validated food-frequency questionnaire. Weight and height were measured and detailed lifestyle data were collected through questionnaires. Participants were followed for the occurrence of cancer. The Healthy Diet Indicator (HDI)) score, based on the WHO dietary guidelines for the prevention of chronic diseases published in 2002, was computed for all participants. Seven food groups and nutrients were included: saturated fatty acids, polyunsaturated fatty acids, cholesterol, protein, dietary fiber, fruits and vegetables, and free sugars. Salt intake was not included because data on added salt were not available. A dichotomous variable was generated for each food group or nutrient resulting in a HDI with a range of 0-7 points. Multivariate-adjusted Cox proportional hazards analysis was used to examine the association between adherence to the HDI and subsequent overall, nutrition-related and smoking-related cancer risk. Adjustments were made for age, body mass index, smoking status and intensity, total energy intake excluding energy from alcohol, alcohol intake, physical activity level and educational level. Analyses were done separately in men and women. Results: During a mean follow-up of 14.3 years 2,994 new cancers were identified. Adherence to the HDI was not associated with a reduced overall cancer risk. The hazard ratio (HR) of overall cancer associated with a one-point increment of the score was 0.96 (95% CI 0.89–1.03) in men, and 1.00 (95% CI 0.96–1.04) in women. We found no associations with adherence to the HDI with nutrition-related cancer risk (HR men: 1.01 (95% CI 0.89–1.13); HR women: 1.03 (95% CI 0.99–1.09)) or with smoking-related cancer risk (HR men: 0.93 (95% CI 0.83-1.03); HR women: 1.00 (95% CI 0.93-1.06)). Conclusions: Greater adherence to a healthy diet defined by WHO guidelines for the prevention of chronic diseases was not associated with reduced overall, nutrition-related or smoking-related cancer risk in men or women participating in the EPIC-NL study. Citation Format: Anne M. May, Nina E. Berentzen, Joline WJ Beulens, Marieke P. Hoevenaar-Blom, Ellen Kampman, H B. Bueno-de-Mesquita, Dora Romaguera, Petra HM Peeters. Adherence to the WHO's Healthy Diet Indicator and overall cancer risk in the Dutch part of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) cohort. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A100.

Dietary Patterns Associated with Alzheimer?s Disease and Related Chronic Disease Risk: A Review

The world’s population is growing older due to improved healthcare and nutrition. As a result, Alzheimer’s disease (AD) prevalence is rapidly increasing. The focus of the current research climate is shifting from understanding AD pathology and diagnosis to primary prevention and intervention strategies. Diet represents one potential intervention strategy accessible to all. Accumulating evidence suggests diet plays a major role in risk and development of AD and AD-related chronic diseases of the periphery like cardiovascular disease (CVD) and diabetes. This paper reviews studies that have explored the relationship between “a priori” dietary patterns, AD and AD-related chronic disease risk. The dietary patterns we will review are the healthy eating index, healthy diet indicator, recommended food score, and the Mediterranean diet (MeDi). Our review of the literature suggests a generally positive association between healthy diet patterns, AD and AD-related chronic disease risk; however the magnitude of the protective effect is modest in many studies. Consequently, we can only confidently conclude that the MeDi is associated with reduced AD risk, and further studies on the remaining indices need to be carried out. It is our opinion that a combination of dietary scores could predict overall dietary quality and chronic disease risk to a greater extent than one score individually. Analysis in multi-ethnic cohorts, investigating combinations of scores must be completed before firm conclusions can be reached on the ideal combination of scores. Obtaining further insight into the association between dietary patterns, AD and AD-related chronic disease risk may help in prioritizing public health efforts and provide a stronger basis for recommendations to improve dietary patterns.

