title: Dietary patterns in relation to disease burden expressed in Disability-Adjusted Life Years.
abstract: BACKGROUND
  Although diet is related to chronic disease risk and mortality, its association with total disease burden is not clear.
  
  
  OBJECTIVE
  We investigated the minimum impact of different dietary patterns on disability-adjusted life years (DALYs) by using individual longitudinal data.
  
  
  METHODS
  A prospective cohort study was conducted in 33,066 healthy men and women aged 20-70 y recruited into the European Prospective Investigation into Cancer and Nutrition-Netherlands study during 1993-1997. We measured adherence to 3 a priori dietary patterns [the modified Mediterranean diet score (mMDS), the WHO-based Healthy Diet Indicator, and the Dutch Healthy Diet index] and 2 a posteriori dietary patterns. Two a posteriori methods were used to extract Western and prudent patterns. Participants were followed until the end of 2007 for the occurrence of and mortality from the most important chronic diseases. The disease burden was expressed in DALYs, which are the sum of Years Lost due to Disability and Years of Life Lost because of premature mortality. The associations between dietary patterns (per SD change in score) and DALYs were estimated by using a 2-part model and adjusted for relevant confounders (sex, age at recruitment, smoking status and intensity, educational level, marital status, job status, energy intake, and physical activity).
  
  
  RESULTS
  After an average follow-up of 12.4 y, higher adherence to the mMDS or prudent pattern was most strongly associated with healthy survival; per SD higher adherence to the mMDS or prudent pattern, fewer healthy life years were lost [51 d (-0.14 DALYs; 95% CI: -0.21, -0.08 DALYs) and 58 d (-0.16 DALYs; 95% CI: -0.23, -0.09 DALYs), respectively].
  
  
  CONCLUSIONS
  In this Dutch study, of various dietary patterns evaluated, higher adherence to the mMDS or prudent dietary pattern was associated with a lower disease burden as assessed by DALYs.
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Struijk
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Fransen
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Jolanda M A
authors.initials: JM
authors.lastname: Boer
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: N Charlotte
authors.initials: NC
authors.lastname: Onland-Moret
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Jeljer
authors.initials: J
authors.lastname: Hoekstra
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP).
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D017281:Cost of Illness; D038441:Diet, Mediterranean; D023381:Endpoint Determination; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018673:Nutrition Policy; D010349:Patient Compliance; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D055815:Young Adult