A high diet quality is associated with lower incidence of cardiovascular events in the Malmö diet and cancer cohort

Joanna Hlebowicz, Isabel Drake, Bo Gullberg, Emily Sonestedt, Peter Wallström, Margaretha Persson, Jan Nilsson, Bo Hedblad, Elisabet Wirfält, Joanna Hlebowicz, Isabel Drake, Bo Gullberg, Emily Sonestedt, Peter Wallström, Margaretha Persson, Jan Nilsson, Bo Hedblad, Elisabet Wirfält

Abstract

Aims: To investigate if diet quality is related to incidence of cardiovascular (CV) events.

Subjects and methods: A diet quality index based on the 2005 Swedish Nutrition Recommendations and the Swedish Dietary Guidelines was created and included six dietary components: saturated fatty acids, polyunsaturated fatty acids, fish and shellfish, dietary fiber, fruit and vegetables, and sucrose. The index ranked 17126 participants (59% women) of the population-based Malmö Diet and Cancer cohort (Sweden) on their dietary intakes. Total index score was categorized as low, medium or high. Cox proportional hazard regression was used to model associations between index score categories and index components with risk of incident CV events, with adjustment for potential confounders. The incidence of first CV events (non-fatal or fatal myocardial infarction or ischemic stroke or death from ischemic heart disease) was monitored from baseline (1991-1996) until December 31, 2008; 703 CV events occurred in women and 1093 in men.

Results: A high diet quality was associated with decreased risk of CV events when compared to a low diet quality. In multivariate analysis, the risk reduction was 32% (hazard ratio = 0.68, 95% confidence interval: 0.49-0.73) in men and 27% (hazard ratio = 0.73, 95% confidence interval: 0.59-0.91) in women. When examined separately and mutually adjusted for each other, the individual components were either not associated with CV risk or marginally decreased risks were seen.

Conclusion: High quality diets in line with current recommendations may reduce the risk of CV events. This study illustrates the importance of considering a combination of dietary factors when evaluating diet-disease associations.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Kaplan-Meier curves of cardiovascular event-free…
Figure 1. Kaplan-Meier curves of cardiovascular event-free survival by categories of DQI-SNR score among men (n = 6 940) in the Malmö Diet and Cancer cohort (1991–2008).
Analysis time was cut-off at 16 years of follow-up.
Figure 2. Kaplan-Meier curves of cardiovascular event-free…
Figure 2. Kaplan-Meier curves of cardiovascular event-free survival by categories of DQI-SNR score among women (n = 10 186) in the Malmö Diet and Cancer cohort (1991–2008).
Analysis time was cut-off at 16 years of follow-up.

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