title: Healthy diet indicator and mortality in Eastern European populations: prospective evidence from the HAPIEE cohort.
abstract: OBJECTIVE
  Unhealthy diet has been proposed as one of the main reasons for the high mortality in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) but individual-level effects of dietary habits on health in the region are sparse. We examined the associations between the healthy diet indicator (HDI) and all-cause and cause-specific mortality in three CEE/FSU populations.
  
  
  METHODS
  Dietary intakes of foods and nutrients, assessed by food frequency questionnaire in the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) cohort study, were used to construct the HDI, which follows the WHO 2003 dietary recommendations. Among 18 559 eligible adult participants (age range: 45-69 years) without a history of major chronic diseases at baseline, 1209 deaths occurred over a mean follow-up of 7 years. The association between HDI and mortality was estimated by Cox regression.
  
  
  RESULTS
  After adjusting for covariates, HDI was inversely and statistically significantly associated with cardiovascular disease (CVD) and coronary heart disease (CHD) mortality, but not with other cause-specific and all-cause mortality in the pooled sample. Hazard ratios per one standard deviation (s.d.) increase in HDI score were 0.95 (95% confidence interval=0.89-1.00, P=0.068), 0.90 (0.81-0.99, P=0.030) and 0.85 (0.74-0.97, P=0.018) for all-cause, CVD and CHD mortality, respectively. Population attributable risk fractions for low HDI were 2.9% for all-cause, 14.2% for CVD and 10.7% for CHD mortality.
  
  
  CONCLUSIONS
  These findings support the hypothesis that unhealthy diet has had a role in the high CVD mortality in Eastern Europe.
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Denes
authors.initials: D
authors.lastname: Stefler
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
authors.affiliation: Division of Human Nutrition, Wageningen University.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jankovic
authors.affiliation: National Institute of Public Health, Prague, Czech Republic.
authors.forename: Ruzena
authors.initials: R
authors.lastname: Kubinova
authors.affiliation: Jagiellonian University, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pajak
authors.affiliation: Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia.|Novosibirsk State Medical University, Novosibirsk, Russia.
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.affiliation: Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia.
authors.forename: Galina
authors.initials: G
authors.lastname: Simonova
authors.affiliation: Division of Human Nutrition, Wageningen University.
authors.forename: Edith J M
authors.initials: EJM
authors.lastname: Feskens
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Peasey
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D005061:Europe, Eastern / Q000453:epidemiology; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires