title: Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States.
abstract: The World Health Organization (WHO) has formulated guidelines for a healthy diet to prevent chronic diseases and postpone death worldwide. Our objective was to investigate the association between the WHO guidelines, measured using the Healthy Diet Indicator (HDI), and all-cause mortality in elderly men and women from Europe and the United States. We analyzed data from 396,391 participants (42% women) in 11 prospective cohort studies who were 60 years of age or older at enrollment (in 1988-2005). HDI scores were based on 6 nutrients and 1 food group and ranged from 0 (least healthy diet) to 70 (healthiest diet). Adjusted cohort-specific hazard ratios were derived by using Cox proportional hazards regression and subsequently pooled using random-effects meta-analysis. During 4,497,957 person-years of follow-up, 84,978 deaths occurred. Median HDI scores ranged from 40 to 54 points across cohorts. For a 10-point increase in HDI score (representing adherence to an additional WHO guideline), the pooled adjusted hazard ratios were 0.90 (95% confidence interval (CI): 0.87, 0.93) for men and women combined, 0.89 (95% CI: 0.85, 0.92) for men, and 0.90 (95% CI: 0.85, 0.95) for women. These estimates translate to an increased life expectancy of 2 years at the age of 60 years. Greater adherence to the WHO guidelines is associated with greater longevity in elderly men and women in Europe and the United States.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jankovic
authors.forename: Anouk
authors.initials: A
authors.lastname: Geelen
authors.forename: Martinette T
authors.initials: MT
authors.lastname: Streppel
authors.forename: Lisette C P G M
authors.initials: LC
authors.lastname: de Groot
authors.forename: Philippos
authors.initials: P
authors.lastname: Orfanos
authors.forename: Edith H
authors.initials: EH
authors.lastname: van den Hooven
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.forename: H B
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pajak
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.forename: Růžena
authors.initials: R
authors.lastname: Kubinova
authors.forename: Pilar
authors.initials: P
authors.lastname: Amiano
authors.forename: Ellen
authors.initials: E
authors.lastname: Kampman
authors.forename: Edith J
authors.initials: EJ
authors.lastname: Feskens
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D004032:Diet; D038441:Diet, Mediterranean; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards; D017408:Guidelines as Topic; D006801:Humans; D008017:Life Expectancy; D008019:Life Style; D008136:Longevity; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D015596:Nutrition Assessment; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014944:World Health Organization
keywords: Consortium on Health and Ageing: Network of Cohorts in Europe and the United States; aging; cohort; diet; longevity; meta-analysis