title: Adherence to the Dutch Guidelines for a Healthy Diet and cancer risk in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort.
abstract: OBJECTIVE
  To examine the association between adherence to the Dutch Guidelines for a Healthy Diet created by the Dutch Health Council in 2006 and overall and smoking-related cancer incidence.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Adherence to the guidelines, which includes one recommendation on physical activity and nine on diet, was measured using an adapted version of the Dutch Healthy Diet (DHD) index. The score ranged from 0 to 90 with a higher score indicating greater adherence to the guidelines. We estimated the hazard ratios (HR) and 95 % confidence intervals for the association between the DHD index (in tertiles and per 20-point increment) at baseline and cancer incidence at follow-up.
  
  
  METHODS
  We studied 35 608 men and women aged 20-70 years recruited into the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study during 1993-1997.
  
  
  RESULTS
  After an average follow-up of 12·7 years, 3027 cancer cases were documented. We found no significant association between the DHD index (tertile 3 v. tertile 1) and overall (HR = 0·97; 95 % CI 0·88, 1·07) and smoking-related cancer incidence (HR = 0·89; 95 % CI 0·76, 1·06) after adjustment for relevant confounders. Excluding the components physical activity or alcohol from the score did not change the results. None of the individual components of the DHD index was significantly associated with cancer incidence.
  
  
  CONCLUSIONS
  In the present study, participants with a high adherence to the Dutch Guidelines for a Healthy Diet were not at lower risk of overall or smoking-related cancer. This does not exclude that other components not included in the DHD index may be associated with overall cancer risk.
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Struijk
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Fransen
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.affiliation: 2National Institute for Public Health and the Environment (RIVM),Bilthoven,The Netherlands.
authors.forename: Jolanda M A
authors.initials: JM
authors.lastname: Boer
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: N Charlotte
authors.initials: NC
authors.lastname: Onland-Moret
authors.affiliation: 2National Institute for Public Health and the Environment (RIVM),Bilthoven,The Netherlands.
authors.forename: Jeljer
authors.initials: J
authors.lastname: Hoekstra
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: 2National Institute for Public Health and the Environment (RIVM),Bilthoven,The Netherlands.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: 1Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,STR 6.131,PO Box 85500,3508 GA Utrecht,The Netherlands.
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
mesh_terms: D000328:Adult; D000368:Aged; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D015596:Nutrition Assessment; D018673:Nutrition Policy; D010349:Patient Compliance; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D044465:White People; D055815:Young Adult