Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition?

Abstract

Guidelines for a healthy diet aim to decrease the risk of chronic diseases. It is unclear as to what extent a healthy diet is also an environmentally friendly diet. In the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition, the diet was assessed with a 178-item FFQ of 40 011 participants aged 20–70 years between 1993 and 1997. The WHO’s Healthy Diet Indicator (HDI), the Dietary Approaches to Stop Hypertension (DASH) score and the Dutch Healthy Diet index 2015 (DHD15-index) were investigated in relation to greenhouse gas (GHG) emissions, land use and all-cause mortality risk. GHG emissions were associated with HDI scores (−3·7 % per sd increase (95 % CI −3·4, −4·0) for men and −1·9 % (95 % CI −0·4, −3·4) for women), with DASH scores in women only (1·1 % per sd increase, 95 % CI 0·9, 1·3) and with DHD15-index scores (−2·5 % per sd increase (95 % CI −2·2, −2·8) for men and −2·0 % (95 % CI −1·9, −2·2) for women). For all indices, higher scores were associated with less land use (ranging from −1·3 to −3·1 %). Mortality risk decreased with increasing scores for all indices. Per sd increase of the indices, hazard ratios for mortality ranged from 0·88 (95 % CI 0·82, 0·95) to 0·96 (95 % CI 0·92, 0·99). Our results showed that adhering to the WHO and Dutch dietary guidelines will lower the risk of all-cause mortality and moderately lower the environmental impact. The DASH diet was associated with lower mortality and land use, but because of high dairy product consumption in the Netherlands it was also associated with higher GHG emissions.

Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

“…Of the 13 related publications, one publication reported the results in two different cohort studies and therefore, was considered as two separate studies [34]. Finally, 17 prospective cohort studies (13 publications) were included in the final analyses [22,23,33,34,[36][37][38][39][40][41][42][43][44]. Three studies (two publications) did not provide sufficient data regarding the number of deaths and risk of mortality based on each category (quartile or quintile) of the DASH diet score; thus, they were not included in the non-linear dose-response meta-analysis [34,40].…”

“…Eleven studies were from the US [22, 23, 33, 36-39, 41, 44], four studies were from Europe [40,42,43], and two studies (one publication) were from Asia [34]. From 17 prospective cohort studies included in this meta-analysis: 13 studies (nine publications) reported data for allcause mortality [23,33,34,36,[38][39][40][41][42][43], 12 studies (nine publications) reported CVD mortality [22,23,[36][37][38][39][40][41]43], 12 studies (seven publications) reported total cancer mortality [22,23,36,[38][39][40][41], and two studies reported stroke mortality [37,44]. All included studies used a validated food frequency questionnaire to assess dietary intakes except two studies that evaluated dietary intakes using 3-day dietary records [36].…”

“…All included studies used a validated food frequency questionnaire to assess dietary intakes except two studies that evaluated dietary intakes using 3-day dietary records [36]. All studies provided adjusted risk estimates and all of HRs were adjusted for age, smoking, energy intake and physical activity and the majority of them adjusted the associations for alcohol consumption (15 studies) [22,23,34,[36][37][38][39][41][42][43][44] and BMI (16 studies) [22,23,33,34,37,38,[40][41][42][43][44]. The general characteristics of the 17 eligible studies are summarized in Table 1.…”

Identification of data-driven Dutch dietary patterns that benefit the environment and are healthy

“…To exclude dietary over and under reporters, participants in the highest and lowest 0.5% of the ratio of reported energy intake to basal metabolic rate were also excluded (n = 400). Participants with a self-reported history of cancer (n = 1645), diabetes (n = 793), myocardial infarction (n = 531), or stroke (n = 463) at baseline were excluded to include the same population as our previous publications (Biesbroek et al 2014;Biesbroek et al 2017). After these exclusions, 36,209 participants remained for analysis.…”

Are our diets getting healthier and more sustainable? Insights from the European Prospective Investigation into Cancer and Nutrition – Netherlands (EPIC-NL) cohort

“…The observed increase in DHD15-index score (men scored 7 points higher and women 8·5) is relevant for public health. In a previous study with baseline data of EPIC-NL we observed that per 1  sd increase in the DHD15-index score (16 points), the overall risk of mortality was 12 (95 % CI 5, 18) % lower in men and 8 (95 % CI 4, 12) % lower in women ( 37 ) .…”