Adherence to the WHO’s Healthy Diet Indicator and Overall Cancer Risk in the EPIC-NL Cohort

Abstract

BackgroundA healthy dietary pattern defined by international recommendations of the World Health Organisation (WHO) has been shown to reduce overall mortality risk. It is unknown whether this healthy dietary pattern is associated with overall cancer incidence.DesignIn total 35,355 men and women within the Dutch European Prospective Investigation into Cancer and Nutrition-cohort were followed for cancer occurrence. Diet was assessed through a validated food-frequency questionnaire. We computed a dietary score for all participants based on the seven WHO dietary guidelines for the prevention of chronic diseases (Healthy Diet Indicator (HDI)). We used the existing HDI score based on the 1990 WHO guidelines, and adapted it to meet with the 2002 WHO guidelines. Multivariate-adjusted Cox proportional hazards analysis was used to examine the association between adherence to the HDI and subsequent overall cancer risk.ResultsA number of 3,007 new cancers were identified during a mean follow-up of 12.7 years. 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 HDI was 0.96 (95% CI 0.89–1.03) in men, and 1.00 (95% CI 0.96–1.04) in women. Adherence to the HDI was not associated with smoking-related cancer ((HR men: 0.94 (95% CI 0.84–1.04); HR women: 1.00 (95% CI 0.94–1.07)), or alcohol-related cancer ((HR men: 1.02 (95% CI 0.87–1.20); HR women: 1.03 (95% CI 0.98–1.08)).ConclusionsGreater adherence to the WHO’s Healthy Diet Indicator, a dietary pattern for prevention of chronic diseases, was not associated with reduced overall, smoking-related or alcohol-related cancer risk in men or women.

Identifying biomarkers of dietary patterns by using metabolomics

“…A summary of diet index scoring algorithms can be found in Table 1 (detailed summary in Supplemental Tables 3-6), as follows: 1) The HEI-2010 was developed by the USDA and the National Cancer Institute as an index of overall diet quality based on the 2010 US Dietary Guidelines for Americans (8,37,38); 2) The HDI is based on the international WHO dietary guidelines for the prevention of chronic diseases (43,44);…”

“…Each food group or nutrient guideline was assigned a score of 1 if intake met the guideline and 0 otherwise. The overall score was the sum of dichotomous variables (range: 0-7) (43,44). 5 The BSD has 9 components: fruit (apples, pears, and berries), vegetables (cabbage, roots, tomatoes, lettuce, and cucumber), fish, whole grains (barley, oats, and rye), low-fat milk, processed meat, restricting fat percentage, ratio of polyunsaturated to saturated and trans fat, and limiting alcohol.…”

Dietary patterns in relation to quality-adjusted life years in the EPIC-NL cohort

“…For the HDI an inverse association was seen with all-cause, CVD and cancer mortality (Huijbregts et al, 1997;Knoops et al, 2006), but not with breast cancer risk (Cade et al, 2011). In the EPIC-NL study no association was found between the HDI and cancer incidence (Berentzen et al, 2013) or CVD risk (Struijk et al, 2014c). These differences across diseases illustrate the need for an approach that summarizes the overall net relation between a dietary pattern and health.…”

“…The association between dietary patterns and single chronic diseases has been investigated before in EPIC-NL (Berentzen et al, 2013;Stricker et al, 2013;Waijers et al, 2006) and other populations (Mente et al, 2009;Romaguera et al, 2012;Sofi et al, 2010;Trichopoulou et al, 2005). The DHD-index was not associated with CVD risk and cancer (Struijk et al, 2014b,c); a Mediterranean-style diet was inversely associated with all-cause mortality (Knoops et al, 2004;Sofi et al, 2010;Trichopoulou et al, 2005).…”

“…Dietary patterns can be defined a priori (based on existing knowledge) or a posteriori (based on observed nutritional data). Both a priori-and a posteriori-defined dietary patterns have been used to investigate their relations with the occurrence of chronic diseases (Berentzen et al, 2013;Mente et al, 2009;Romaguera et al, 2012;Sofi et al, 2010;Stricker et al, 2013;Waijers et al, 2006). Adherence to healthier dietary patterns has been associated with lower risk of cardiovascular disease, cancer, and overall mortality in several (Mente et al, 2009;Romaguera et al, 2012;Sofi et al, 2010;Stricker et al, 2013;Waijers et al, 2006), but not all (Berentzen et al, 2013) studies.…”