Healthy diet indicator and mortality in Eastern European populations: prospective evidence from the HAPIEE cohort

Abstract

Background/Objectives Unhealthy diet has been proposed as one of the main reasons for the high mortality in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) but individual-level effects of dietary habits on health in the region are sparse. We examined the associations between the healthy diet indicator (HDI) and all-cause and cause-specific mortality in three CEE/FSU populations. Subjects/Methods Dietary intakes of foods and nutrients, assessed by food frequency questionnaire (FFQ) in the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) cohort study, were used to construct the HDI which follows the WHO 2003 dietary recommendations. Among 18 559 eligible adult participants (age range: 45-69 years) without history of major chronic diseases at baseline, 1 209 deaths occurred over mean follow up of 7 years. The association between HDI and mortality was estimated by Cox regression. Results After adjusting for covariates, HDI was inversely and statistically significantly associated with cardiovascular disease (CVD) and coronary heart disease (CHD) mortality, but not with other cause-specific and all-cause mortality in the pooled sample. Hazard ratios per one standard deviation (SD) increase in HDI score were 0.95 (95%CI 0.89-1.00, p=0.068), 0.90 (0.81-0.99, p=0.030) and 0.85 (0.74-0.97, p=0.018) for all-cause, CVD and CHD mortality, respectively. Population attributable risk fractions for low HDI were 2.9% for all-cause, 14.2% for CVD and 10.7% for CHD mortality. Conclusions These findings support the hypothesis that unhealthy diet has played a role in the high CVD mortality in Eastern Europe.

Dietary habits and leisure-time physical activity in relation to adiposity, dyslipidemia, and incident dysglycemia in the pathobiology of prediabetes in a biracial cohort study

“…The demonstrated congruent correlations argue against major systematic misrepresentations by our study participants in their responses to the food habits and physical activity questionnaires. Our findings are in accord with previous reports of significant associations between self-reported dietary and exercise data and objective metabolic measurements (32)(33)(34)(35)(36)(37).…”

“…It is remarkable that, despite the numerous limitations of self-reported data, the subjective responses by our study subjects correlated significantly and congruently with several objective biological measures of cardiometabolic health. Although self-reported behavioral data are often described as "soft" data, congruent associations with objective measures have frequently been reported (30)(31)(32)(33)(34)(35)(36). For example, alcohol abuse screening questionnaire responses are associated with biological measures of alcohol withdrawal symptoms (30), self-reported smoking status is highly correlated with circulating cotinine levels (31), and dietary and physical activity habits have been shown to predict obesity and cardiometabolic risks (32)(33)(34)(35)(36)(37).…”

Are dietary habits of the Polish population consistent with the recommendations for prevention of cardiovascular disease? — WOBASZ II project

“…Higher scores using that scale were found to be associated with prolonged survival (by mean 2 years) [24]. Similar observation in the Eastern European population showed an inverse association between HDI scores and CVD and coronary artery disease mortality, with no association with mortality due to other causes [25].…”

Hypolipidemic and Antioxidant Effects of Camel Milk in High Fat Diet Fed Hyperlipidemic Rats

“…Unhealthy lifestyle such as bad eating habit, a sedentary lifestyle is often described as the hallmark of chronic conditions such as metabolic syndrome, diabetes, and obesity. In a study, Stefler et al, (47)has shown that unhealthy diet is the main culprit to be blamed for the high mortality rate in a European population as a result of cardiovascular disease. On the other hand, a healthy diet might prevent the development of these conditions leading to a better life.…”