title: Healthy eating and survival among elderly men with and without cardiovascular-metabolic diseases.
abstract: OBJECTIVE
  The strength of the associations of dietary scores with cardiovascular disease (CVD) and all-cause mortality in elderly vary considerably between a priori scores. To assess whether healthy eating lowers the risk of CVD and all-cause mortality among elderly men.
  
  
  RESULTS
  The Zutphen Elderly Study (age 65-84 years) was divided into men with (n = 210) and without (n = 616) cardiovascular-metabolic diseases at baseline in 1985. Diet was assessed with the cross-check dietary history method. We created the "Dutch Healthy Nutrient and Food Score" (DHNaFS) and the "Dutch Undesirable Nutrient and Food Score" (DUNaFS). Associations of the scores with CVD and all-cause mortality were assessed using multivariable Cox regression models. Associations of scores with life years gained used general linear models. During a median follow-up of 10.6 years (IQR 5.8-15.9) 806 participants died, of whom 359 from CVD. In all men, diet scores did not predict death. Among men with cardiovascular-metabolic diseases, DHNaFS was associated with lower CVD (HR: 0.57; 95% CI: 0.35-0.93) and all-cause mortality risk (HR: 0.64; 95% CI: 0.44-0.94) comparing the highest vs. the lowest score tertiles. Men with cardiovascular-metabolic diseases in the highest vs. the lowest tertile of the DHNaFS lived approximately 2.5 years longer. The DHNaFS was not associated with CVD and all-cause mortality in men without cardiovascular-metabolic diseases. The DUNaFS was not associated with any of the outcomes.
  
  
  CONCLUSIONS
  A high quality diet was associated with a 40% lower mortality risk and 2.5 years longer life expectancy in elderly men with, but not without, cardiovascular-metabolic diseases.
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: F P C
authors.initials: FP
authors.lastname: Sijtsma
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands. Electronic address: sabita.soedamah-muthu@wur.nl.
authors.forename: S S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: S E M
authors.initials: SE
authors.lastname: de Hoon
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; The Department of Nutrition, University of Oslo, Oslo, Norway.
authors.forename: D R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: D
authors.initials: D
authors.lastname: Kromhout
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000401:mortality* / Q000517:prevention & control*; D016022:Case-Control Studies; D004032:Diet; D058620:Elder Nutritional Physiological Phenomena / Q000502:physiology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016014:Linear Models; D008297:Male; D024821:Metabolic Syndrome / Q000178:diet therapy / Q000401:mortality* / Q000517:prevention & control*; D015999:Multivariate Analysis; D009751:Nutritional Requirements; D011379:Prognosis; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis
keywords: Cardiovascular-metabolic disease; Epidemiology; Food-based dietary scores; Life years gained; Mortality