Diet Quality Is Independently Associated with Weight Status in Children Aged 9–10 Years1–3

AbstractAlthough energy imbalance is key to the development of childhood obesity, the association between different dietary components, reflected in diet quality scores, and children's weight status has not been extensively studied. The current study determined if diet quality, characterized according to 3 predefined scores, was associated with weight status in a population-based sample of 9- to 10-y-old British children, independently of factors previously associated with weight status. In a cross-sectional study of 1700 children (56% girls), data from 4-d food diaries were used to calculate 3 diet quality scores modified to be reflective of children's diets: the Diet Quality Index (DQI), Healthy Diet Indicator (HDI), and Mediterranean Diet Score (MDS). Physical activity was measured with 7-d accelerometery, and height, weight, waist, and bio-impedance were objectively measured and used to calculate weight status variables. After multiple adjustments, including physical activity and overall energy density, higher DQI and HDI scores were significantly associated with improved weight status. Comparing extreme quintiles of the scores revealed the DQI and HDI were associated with lower waist circumference (-3.0%, P = 0.005 and -2.5%, P = 0.033, respectively), and lower body fat (-5.1%, P = 0.023 and -4.9%, P = 0.026, respectively). The DQI was also associated with lower weight (-5.9%; P = 0.002) and BMI (-4.2%; P = 0.004). No significant associations were observed with the MDS. These findings suggest that diet quality is independently associated with children's weight status. Future work should consider if diet quality scores could be key components of interventions designed to reduce obesity in children.

Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in Sweden

Comparative studies on dietary patterns and long-term mortality are sparse. The objective was to examine the relations between 10-y mortality and adherence to the World Health Organization dietary guidelines [Healthy Diet Indicator (HDI)], a Mediterranean-like diet, and a carbohydrate-restricted (CR) diet in elderly Swedish men. Dietary habits were determined by 7-d dietary records in a population-based longitudinal study of 924 Swedish men (age: 71 ± 1 y). The HDI score (-1 to 8 points), the Mediterranean Diet Score (MDS; 0-8 points), and the CR score (2-20 points) were calculated for each participant. Nonadequate reporters of energy intake were identified (n = 413). Mortality was registered during a median follow-up of 10.2 y. Cox proportional hazards regression, with multivariable adjustments, was used to determine the effects of adherence to each dietary pattern. Two hundred fifteen and 88 subjects died of all-cause and cardiovascular disease, respectively. In all individuals, risk relations to mortality for each SD increment in the scores were observed for only MDS, with an adjusted hazard ratio (HR) of 0.83 (95% CI: 0.70, 0.99). Among adequate dietary reporters (n = 511), adjusted HRs for each SD increment in scores were enhanced for MDS (ie, 0.71; 95% CI: 0.55, 0.92) for all-cause mortality and 0.63 (95% CI: 0.42, 0.96) for cardiovascular mortality. Corresponding HRs for CR diet score were 1.19 (95% CI: 0.97, 1.45) for all-cause mortality and 1.44 (95% CI: 1.03, 2.02) for cardiovascular mortality. Adherence to a Mediterranean-like dietary pattern reduced mortality, whereas adherence to a CR dietary pattern appeared to increase mortality in elderly Swedish men, especially when only adequate dietary reporters were considered.

Dietary habits in three Central and Eastern European countries: the HAPIEE study.

BackgroundThe high cardiovascular mortality in Eastern Europe has often been attributed to poor diet, but individual-level data on nutrition in the region are generally not available. This paper describes the methods of dietary assessment and presents preliminary findings on food and nutrient intakes in large general population samples in Russia, Poland and the Czech Republic.MethodsThe HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study examined random samples of men and women aged 45-69 years at baseline in Novosibirsk (Russia), Krakow (Poland) and six Czech urban centres in 2002-2005. Diet was assessed using a food frequency questionnaire (at least 136 items); complete dietary information was available for 26,870 persons.ResultsTotal energy intakes among men ranged between 8.7 MJ in the Czech sample and 11.7 MJ in the Russian sample, while among women, energy intakes ranged between 8.2 MJ in the Czech sample and 9.8 MJ in the Russian sample. A Healthy Diet Indicator (HDI), ranging from a score of 0 (lowest) to 7 (highest), was developed using the World Health Organisation's (WHO) guidelines for the prevention of chronic diseases. The mean HDI scores were low, ranging from 1.0 (SD = 0.7) among the Polish subjects to 1.7 (SD = 0.8) among the Czech females. Very few subjects met the WHO recommended intakes for complex carbohydrates, pulses or nuts; intakes of saturated fatty acids, sugar and protein were too high. Only 16% of Polish subjects met the WHO recommendation for polyunsaturated fat intake. Consumption of fruits and vegetables was lower than recommended, especially among those Russian subjects who were assessed during the low intake season. Fewer than 65% of subjects consumed adequate amounts of calcium, magnesium and potassium, when compared with the United Kingdom's Reference Nutrient Intake.ConclusionThis first large scale study of individual-based dietary intakes in the general population in Eastern Europe implies that intakes of saturated fat, sugar and complex carbohydrates are a cause for concern. The development of country-specific nutritional tools must be encouraged and nutritional campaigns must undergo continuing development.

