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Epidemiology

Adherence to the Dutch dietary guidelines is inversely associated with 20-year mortality in a large prospective cohort study

European Journal of Clinical Nutrition volume 70, pages 262–268 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

The Dutch guidelines for a healthy diet aim to reduce major chronic diseases. However, supporting evidence on their overall association with all-cause and cause-specific mortality is limited. Recently, the Dutch Healthy Diet-index (DHD-index) has been developed to assess adherence to these guidelines. The aim was to examine the association between the DHD-index and all-cause mortality and deaths from cardiovascular disease (CVD), coronary heart disease (CHD), stroke and cancer.

Subjects/Methods:

We followed 3593 men and women aged 55 years and older enrolled in the Rotterdam Study, a population-based prospective cohort study, from baseline in 1990–1993 to 2011. A validated 170-item food frequency questionnaire at baseline was used to calculate the DHD-index score (maximum 90 points). Cox proportional hazard models were used to estimate hazard ratios (HRs) adjusting for age, sex, total energy intake, smoking and educational level.

Results:

During the 20-year follow-up, 1831 (51%) deaths were reported. Mean DHD-index score was 60.6 (s.d. 10.6). The score was inversely associated with all-cause mortality (highest vs lowest quartile HR 0.77; 95% confidence interval (CI) 0.67, 0.89). Inverse but non-significant associations were observed for mortality due to CVD (HR 0.74; 95% CI 0.55, 1.01), CHD (HR 0.60; 95% CI 0.34, 1.06) and stroke (HR 0.67; 95% CI 0.36, 1.22), whereas no association was observed with cancer mortality (HR 0.99; 95% CI 0.90, 1.11).

Conclusions:

A higher level of adherence to the Dutch dietary guidelines, as assessed with the DHD-index, was associated with a lower risk of all-cause mortality, probably due to an inverse association with cardiovascular causes of death.

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Acknowledgements

The contributions of the authors were as follows: LL, AG, NJ, NV and EF designed the research; LL, AG and EF conducted the research; JK, JW, AH and OF provided the cohort database; LL performed statistical analyses; LL, AG and EF wrote the manuscript; EF had primary responsibility for final content. All authors read and approved the final manuscript. This study was funded by the Netherlands Organization for Health Research and Development (ZonMw; grant number 115100007). The Rotterdam Study is supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam, The Netherlands Organization for Scientific Research (NWO), The Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), The Netherlands Genomics Initiative (NGI), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. OHF has received a grant from Nestlé Nutrition (Nestec Ltd.), Metagenics Inc. and AXA to establish a center on aging research. All funding sources had no role in design and conduct of this manuscript; collection, management, analysis and interpretation of the data; and preparation, review or approval of this manuscript.

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Authors and Affiliations

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

    L van Lee, A Geelen, N Vonk, N Jankovic, E J C Hooft van Huysduynen, J H M de Vries, P van 't Veer & E J M Feskens

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

    J C Kiefte-de Jong, J C M Witteman, A Hofman & O H Franco

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  1. L van Lee
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  2. A Geelen
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  3. J C Kiefte-de Jong
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  6. N Vonk
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Correspondence to E J M Feskens.

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van Lee, L., Geelen, A., Kiefte-de Jong, J. et al. Adherence to the Dutch dietary guidelines is inversely associated with 20-year mortality in a large prospective cohort study. Eur J Clin Nutr 70, 262–268 (2016). https://doi.org/10.1038/ejcn.2015.163

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  • DOI: https://doi.org/10.1038/ejcn.2015.163

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