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Epidemiology

Nutrient-rich foods, cardiovascular diseases and all-cause mortality: the Rotterdam study

European Journal of Clinical Nutrition volume 68, pages 741–747 (2014)Cite this article

Subjects

Abstract

Background/Objectives:

The nutrient-rich food (NRF) index assesses nutrient quality of individual food items by ranking them according to their nutrient composition. The index reflects the nutrient density of the overall diet. We examined the associations between the NRF9.3 index—a score on the basis of nine beneficial nutrients (protein, fiber, vitamins and minerals) and three nutrients to limit (saturated fat, sugar and sodium)—incidence of cardiovascular disease (CVD) events and all-cause mortality.

Subjects/Methods:

A total of 4969 persons aged 55 and older from the Rotterdam Study, a prospective cohort study in the Netherlands, were studied. First, all foods were scored on the basis of their nutrient composition, resulting in an NRF9.3 score on food item level. Subsequently, they were converted into individual weighted scores on the basis of the amount of calories of each food item consumed by the subjects and the total energy intake. The hazard ratios (HRs) of the NRF9.3 index score were adjusted for age, gender, body mass index, smoking history, doctor-prescribed diet, alcohol consumption and education.

Results:

Food groups that contributed most to the NRF9.3 index score were vegetables, milk and milk products, fruit, bread and potatoes. A high NRF9.3 index score was inversely associated with all-cause mortality (HR Q4 versus Q1: 0.84 (95% confidence interval: 0.74, 0.96)). Associations were stronger in women than in men. The NRF9.3 index score was not associated with incidence of CVD.

Conclusion:

Elderly with a higher NRF9.3 index score, indicating more beneficial components and/or less limiting components, had a lower risk of all-cause mortality. Consuming a nutrient-dense diet may improve survival.

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Acknowledgements

We thank Anouk Engelen, MSc from Wageningen University for providing us with data on added sugars. The present study was partially supported by an unrestricted grant from the Dutch Dairy Foundation and by a grant from the Cooperative Research Program for Agriculture Science & Technology Development (no. PJ007208), Rural Development Administration, Republic of Korea. The Rotterdam Study is supported by the Erasmus Medical Center and Erasmus University Rotterdam, the Netherlands Organization of Scientific Research (NWO), the Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports and the European Commission (DG XII).

Disclaimer

The sponsors had no input in the design, the conduct, the analysis or the interpretation of the study, and did not influence the manuscript preparation.

Author contributions

All authors had full access to all of the data (including statistical reports and tables) and take responsibility for the integrity of the data and the accuracy of the data analysis. AH and JW were responsible for study concept and design. OHF, AH and JCMW acquired the data. MTS, DS, JFvY, AG and EJMF analyzed and interpreted the data. MTS, DS and JFvY drafted the manuscript, which was critically revised for important intellectual content by all authors. MTS, DS and EJMF were responsible for the statistical analysis. EJMF supervised the study and is guarantor.

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Authors and Affiliations

  1. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands

    M T Streppel, D Sluik, J F van Yperen, A Geelen & E J M Feskens

  2. Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands

    A Hofman, O H Franco & J C M Witteman

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  1. M T Streppel
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Correspondence to D Sluik.

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Streppel, M., Sluik, D., van Yperen, J. et al. Nutrient-rich foods, cardiovascular diseases and all-cause mortality: the Rotterdam study. Eur J Clin Nutr 68, 741–747 (2014). https://doi.org/10.1038/ejcn.2014.35

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