Portuguese households’ diet quality (adherence to Mediterranean food pattern and compliance with WHO population dietary goals): trends, regional disparities and socioeconomic determinants

To evaluate households' diet-quality trends and regional disparities, as well as to identify the influence of its socioeconomic determinants. Two dietary indexes were applied: a revised Healthy Diet Indicator version (HDIr) and the Mediterranean Adequacy Index (MAI). The socioeconomic differences between households with low-diet quality (if their scoring in HDIr or MAI was below the national median) and the remaining ones were analysed by means of logistic regression. Representative samples of households among each region were analysed. Adherence to a Mediterranean diet was poor in all Portuguese regions; the proportion of households adhering to it has diminished in the North, Centre, Lisbon and Tejo valley. The proportion of households with high HDIr decreased in the North, Centre, Lisbon and Tejo valley and Algarve. In multivariate analysis, households whose head had secondary or higher education, living in semi-urban or urban areas, from the Azores region, within the higher income or outside home food expenditures groups were more likely to be in low-quality diet. The decreasing adherence to a Mediterranean food pattern and the diminishing compliance with World Health Organization dietary goals show that Portuguese households have reduced their diet quality. The observed influence of urbanization and region on diet quality highlights the importance of considering regional nutrition strategies.

Household diet quality in relation to mortality in Portuguese regions: an ecological study

The aim of this study was to investigate the association between regional household diet quality and corresponding mortality data. Two household diet quality scores derived from household budget survey food and nutrient data were used: the Mediterranean Adequacy Index (MAI), assessing adherence to a Mediterranean food pattern, and a revised Healthy Diet Indicator (HDIr), based on compliance with WHO population dietary goals. Seven Portuguese regions were considered, in accordance with the officially adopted national territorial division NUT II. The corresponding regional age-standardised death rates were calculated for selected diet-related mortality causes. In order to allow for a minimum of 10 years latency period between exposure and outcome, dietary scores from 1989/1990 and its components were correlated to the 3-year average 1999/2001 death rates. Tobacco expenses were included for adjustment. Significant negative correlations with the proportion of families with highest MAI (≥4) or HDIr (≥7) scores were observed for mortality from diabetes mellitus (−0.87, P < 0.05; −0.89, P < 0.5), cardiovascular diseases (−0.89, P < 0.05; −0.96, P < 0.01) and ischaemic heart disease (−0.89, P < 0.05; −0.90, P < 0.05). Malignant neoplasms were positively correlated with protein, cholesterol and soft drinks, but inversely with polyunsaturated fatty acids (PUFA). Diabetes showed significant positive correlations with simple sugars and animal fat intake, but inversely with fruits and vegetables. Cardiovascular diseases presented positive correlations with simple sugars, milk and dairy products and animal fat, but inverse with fruits and vegetables and vegetable oils. Despite the limitations of ecological approaches in general and of the statistical power in this particular study, due to the use of broad geographical areas, significant correlations in the expected direction of reduced mortality risk with improved household diet quality was reported. The use of diet quality scores in data from household budget surveys could depict variations in Portuguese regional food and nutrient patterns, which were revealed to be related and partially explain differences in regional cause-specific mortality rates from diet-related diseases.

Factors associated with the consumption of fruits and vegetables in south-east Hungary

Several risk factors of diet-related diseases are present in the nutrition of the Hungarian population. The aim of the study was to investigate the health status and the association of the daily consumption of fruits and vegetables as indicators of healthy diet with sociodemographic factors, health behaviours in the south-eastern part of Hungary. In 2002, a cross-sectional study based on interviewer-administered questionnaires was conducted in the south-eastern part of Hungary. The sample comprised of 3419 people, aged between 15 and 75, with about 40 persons from each practice. The results demonstrated that fruit and vegetable consumption of the studied population were determined by certain demographical, economical and lifestyle factors, and were also associated with self-assessed health and health status. Altering the habits of nutrition is an integral part of health intervention programs. Success rate may, however, be largely reduced by the social and economic background of the habits in question.

Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort)

To describe the selection and modification of an appropriate diet score to assess diet quality in early old age. Cross-sectional analyses of the Boyd Orr cohort - a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy. In total, 1475 traced, surviving cohort members aged 60 years and over. Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r=0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r=-0.57), red meat (r=-0.46), dietary fibre (r=0.58), fruit and vegetables (r=0.54) and percentage energy from carbohydrates (r=0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items. The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.

A Healthy Diet Indicator: Quantifying Compliance with the Dietary Guidelines Using the BRFSS

Background. The Behavioral Risk Factor Surveillance System (BRFSS) monitors population prevalence of risk factors related to chronic disease through annual telephone surveys. The purpose of this study was to investigate the feasibility of using the BRFSS to estimate an indicator of overall diet quality among adults.Methods. The authors developed a brief set of dietary questions that were included in the 1997 Michigan BRFSS. Responses to these questions were analyzed to calculate the Michigan healthy diet indicator (MI-HDI), which was modeled after the U.S. Department of Agriculture's Healthy Eating Index.Results. Among 2,532 respondents, the mean MI-HDI was 55.7 points (maximum score = 100). The mean MI-HDI decreased consistently with declining self-rated eating habits, from 61.5 among those with excellent eating habits to 45.2 among those with poor habits. Diet quality, as measured by the MI-HDI, was higher among women than men and improved with age, education, and factors related to certain interactions with health professionals.Conclusions. A BRFSS-based indicator can be a feasible and valuable tool for evaluating diet quality among adults using an established state-level surveillance system.

Nutrition and cognitive deficit in the elderly: a population study.

To investigate the association between a healthy diet indicator and the prevalence of cognitive impairment in the elderly. Cross-sectional study. Population based. A total of 1651 subjects (560 men and 1091 women) including everybody aged 70 y or more, and a random sample of people (about 40%) aged 65-69 y resident in four rural towns in the province of Pavia, Italy in 1992-1993. The healthy diet indicator based on the WHO guidelines for the prevention of chronic diseases was calculated as reported by Huijbregts et al (1998; Eur. J. Clin. Nutr. 52, 826-831). Food intake was estimated by means of a 180-item food-frequency questionnaire and nutrient intake was calculated using the food composition database compiled for epidemiologic studies in Italy. The cognitive function was categorized into four levels-normal cognition, mild, moderate and severe cognitive deficit-according to the neuropsychological test score. The relationship between the dietary and the ordinal cognitive function variables was studied using the proportional-odds model. After adjustment for age, sex, education, total energy intake, cigarette smoking, alcohol consumption and physical activity, a better healthy diet score was associated with a lower prevalence of cognitive deficit. The cumulative odds ratio was 0.85 (95% CI 0.77-0.93). Our results suggest an association between a globally satisfactory diet and better cognitive performance in the elderly. However, the specific aspects of a 'healthy diet' for the elderly should be clarified. National Research Council (Italy), 'Invecchiamento' Project no. 95.01048.PF40.

Evaluation of dietary quality in relationship to nutritional and lifestyle factors in elderly people of the US Framingham Heart Study and the European SENECA study.

