title: Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.
abstract: Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.
authors.forename: Camille
authors.initials: C
authors.lastname: Lassale
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Gunter
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.|Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Dora
authors.initials: D
authors.lastname: Romaguera
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: Van der Schouw
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Heinz
authors.initials: H
authors.lastname: Freisling
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: David C
authors.initials: DC
authors.lastname: Muller
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Inge
authors.initials: I
authors.lastname: Huybrechts
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population, Health, U1018, Team 9, Villejuif, France.|Institut Gustave Roussy, Villejuif, France.|Paris South University, Unité Mixte de Recherche 1018, Villejuif, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population, Health, U1018, Team 9, Villejuif, France.|Institut Gustave Roussy, Villejuif, France.|Paris South University, Unité Mixte de Recherche 1018, Villejuif, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population, Health, U1018, Team 9, Villejuif, France.|Institut Gustave Roussy, Villejuif, France.|Paris South University, Unité Mixte de Recherche 1018, Villejuif, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Affret
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Christina C
authors.initials: CC
authors.lastname: Dahm
authors.affiliation: Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark.
authors.forename: Nina
authors.initials: N
authors.lastname: Roswall
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.|German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
authors.forename: Konstantinos K
authors.initials: KK
authors.lastname: Tsilidis
authors.affiliation: Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke German Institute of Human Nutrition, Potsdam, Germany.
authors.forename: Verena A
authors.initials: VA
authors.lastname: Katzke
authors.affiliation: Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke German Institute of Human Nutrition, Potsdam, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
authors.affiliation: Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Brian
authors.initials: B
authors.lastname: Buijsse
authors.affiliation: Public Health Directorate, Asturias, Oviedo, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: José-Ramón
authors.initials: JR
authors.lastname: Quirós
authors.affiliation: Andalusian School of Public Health, Granada, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Sánchez-Cantalejo
authors.affiliation: Public Health Direction and Biodonostia Basque Regional Health Department, San Sebastian, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Etxezarreta
authors.affiliation: Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: Navarre Public Health Institute, Pamplona, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.affiliation: Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Bonet
authors.affiliation: University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit, Cambridge, United Kingdom.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Hellenic Health Foundation, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Hellenic Health Foundation, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Hellenic Health Foundation, Athens, Greece.
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.affiliation: Epidemiology and Prevention Unit, Department of Preventive and Predictive Medicine, Foundation of the Carlo Besta Neurological Institute, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Agnoli
authors.affiliation: Cancer Registry and Histopathology Unit, "Civic MP Arezzo" Hospital, Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Human Genetics Foundation, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fasanelli
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: Jolanda M A
authors.initials: JM
authors.lastname: Boer
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
authors.forename: Emily
authors.initials: E
authors.lastname: Sonestedt
authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
authors.forename: Lena Maria
authors.initials: LM
authors.lastname: Nilsson
authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
authors.forename: Frida
authors.initials: F
authors.lastname: Renström
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Eiliv
authors.initials: E
authors.lastname: Lund
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.
authors.forename: Elio
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.
authors.forename: Ioanna
authors.initials: I
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mesh_terms: D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D004032:Diet; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D044465:White People