Traditional Eastern European diet and mortality: prospective evidence from the HAPIEE study

Abstract

Purpose Cardiovascular disease (CVD) and cancer mortality rates in Eastern Europe are among the highest in the world. Although diet is an important risk factor, traditional eating habits in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European cohorts. Methods Data from the Health, Alcohol and Psychosocial factors in Eastern Europe prospective cohort were used, including participants from Russia, Poland and the Czech Republic. Based on food frequency questionnaire data, we constructed an Eastern European diet score (EEDS) from nine food groups which can be considered as traditional in this region. The relationship between categorical (low, moderate, high) and continuous (range 0-18) EEDS and mortality was estimated with Cox-regression. Results From 18,852 eligible participants, 2234 died during follow-up. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.23; 95% CI 1.08-1.42) and CVD (1.34; 1.08-1.66) deaths compared to those with low adherence. The association with cancer mortality was only significant in Poland (high vs. low EEDS: 1.41; 1.00-1.98). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while preserved fruit and vegetable consumption showed consistent inverse associations. Conclusion Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential.

Dysglycemia and Abnormal Adiposity Drivers of Cardiometabolic-Based Chronic Disease in the Czech Population: Biological, Behavioral, and Cultural/Social Determinants of Health

“…The Eastern European and Czech eating patterns are characterized by high consumption of saturated fats, salt, and alcohol, with insufficient intake of fresh fruit, vegetables, whole grains, and fish [ 34 ]. Highly processed foods (commercially prepared, which require no or minimal domestic preparation) comprised more than 70% of the mean energy intake in the region [ 35 ].…”

“…Highly processed foods (commercially prepared, which require no or minimal domestic preparation) comprised more than 70% of the mean energy intake in the region [ 35 ]. Consumption of processed meat is a traditional part of the Eastern European diet [ 34 ]. Despite of the relatively small population, in 2018, Czechia placed 14th place in regard to the production of processed meat in the world, with 14,000 tons produced annually [ 36 ].…”

Household availability of dietary fats and cardiovascular disease and mortality: prospective evidence from Russia

“…Follow-up time for each participant was calculated as the time in years between 1994 and the year when CVD diagnosis or death was reported (participant reached the end-point) or the year of last contact (participant censored), whichever came first. The median (IQR) follow-up time in the analytical sample was 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) years.…”

“…astern European countries have the highest dietary cholesterol intake globally, and they are also among the world leaders for saturated fat consumption. 1 Traditionally meat-rich diet and the popularity of using animal fats for cooking in Eastern European cuisine [2][3][4] are likely to be responsible for this observation, and animal fats may also contribute to the poor population health and high cardiovascular disease (CVD) mortality rates of the region. 5 However, dietary habits are changing, and cooking with vegetable oils has become more common in recent decades.…”

“…For example, lard, which is a common ingredient in Eastern European cooking, is considerably under-researched and the evidence on the association between its consumption and CVD or other diseases is still very limited. 4 Household Budget Surveys (HBSs) are often used to assess food availability in various populations. Considering that dietary fats and oils are usually used for cooking rather than consumed on their own, it is suggested that HBSs may be more suitable to capture the presence of these foods in diet compared to nutritional assessment methods measuring actual intakes.…”