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PLoS One. 2016 Jul 13;11(7):e0159025. doi: 10.1371/journal.pone.0159025. eCollection 2016.

Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.

Author information

1
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.
2
Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain.
3
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
4
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
5
International Agency for Research on Cancer, Lyon, France.
6
Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population, Health, U1018, Team 9, Villejuif, France.
7
Institut Gustave Roussy, Villejuif, France.
8
Paris South University, Unité Mixte de Recherche 1018, Villejuif, France.
9
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
10
Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark.
11
German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
12
Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke German Institute of Human Nutrition, Potsdam, Germany.
13
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
14
Public Health Directorate, Asturias, Oviedo, Spain.
15
Andalusian School of Public Health, Granada, Spain.
16
Public Health Direction and Biodonostia Basque Regional Health Department, San Sebastian, Spain.
17
Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
18
Navarre Public Health Institute, Pamplona, Spain.
19
Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain.
20
University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit, Cambridge, United Kingdom.
21
Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
22
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
23
Hellenic Health Foundation, Athens, Greece.
24
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
25
Epidemiology and Prevention Unit, Department of Preventive and Predictive Medicine, Foundation of the Carlo Besta Neurological Institute, Milan, Italy.
26
Cancer Registry and Histopathology Unit, "Civic MP Arezzo" Hospital, Ragusa, Italy.
27
Human Genetics Foundation, Turin, Italy.
28
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
29
Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
30
Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
31
Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
32
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
33
Department of Research, Cancer Registry of Norway, Oslo, Norway.
34
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
35
Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.

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.

PMID:
27409582
PMCID:
PMC4943719
DOI:
10.1371/journal.pone.0159025
[Indexed for MEDLINE]
Free PMC Article

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