4.6 Article

The application of six dietary scores to a Middle Eastern population: a comparative analysis of mortality in a prospective study

期刊

EUROPEAN JOURNAL OF EPIDEMIOLOGY
卷 34, 期 4, 页码 371-382

出版社

SPRINGER
DOI: 10.1007/s10654-019-00508-3

关键词

Dietary indices; Dietary guidelines; Death; Golestan Cohort; Mediterranean diet; DASH

资金

  1. World Cancer Research Fund International [WCRF 2016/1633]
  2. Tehran University of Medical Sciences [81/15]
  3. Cancer Research UK [C20/A5860]
  4. Intramural Research Program of the U.S. National Cancer Institute, National Institutes of Health
  5. International Agency for Research on Cancer
  6. NATIONAL CANCER INSTITUTE [ZIACP000185] Funding Source: NIH RePORTER

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Background The associations between dietary indices and mortality have not been evaluated in populations from the Middle East, which have different dietary patterns compared to the US and Europe. In this study, we evaluated the association between six dietary indices and mortality in the Golestan Cohort Study (GCS) in Iran, which is the largest prospective study in the Middle East with 50,045 participants. Methods The six dietary indices, namely the Healthy Eating Index (HEI-2015), Alternative Healthy Eating Index (AHEI-2010), Alternative Mediterranean Diet (AMED), Dietary Approach to Stop Hypertension created by Fung (DASH-Fung) and Mellen (DASH-Mellen), and the World Cancer Research Fund (WCRF/AICR) index, were applied to data from a food frequency questionnaire, computed and divided into quintiles. Adjusted Cox models were used to estimate hazards ratio (HR) and 95% confidence intervals (CI) for overall and cause-specific mortality, using the lowest quintile as a reference group. Results Among 42,373 participants included in the current analyses, 4424 subjects died during 10.6years of follow-up. Participants with the highest quintile dietary scores, compared with the lowest quintile dietary scores, had significantly decreased overall mortality in the AHEI-2010, AMED, DASH-Fung, and WCRF/AICR indices (HR 0.88, 95% CI=0.80-0.97; 0.80, 0.70-0.91; 0.77, 0.70-0.86; and 0.79, 0.70-0.90, respectively). A reduced cardiovascular mortality was found for high AHEI-2010 and DASH-Fung scores (17% and 23%, respectively), and a reduced cancer mortality for high HEI-2015, AMED, and DASH-Fung scores (21, 37 and 25%, respectively). Conclusion Various indices of dietary quality are inversely associated with overall mortality, and selectively with cancer and cardiovascular mortality in the GCS, which contribute to the generalizability and validity of dietary guidelines.

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