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Scoring models of a diet quality index and the predictive capability of mortality in a population-based cohort of Swedish men and women

  • Isabel Drake (a1) (a2), Bo Gullberg (a1), Emily Sonestedt (a1), Peter Wallström (a1), Margaretha Persson (a1) (a2), Joanna Hlebowicz (a1) (a2), Jan Nilsson (a1) (a2), Bo Hedblad (a1) (a2) and Elisabet Wirfält (a1)...

Abstract

Objective

To examine how different scoring models for a diet quality index influence associations with mortality outcomes.

Design

A study within the Malmö Diet and Cancer cohort. Food and nutrient intakes were estimated using a diet history method. The index included six components: SFA, PUFA, fish and shellfish, fibre, fruit and vegetables, and sucrose. Component scores were assigned using predefined (based on dietary recommendations) and population-based cut-offs (based on median or quintile intakes). Multivariate Cox regression was used to model associations between index scores (low, medium, high) and all-cause and cause-specific mortality by sex.

Setting

Malmö, the third largest city in Sweden.

Subjects

Men (n 6940) and women (n 10 186) aged 44–73 years. During a mean follow-up of 14·2 years, 2450 deaths occurred, 1221 from cancer and 709 from CVD.

Results

The predictive capability of the index for mortality outcomes varied with type of scoring model and by sex. Stronger associations were seen among men using predefined cut-offs. In contrast, the quintile-based scoring model showed greater predictability for mortality outcomes among women. The scoring model using median-based cut-offs showed low predictability for mortality among both men and women.

Conclusions

The scoring model used for dietary indices may have a significant impact on observed associations with disease outcomes. The rationale for selection of scoring model should be included in studies investigating the association between dietary indices and disease. Adherence to the current dietary recommendations was in the present study associated with decreased risk of all-cause and cause-specific mortality, particularly among men.

