title: Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort.
abstract: BACKGROUND
  Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke.
  
  
  METHODS
  A prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20-70 years recruited into the EPIC-NL study during 1993-1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk.
  
  
  RESULTS
  After an average follow-up of 12.2 years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk.
  
  
  CONCLUSIONS
  The HDI and the DHD-index were not associated with CVD risk, while the DASH diet was significantly associated with a lower risk of developing CVD, CHD and stroke.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: e.struijk-2@umcutrecht.nl.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Struijk
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Nick L W
authors.initials: NL
authors.lastname: Wezenbeek
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Fransen
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Sabita S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Anouk
authors.initials: A
authors.lastname: Geelen
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Jolanda M A
authors.initials: JM
authors.lastname: Boer
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands; School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000178:diet therapy* / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D018673:Nutrition Policy / Q000639:trends; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: CVD; DASH diet; DHD-index; Dietary guidelines; EPIC-NL; HDI