Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study

Abstract

We aimed to evaluate the criterion validity of the 2015 food-based Dutch dietary guidelines, which were formulated based on evidence on the relation between diet and major chronic diseases. We studied 9701 participants of the Rotterdam Study, a population-based prospective cohort in individuals aged 45 years and over [median 64.1 years (95%-range 49.0-82.8)]. Dietary intake was assessed at baseline with a food-frequency questionnaire. For all participants, we examined adherence (yes/no) to fourteen items of the guidelines: vegetables (C200 g/day), fruit (C200 g/day), whole-grains (C90 g/day), legumes (C135 g/week), nuts (C15 g/day), dairy (C350 g/day), fish (C100 g/week), tea (C450 mL/day), ratio whole-grains:-total grains (C50%), ratio unsaturated fats and oils:total fats (C50%), red and processed meat (\300 g/week), sugar-containing beverages (B150 mL/day), alcohol (B10 g/day) and salt (B6 g/day). Total adherence was calculated as sum-score of the adherence to the individual items (0-14). Information on disease incidence and allcause mortality during a median follow-up period of 13.5 years (range 0-27.0) was obtained from data collected at our research center and from medical records. Using Cox proportional-hazards models adjusted for confounders, we observed every additional component adhered to was associated with a 3% lower mortality risk (HR 0.97, 95% CI 0.95; 0.98), lower risk of stroke (HR 0.95, 95% CI 0.92; 0.99), chronic obstructive pulmonary disease (HR 0.94, 95% CI 0.91; 0.98), colorectal cancer (HR 0.90, 95% CI 0.84; 0.96), and depression (HR 0.97, 95% CI 0.95; 0.999), but not with incidence of coronary heart disease, type 2 diabetes, heart failure, lung cancer, breast cancer, or dementia. These associations were not driven by any of the individual dietary components. To conclude, adherence to the Dutch dietary guidelines was associated with a lower mortality risk and a lower risk of developing some but not all of the chronic diseases on which the guidelines were based.

Adherence to a food group-based dietary guideline and incidence of prediabetes and type 2 diabetes

“…Direct evidence on adherence to the DHD15-index and incident chronic diseases is still limited, with only one earlier study showing that high adherence to DHD15-index was associated with a lower risk of mortality [10]. Another study investigated the association between adherence to the Dutch guidelines 2015 and 10 chronic diseases in the Rotterdam Study, but did not use the DHD15-index [11]. This study showed that higher adherence to the Dutch dietary guidelines of 2015 was associated with a lower risk of mortality, stroke, chronic obstructive pulmonary disease, colorectal cancer, and depression, but not with T2D.…”

Adherence to a Mediterranean-like Diet as a Protective Factor Against COPD: A Nested Case-Control Study

“…Previous prospective studies examining dietary patterns and the risk of developing COPD have focused on either prudent/healthy or Western diets (9,10,28,29). In these studies, a prudent/healthy diet lowered the risk of developing COPD, whereas a Western diet increased the risk.…”

Relationship between dietary patterns and COPD: a systematic review and meta-analysis

“…While eligible for inclusion in our review, OGUNMOROTI et al [18] and VOORTMAN et al [38] were not included in this meta-analysis as there were insufficient data provided to calculate odds ratios or RRs based on the HR. OGUNMOROTI et al [18] reported that the ideal diet according to the AHA was not significantly associated with new-onset of COPD compared to a poor diet (HR 0.44, 95% CI 0.06-3.21), while VOORTMAN et al [38] demonstrated that following the Dutch dietary guidelines was associated with reduced COPD (HR 0.94, 95% CI 0.91-0.98).…”