title: Dietary patterns in relation to quality-adjusted life years in the EPIC-NL cohort.
abstract: BACKGROUND
  Dietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention.
  
  
  OBJECTIVE
  The aim of our study was to relate dietary patterns to health expectancy using quality-adjusted life years (QALYs) as outcome parameter.
  
  
  METHODS
  Data from the EPIC-NL study were used, a prospective cohort study of 33,066 healthy men and women aged 20-70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at study entry (1993-1997). Five dietary patterns were studied: three a priori patterns (the modified Mediterranean Diet Score (mMDS), the WHO-based Healthy Diet Indicator (HDI) and the Dutch Healthy Diet index (DHD-index)) and two a posteriori data-based patterns. QALYs were used as a summary health measure for healthy life expectancy, combining a person's life expectancy with a weight reflecting loss of quality of life associated with having chronic diseases.
  
  
  RESULTS
  The mean QALYs of the participants were 74.9 (standard deviation 4.4). A higher mMDS and HDI were associated with a longer life in good health. Participants who had a high mMDS score (6-9) had 0.17 [95% CI, 0.05; 0.30] more QALYs than participants with a low score (0-3), equivalent to two months longer life in good health. Participants with a high HDI score also had more QALYs (0.15 [95% CI, 0.03; 0.27]) than participants with a low HDI score.
  
  
  CONCLUSIONS
  A Mediterranean-type diet and the Healthy Diet Indicator were associated with approximately 2months longer life in good health.
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: h.p.fransen@umcutrecht.nl.
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Fransen
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
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: 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: Ellen A
authors.initials: EA
authors.lastname: Struijk
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; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: N Charlotte
authors.initials: NC
authors.lastname: Onland-Moret
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; Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Jeljer
authors.initials: J
authors.lastname: Hoekstra
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Dietary patterns; Prospective studies; Quality-adjusted life years