To evaluate dietary quality of European and American elderly subjects using different derivatives of dietary patterns (dietary scores and clusters) and to investigate the relationship of these approaches to nutritional and lifestyle factors. Data from the cross-sectional SENECA baseline study and Framingham Heart Study (original cohort and offspring) were used for data analysis. Food intake data were summarised into dietary clusters and into dietary scores (Healthy Diet Indicator and Mediterranean Diet Score). These measures of dietary quality were then tested for associations with lifestyle factors and measures of nutritional status. The study population, aged 70-77 y, consisted of 828 subjects from Framingham, MA (USA) and 1282 subjects from the following European centres: Hamme, Belgium; Roskilde, Denmark; Padua, Italy; Culemborg, The Netherlands; Vila Franca de Xira, Portugal; Betanzos, Spain; and Yverdon, Burgdorf and Bellinzona, Switzerland. Dietary intake varied widely across the European and American research centres. In general, Southern European centres and Framingham had higher mean diet scores, indicating a higher dietary quality, than Northern European centres (MD-scores: 4.2-4.4 vs 2.7-3.5). Cluster analysis identified the following five dietary patterns characterised by: (1) sugar and sugar products; (2) fish and grain; (3) meat, eggs and fat; (4) milk and fruit; and (5) alcohol intake. The meat, eggs and fat pattern had significantly lower average dietary quality, as measured with all three diet scores than all other groups except the alcohol group. The fish and grain group had significantly better Mediterranean diet scores than all other groups. Dietary scores and dietary clusters are complementary measures to classify dietary quality. The associations with nutritional and lifestyle factors indicate the adequate categorisation into dietary quality groups. European Union, US Department of Agriculture, Agriculture Research Service, under agreement (58-1950-9-001), Haak Bastiaanse-Kuneman Foundation.

Wine drinking and diet in Italy.

To investigate the relation between wine drinking and intake of selected indicator foods, which may vary in various populations. Cross-sectional analysis of the comparison group of a case- control study. A network of teaching and general hospitals from six Italian areas. 5642 control subjects (3261 females and 2381 males) aged 20-74 y (median age 58 y), admitted for acute, non-neoplastic conditions unrelated to alcohol consumption. Participation rate was over 95%. Trained interviewers collected information using a structured and validated questionnaire. The average intakes of selected food items were computed, together with the multivariate odds ratios (OR) of eating above the median of each food. No appreciable difference in either sex for any food indicator considered (fruit, raw vegetables, cooked vegetables, salad and fish) was observed between abstainers, wine, and other alcoholic beverage drinkers. If anything, female wine drinkers reported less frequently high consumption of salad (OR=0.8) and raw vegetables (OR=0.8), both estimates being of borderline significance. In no instance did wine drinkers or mixed drinkers (who include a large proportion of wine drinkers, too) show an association with indicators of healthy diet. Italian Association for Cancer Research, Milan, Italy. European Journal of Clinical Nutrition (2000) 54, 177-179

Costs of a healthy diet: analysis from the UK Women's Cohort Study.

To investigate the direct and indirect cost differences associated with eating a 'healthy' or 'unhealthy' diet. Analysis of data from a baseline postal questionnaire for the UK Women's Cohort Study, including a detailed food frequency questionnaire (FFQ), supplemented by a telephone interview on a sub-sample. The first 15,191 women who responded to the questionnaire, aged 35-69 years with similar numbers of meat eaters, fish eaters and vegetarians. A healthy diet indicator (hdi), with values from 0 (lowest) to 8 (highest) was developed based on the WHO dietary recommendations. Direct monetary cost of the diet was calculated using prices from the 1995 National Food Survey and the Tesco home shopping catalogue. Women in the healthy diet group were almost four times as likely to be vegetarian and have a higher educational level. For direct costs, the difference between the most extreme hdi groups was 1.48 day-1 (equivalent to 540 year-1), with fruit and vegetable expenditure being the main items making a healthy diet more expensive. Forty-nine per cent of the food budget was spent on fruit and vegetables in hdi group 8 compared to 29% in hdi group 0. Interestingly, 52% of those questioned in both extreme hdi groups did not think that it was difficult to eat healthily. To achieve a particularly healthy diet independent predictive factors were spending more money, being a vegetarian, having a higher energy intake, having a lower body mass index (BMI) and being older.

Wine intake and diet in a random sample of 48763 Danish men and women

Variation in diet associated with drinking patterns may explain why wine seems to reduce ischemic heart disease mortality. Our objective was to study the association between intake of different alcoholic beverages and selected indicators of a healthy diet. This was a cross-sectional study conducted in Copenhagen and Aarhus, Denmark, from 1995 to 1997, and included 23 284 men and 25 479 women aged 50-64 y. The main outcome measures were groups of selected foods that were indicators of a healthy dietary pattern. Wine, as compared with other alcoholic drinks, was associated with a higher intake of fruit, fish, cooked vegetables, salad, and the use of olive oil for cooking in both men and women. Men who preferred beer and spirits had odds ratios of 0.42 (95% CI: 0.39, 0.45) and 0.51 (95% CI: 0.43, 0.60), respectively, for a high intake of salad compared with those who preferred wine. Higher wine intake was associated with a higher intake of healthy food items compared with intake of < or = 2.5 glasses of wine/mo; odds ratios for drinkers of between 30 and 135 glasses of wine/mo for all the chosen indicators of healthy diet varied between 1.23 and 4.20, and were all strongly significant. Wine drinking is associated with an intake of a healthy diet. This finding may have implications for the interpretation of previous reports of the relation between type of alcoholic beverage and mortality.

Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands.

To relate dietary patterns to cognitive function in elderly men. Cross-sectional study. Population based. 1049 men aged 70-91 years around 1990 in five cohorts from the Seven Countries Study: Finland (2 cohorts), the Netherlands (1 cohort), and Italy (2 cohorts). Food intake was estimated by a cross-check dietary history. Based on the WHO guidelines for the prevention of chronic diseases, a healthy diet indicator was calculated (HDI). A higher HDI indicates a diet more in accordance with the WHO guidelines, and previously we showed that HDI predicted reduced all-cause mortality in our cohorts. Cognitive function was measured using the Mini-Mental State Examination (MMSE), and a score of 23 or lower was used to indicate cognitive impairment. The prevalence of cognitive impairment varied from 14.4% in Zutphen (The Netherlands) to 42.1% in Crevalcore (Italy). There was a tendency towards a lower prevalence of cognitive impairment associated with increased HDI in four out of five cohorts (not in East Finland). In Zutphen this association was borderline significant (OR=0.81; 95% CI 0.63-1.04) after adjustment for age, education, cigarette smoking, alcohol consumption and energy intake. In Crevalcore the association was statistically significant (OR = 0.75; 95% CI 0.58-0.97). A healthy diet might be associated with a better cognitive function in elderly men. However, since the results were not consistent over all five cohorts, further research is needed to confirm this finding and to decide whether this association is causal.

Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study

Objective: To investigate the association of dietary pattern and mortality in international data.Design: Cohort study with 20 years' follow up of mortality.Setting: Five cohorts in Finland, the Netherlands, and Italy.Subjects:...

The families of dull children. A classification for predicting careers.

<h3>Objectives</h3> To examine associations of three diet quality indices and a polygenic risk score with incidence of all-cause mortality, cardiovascular disease (CVD) mortality, myocardial infarction (MI) and stroke. <h3>Design</h3> Prospective cohort study. <h3>Setting</h3> UK Biobank, UK. <h3>Participants</h3> 77 004 men and women (40–70 years) recruited between 2006 and 2010. <h3>Main outcome measures</h3> A polygenic risk score was created from 300 single nucleotide polymorphisms associated with CVD. Cox proportional HRs were used to estimate independent effects of diet quality and genetic risk on all-cause mortality, CVD mortality, MI and stroke risk. Dietary intake (Oxford WebQ) was used to calculate Recommended Food Score (RFS), Healthy Diet Indicator (HDI) and Mediterranean Diet Score (MDS). <h3>Results</h3> New all-cause (n=2409) and CVD (n=364) deaths and MI (n=1141) and stroke (n=748) events were identified during mean follow-ups of 7.9 and 7.8 years, respectively. The adjusted HR associated with one-point higher RFS for all-cause mortality was 0.96 (95% CI: 0.94 to 0.98), CVD mortality was 0.94 (95% CI: 0.90 to 0.98), MI was 0.97 (95% CI: 0.95 to 1.00) and stroke was 0.94 (95% CI: 0.91 to 0.98). The adjusted HR for all-cause mortality associated with one-point higher HDI and MDS was 0.97 (95% CI: 0.93 to 0.99) and 0.95 (95% CI: 0.91 to 0.98), respectively. The adjusted HR associated with one-point higher MDS for stroke was 0.93 (95% CI: 0.87 to 1.00). There was little evidence of associations between HDI and risk of CVD mortality, MI or stroke. There was evidence of an interaction between diet quality and genetic risk score for MI. <h3>Conclusion</h3> Higher diet quality predicted lower risk of all-cause mortality, independent of genetic risk. Higher RFS was also associated with lower risk of CVD mortality and MI. These findings demonstrate the benefit of following a healthy diet, regardless of genetic risk.