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Adherence to recommendations of the German food pyramid and risk of chronic diseases: results from the EPIC-Potsdam study

European Journal of Clinical Nutrition volume 64, pages 1251–1259 (2010)Cite this article

Subjects

Abstract

Background:

The German food pyramid was set up to foster and communicate healthy food choices.

Methods:

The adherence to recommendations of the food pyramid was translated into an index (German Food Pyramid Index (GFPI)) by scoring the ratio of consumed and recommended daily servings of eight food groups, wherein higher scores indicated greater adherence. The GFPI was calculated for 23 531 subjects who participated in the European Prospective Investigation into Cancer and Nutrition-Potsdam study and were recruited between 1994 and 1998. Associations between quintiles of GFPI scores and risk of incident cardiovascular diseases (CVD), type-2 diabetes (T2D) and cancer were evaluated using Cox proportional hazard regression models. During 183 740 person-years of follow-up, 363 incident cases of CVD (myocardial infarction or stroke), 837 incident cases of T2D and 844 incident cases of cancer occurred.

Results:

The GFPI was inversely related to CVD risk in men (multivariable-adjusted hazard ratio (HR) for highest versus lowest quintiles=0.56; 95% confidence interval (CI): 0.34–0.94) but not in women (HR=1.39; 95% CI: 0.76–2.55). No association between GFPI and cancer was observed. An inverse relation between GFPI and T2D (men: HR= 0.71 (0.52–0.97); women: HR= 0.69 (0.50–0.96)) in age-adjusted models was substantially attenuated after multivariable adjustments, particularly by body mass index (BMI) (men: HR=0.94 (0.69–1.30); women: HR=1.09 (0.77–1.54)). The same was observed for overall major chronic disease risk (CVD, T2D and total cancer).

Conclusion:

Adherence to the German food pyramid recommendations is not associated with a decreased risk of chronic diseases when considering BMI as confounder, except of CVD in men.

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Acknowledgements

We thank our study participants. We also thank Ellen Kohlsdorf and Wolfgang Bernigau for data management and Wolfgang Fleischhauer for case ascertainment. The recruitment phase of the EPIC-Potsdam Study was supported by the Federal Ministry of Science, Germany (grant 01 EA 9401). Further financial support was provided by the ‘Europe against Cancer’ program of the European Community (grant SOC 95 201408 05F02). The EPIC-Potsdam Study is now supported by the German Cancer Aid (grant 70-2488-Ha I) and the European Community (grant SOC 98 200769 05F02). BB was funded by FP-6 (Integrated Project LSHM-CT-2006-037197).

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Authors and Affiliations

  1. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

    A von Ruesten, A-K Illner, B Buijsse & H Boeing

  2. Department of Epidemiology and Health Reporting, Robert Koch-Institute, Berlin, Germany

    C Heidemann

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  1. A von Ruesten
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  2. A-K Illner
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  3. B Buijsse
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Correspondence to A von Ruesten.

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von Ruesten, A., Illner, AK., Buijsse, B. et al. Adherence to recommendations of the German food pyramid and risk of chronic diseases: results from the EPIC-Potsdam study. Eur J Clin Nutr 64, 1251–1259 (2010). https://doi.org/10.1038/ejcn.2010.151

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