title: Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study.
abstract: OBJECTIVE
  Mediterranean-type dietary pattern has been associated with lower risk of cardiovascular (CVD) and other chronic diseases, primarily in Southern European populations. We examined whether Mediterranean diet score (MDS) is associated with total, CVD, coronary heart disease (CHD) and stroke mortality in a prospective cohort study in three Eastern European populations.
  
  
  METHODS
  A total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study in the Czech Republic, Poland and the Russian Federation were included in the analysis. Diet was assessed by food frequency questionnaire, and MDS was derived from consumption of nine groups of food using absolute cut-offs. Mortality was ascertained by linkage with death registers.
  
  
  RESULTS
  Over the median follow-up time of 7 years, 1314 participants died. The proportion of participants with high adherence to Mediterranean diet was low (25 %). One standard deviation (SD) increase in the MDS (equivalent to 2.2 point increase in the score) was found to be inversely associated with death from all causes (HR, 95 % CI 0.93, 0.88-0.98) and CVD (0.90, 0.81-0.99) even after multivariable adjustment. Inverse but statistically not significant link was found for CHD (0.90, 0.78-1.03) and stroke (0.87, 0.71-1.07). The MDS effects were similar in each country cohort.
  
  
  CONCLUSIONS
  Higher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban populations. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean populations.
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK. denes.stefler.10@ucl.ac.uk.
authors.forename: Denes
authors.initials: D
authors.lastname: Stefler
authors.affiliation: Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk State Medical University, B. Bogatkova 175/1, Novosibirsk, Russia, 630089.
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.affiliation: National Institute of Public Health, Šrobárova 48, 100 42, Prague, Czech Republic.
authors.forename: Ruzena
authors.initials: R
authors.lastname: Kubinova
authors.affiliation: Department of Epidemiology and Population Sciences, Jagiellonian University, Grzegorzcka 20, 31-531, Kraków, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pajak
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Peasey
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK.
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Brunner
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D002908:Chronic Disease; D018153:Czech Republic / Q000453:epidemiology; D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010349:Patient Compliance; D011044:Poland / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Diet; Eastern Europe; Mortality; Nutrition; Prevention