Nutrient-rich foods, cardiovascular diseases and all-cause mortality: the Rotterdam study

Streppel, Martinette T; Sluik, Diewertje; Yperen, James Van; Geelen, Anouk; Hofman, Albert; Franco, Oscar H.; Witteman, Jacqueline C. M.; Feskens, Edith J. M.

doi:10.1038/ejcn.2014.35

Cited by 49 publications

(44 citation statements)

References 37 publications

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“…Several studies reported significant inverse associations of dietary scores with CVD and all-cause mortality in elderly men free from cardiovascular-metabolic diseases [4,5,7]. Our results in healthy men are in line with those of Hamer et al on a Mediterranean-style dietary pattern [10] and Streppel et al on the NRF9.3 score who observed no association with all-cause mortality in healthy men [24]. One explanation for the different associations in men with and without cardiovascular-metabolic diseases could be that only 17% of the healthy men were on a prescribed diet compared to more than 54% of the diseased men.…”

Section: Discussionsupporting

confidence: 92%

Healthy eating and survival among elderly men with and without cardiovascular-metabolic diseases

Sijtsma

Soedamah‐Muthu

Hoon

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

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Section: Discussionsupporting

confidence: 92%

Healthy eating and survival among elderly men with and without cardiovascular-metabolic diseases

Sijtsma

Soedamah‐Muthu

Hoon

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

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“…This approach allowed us to examine the effects of specific nutrients on consumer attention within individuals, unlike FOP manipulations that present nutrients unsystematically [ 18 , 19 ] and to relate specific nutrients to healthfulness accuracy. As a manipulation check, we compared the nutrient density scores, which represent another approach to defining relative healthfulness (NRF9.3; [ 20 ]), of pairs of products and confirmed that the more healthful product in each pair had a higher nutrient density score, paired t-test, p < .001. Individuals were shown a pair of products on a single screen and were asked to identify the more healthful choice by clicking on a button below the product of their choice.…”

Section: Methodsmentioning

confidence: 87%

Misunderstanding of Front-Of-Package Nutrition Information on US Food Products

et al. 2015

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Front-of-package nutrition symbols (FOPs) are presumably readily noticeable and require minimal prior nutrition knowledge to use. Although there is evidence to support this notion, few studies have focused on Facts Up Front type symbols which are used in the US. Participants with varying levels of prior knowledge were asked to view two products and decide which was more healthful. FOPs on packages were manipulated so that one product was more healthful, allowing us to assess accuracy. Attention to nutrition information was assessed via eye tracking to determine what if any FOP information was used to make their decisions. Results showed that accuracy was below chance on half of the comparisons despite consulting FOPs. Negative correlations between attention to calories, fat, and sodium and accuracy indicated that consumers over-relied on these nutrients. Although relatively little attention was allocated to fiber and sugar, associations between attention and accuracy were positive. Attention to vitamin D showed no association to accuracy, indicating confusion surrounding what constitutes a meaningful change across products. Greater nutrition knowledge was associated with greater accuracy, even when less attention was paid. Individuals, particularly those with less knowledge, are misled by calorie, sodium, and fat information on FOPs.

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“…When looking at the contribution of food groups to the individual NRF9.3 index scores in the study population, it was seen that vegetables, cereals and dairy products had the largest contribution. Within the Rotterdam Study, we have previously found that the NR9, LIM3 and NRF9.3 index scores were associated with all-cause mortality, but not with major CVD events ( 4 ) . We have discussed that this might have been caused by the fact that individual weighted NRF scores not only depend on the NRF score on the food-item level, but also on which products are eaten and in which amount.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously evaluated the NRF index in terms of association with all-cause mortality and CVD among 4969 individuals aged 55 years and older from the Rotterdam Study. The NRF9.3 index showed to be inversely related to overall mortality, but not significantly with incident CVD ( 4 ) . To test the performance of nutrient profile models such as the NRF index, they should also be compared with each other and with other measures of a healthy diet.…”

mentioning

confidence: 99%

Evaluation of a nutrient-rich food index score in the Netherlands

et al. 2015

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Nutrient-rich food (NRF) index scores are dietary quality indices based on nutrient density. We studied the design aspects involved in the development and validation of NRF index scores, using the Dutch consumption data and guidelines as an example. We evaluated fifteen NRF index scores against the Dutch Healthy Diet Index (DHD-index), a measure of adherence to the Dutch dietary guidelines, and against energy density. The study population included 2106 adults from the Dutch National Food Consumption Survey 2007–2010. The index scores were composed of beneficial nutrients (protein, fibre, fatty acids, vitamins, minerals), nutrients to limit (saturated fat, sugar, Na) or a combination. Moreover, the influence of methodological decisions was studied, such as the choice of calculation basis (100 g or 100 kcal (418 kJ)). No large differences existed in the prediction of the DHD-index by the fifteen NRF index scores. The score that best predicted the DHD-index included nine beneficial nutrients and three nutrients to limit on a 100-kcal basis, the NRF9.3 with a model R2 of 0·34. The scores were quite robust with respect to sex, BMI and differences in calculation methods. The NRF index scores were correlated with energy density, but nutrient density better predicted the DHD-index than energy density. Consumption of vegetables, cereals and cereal products, and dairy products contributed most to the individual NRF9.3 scores. In conclusion, many methodological considerations underlie the development and evaluation of nutrient density models. These decisions may depend upon the purpose of the model, but should always be based upon scientific, objective and transparent criteria.

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Nutrient-rich foods, cardiovascular diseases and all-cause mortality: the Rotterdam study

Abstract: Elderly with a higher NRF9.3 index score, indicating more beneficial components and/or less limiting components, had a lower risk of all-cause mortality. Consuming a nutrient-dense diet may improve survival.

Cited by 49 publications

References 37 publications

Healthy eating and survival among elderly men with and without cardiovascular-metabolic diseases

Healthy eating and survival among elderly men with and without cardiovascular-metabolic diseases

Misunderstanding of Front-Of-Package Nutrition Information on US Food Products

Evaluation of a nutrient-rich food index score in the Netherlands

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