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Copyright

Corresponding author

*Corresponding author: Email Isabel.Drake@med.lu.se

References

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1.Nordic Council of Ministers (2004) Nordic Nutrition Recommendations 2004 – Integrating Nutrition and Physical Activity, 4th ed. Copenhagen: Nordic Council of Ministers.
2.World Health Organization/Food and Agriculture Organization of the United Nations (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Geneva: WHO.
3.US Department of Agriculture & US Department of Health and Human Services (2010) Dietary Guidelines for Americans, 2010, 7th ed. Washington, DC: US Government Printing Office.
4.Hu, F (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.
5.Huijbregts, P, Feskens, E, Räsänen, Let al. (1997) Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study. BMJ 315, 1317.
6.Seymour, J, Calle, E, Flagg, Eet al. (2003) Diet quality index as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort. Am J Epidemiol 157, 980988.
7.Knoops, K, Groot de, L, Fidanza, Fet al. (2006) Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project. Eur J Clin Nutr 60, 746755.
8.Kant, A, Schatzkin, A, Graubard, Bet al. (2000) A prospective study of diet quality and mortality in women. JAMA 283, 21092115.
9.McCullough, ML, Feskanich, D, Stampfer, MJet al. (2002) Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76, 12611271.
10.Alberti, A, Fruttini, D & Fidanza, F (2009) The Mediterranean Adequacy Index: further confirming results of validity. Nutr Metab Cardiovasc Dis 19, 6166.
11.Fung, TT, Hu, FB, Wu, Ket al. (2010) The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and colorectal cancer. Am J Clin Nutr 92, 14291435.
12.Fung, TT, Hu, FB, McCullough, MLet al. (2006) Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women. J Nutr 136, 466472.
13.Reedy, J, Mitrou, PN, Krebs-Smith, SMet al. (2008) Index-based dietary patterns and risk of colorectal cancer. Am J Epidemiol 168, 3848.
14.Drake, I, Gullberg, B, Ericson, Uet al. (2011) Development of a diet quality index assessing adherence to the Swedish nutrition recommendations and dietary guidelines in the Malmö Diet and Cancer cohort. Public Health Nutr 14, 835845.
15.Becker, W (1999) Dietary guidelines and patterns of food and nutrient intake in Sweden. Br J Nutr 81, Suppl. 2, S113S117.
16.Waijers, P, Feskens, E & Ocké, M (2007) A critical review of predefined diet quality scores. Br J Nutr 97, 219231.
17.Arvaniti, F & Panagiotakos, D (2008) Healthy indexes in public health practice and research: a review. Crit Rev Food Sci Nutr 48, 317327.
18.Kourlaba, G & Panagiotakos, D (2009) Dietary quality indices and human health: a review. Maturitas 62, 18.
19.Berglund, G, Elmståhl, S, Janzon, Let al. (1993) The Malmö Diet and Cancer study. Design and feasibility. J Intern Med 233, 4551.
20.Manjer, J, Carlsson, S, Elmståhl, Set al. (2001) The Malmo diet and cancer study: representativity, cancer incidence and mortality in participants and non-participants. Eur J Cancer Prev 10, 489499.
21.Mattisson, I, Wirfält, E, Aronsson, CAet al. (2005) Misreporting of energy: prevalence, characteristics of misreporters and influence on observed risk estimates in the Malmö Diet and Cancer cohort. Br J Nutr 94, 832842.
22.Sonestedt, E, Wirfält, E, Gullberg, Get al. (2005) Past food habit change is related to obesity, lifestyle and socio-economic factors in the Malmo Diet and Cancer Cohort. Public Health Nutr 8, 876885.
23.Callmer, E, Riboli, E, Saracci, Ret al. (1993) Dietary assessment methods evaluated in the Malmö food study. J Intern Med 233, 5357.
24.Elmståhl, S, Riboli, E, Lindgärde, Fet al. (1996) The Malmö food study: the relative validity of a modified diet history method and an extensive food frequency questionnaire for measuring food intake. Eur J Clin Nutr 50, 143151.
25.Riboli, E, Elmståhl, S, Saracci, Ret al. (1997) The Malmö food study: validity of two dietary assessment methods for measuring nutrient intake. Int J Epidemiol 26, Suppl. 1, S161S173.
26.Elmståhl, S, Gullberg, B, Riboli, Eet al. (1996) The Malmö food study: the reproducibility of a novel diet history method and an extensive food frequency questionnaire. Eur J Clin Nutr 50, 134142.
27.Wirfält, E, Mattisson, I, Johansson, Uet al. (2002) A methodological report from the Malmö Diet and Cancer study: development and evaluation of altered routines in dietary data processing. Nutr J 1, 3.
28.Swedish National Bureau of Statistics (1989) Occupations in Population and Housing Census 1985 (FoB 85) according to Nordic Standard Occupational Classification (Nordisk yrkesklassificering NYK) and Swedish Socioeconomic Classification (Socioekonomisk indelning SEI). Stockholm: National Bureau of Statistics.
29.Royal College of Psychiatrists (1986) Alcohol: Our Favorite Drug. London: Tavistock.
30.Sofi, F, Cesari, F, Abbate, Ret al. (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337, a1344.
31.Park, Y, Subar, A & Hollenbeck, A (2011) Dietary fiber intake and mortality in the NIH–AARP Diet and Health study. Arch Intern Med 171, 10611068.
32.Thiébaut, A, Kipnis, V, Schatzkin, Aet al. (2008) The role of dietary measurement error in investigating the hypothesized link between dietary fat intake and breast cancer – a story with twists and turns. Cancer Invest 26, 6873.
33.Patterson, RE, Haines, PS & Popkin, BM (1994) Diet quality index: capturing a multidimensional behaviour. J Am Diet Assoc 94, 5764.
34.Harnack, L, Nicodemus, K, Jacobs, DR Jret al. (2002) An evaluation of the Dietary Guidelines for Americans in relation to cancer occurrence. Am J Clin Nutr 76, 889896.
35.Fondell, E, Christensen, SE, Bälter, Oet al. (2011) Adherence to the Nordic Nutrition Recommendations as a measure of a healthy diet and upper respiratory tract infection. Public Health Nutr 14, 860869.
36.Trichopoulou, A, Costacou, T, Bamia, Cet al. (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.
37.Kennedy, ET, Ohls, J, Carlson, Set al. (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.

Keywords

Scoring models of a diet quality index and the predictive capability of mortality in a population-based cohort of Swedish men and women

  • Isabel Drake (a1) (a2), Bo Gullberg (a1), Emily Sonestedt (a1), Peter Wallström (a1), Margaretha Persson (a1) (a2), Joanna Hlebowicz (a1) (a2), Jan Nilsson (a1) (a2), Bo Hedblad (a1) (a2) and Elisabet Wirfält (a1)...

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