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. 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

Camille Lassale  1 , Marc J Gunter  1 , Dora Romaguera  1   2   3 , Linda M Peelen  4 , Yvonne T Van der Schouw  4 , Joline W J Beulens  4 , Heinz Freisling  5 , David C Muller  5 , Pietro Ferrari  5 , Inge Huybrechts  5 , Guy Fagherazzi  6   7   8 , Marie-Christine Boutron-Ruault  6   7   8 , Aurélie Affret  6   7   8 , Kim Overvad  9 , Christina C Dahm  9 , Anja Olsen  10 , Nina Roswall  10 , Konstantinos K Tsilidis  1   11 , Verena A Katzke  12 , Tilman Kühn  12 , Brian Buijsse  13 , José-Ramón Quirós  14   3 , Emilio Sánchez-Cantalejo  15   3 , Nerea Etxezarreta  16   3 , José María Huerta  17   3 , Aurelio Barricarte  18   3 , Catalina Bonet  19   3 , Kay-Tee Khaw  20 , Timothy J Key  21 , Antonia Trichopoulou  22   23 , Christina Bamia  22   23 , Pagona Lagiou  22   23 , Domenico Palli  24 , Claudia Agnoli  25 , Rosario Tumino  26 , Francesca Fasanelli  27 , Salvatore Panico  28 , H Bas Bueno-de-Mesquita  29 , Jolanda M A Boer  29 , Emily Sonestedt  30 , Lena Maria Nilsson  31 , Frida Renström  31 , Elisabete Weiderpass  32   33   34   35 , Guri Skeie  32 , Eiliv Lund  32 , Karel G M Moons  4 , Elio Riboli  1 , Ioanna Tzoulaki  1
Affiliations

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

Camille Lassale et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Discrimination (Harrell’s C statistic) of the baseline model a, Model 1 b and Model 2 c for the prediction of 10-year mortality risk in 451,256 d,e participants to the EPIC study.
Abbreviations: MDS, Mediterranean Diet Scale; rMED, relative Mediterranean diet score; MSDPS, Mediterranean Style Dietary Pattern Score; DQI-I, Diet Quality Index–International; HNFI, Healthy Nordic Food Index; HEI-2010, Healthy Eating Index 2010; WHO HDI, World Health Organization Healthy Diet Index; DASH, Dietary Approaches to Stop Hypertension; HLI, Healthy Lifestyle Index; HLI-diet, diet component of the HLI; WCRF, World Cancer Research Fund / American Institute for Cancer Research a Baseline model includes only age as a predictor, stratified by sex and center; b Model 1 = baseline + dietary score; c Model 2 = Model 1+ lifestyle factors: smoking, BMI, physical activity, educational level unless otherwise stated. d Model 2 = Model 1 + educational level because BMI, physical activity, smoking are components of the Healthy Lifestyle Index, n = 376,553. e Model 2 = Model 1 + smoking and educational level as BMI and physical activity are components of the WCRF score, n = 363,207.
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