Elsevier

Preventive Medicine

Volume 77, August 2015, Pages 119-124
Preventive Medicine

Dietary patterns in relation to quality-adjusted life years in the EPIC-NL cohort

https://doi.org/10.1016/j.ypmed.2015.05.014Get rights and content

Highlights

  • We related dietary patterns to health expectancy using quality-adjusted life years.

  • Two out of five dietary patterns were associated with quality-adjusted life years.

  • A Mediterranean-type dietary pattern was associated with a longer healthy life.

  • Also adhering to the WHO-based Healthy Diet Indicator was related to more QALYs.

  • These healthy diets were associated with a 2 months longer life in good health.

Abstract

Background

Dietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention.

Objective

The aim of our study was to relate dietary patterns to health expectancy using quality-adjusted life years (QALYs) as outcome parameter.

Methods

Data from the EPIC-NL study were used, a prospective cohort study of 33,066 healthy men and women aged 20–70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at study entry (1993–1997). Five dietary patterns were studied: three a priori patterns (the modified Mediterranean Diet Score (mMDS), the WHO-based Healthy Diet Indicator (HDI) and the Dutch Healthy Diet index (DHD-index)) and two a posteriori data–based patterns. QALYs were used as a summary health measure for healthy life expectancy, combining a person’s life expectancy with a weight reflecting loss of quality of life associated with having chronic diseases.

Results

The mean QALYs of the participants were 74.9 (standard deviation 4.4). A higher mMDS and HDI were associated with a longer life in good health. Participants who had a high mMDS score (6–9) had 0.17 [95% CI, 0.05; 0.30] more QALYs than participants with a low score (0–3), equivalent to two months longer life in good health. Participants with a high HDI score also had more QALYs (0.15 [95% CI, 0.03; 0.27]) than participants with a low HDI score.

Conclusion

A Mediterranean-type diet and the Healthy Diet Indicator were associated with approximately 2 months longer life in good health.

Introduction

Non-communicable diseases such as cancer and cardiovascular diseases are responsible for more than half of the global burden of disease (Murray et al., 2012). An important modifiable risk factor for many non-communicable diseases is diet (Ezzati and Riboli, 2013, Murray et al., 2012). In the Netherlands, 5%–10% of the burden of disease is related to diet (Van Grinsven, 2014). The relation between diet and chronic diseases can be investigated using dietary patterns, where possible correlations and interactions between nutrients or foods are taken into account (Hu, 2002). Dietary patterns can be defined a priori (based on existing knowledge) or a posteriori (based on observed nutritional data). Both a priori– and a posteriori–defined dietary patterns have been used to investigate their relations with the occurrence of chronic diseases (Berentzen et al., 2013, Mente et al., 2009, Romaguera et al., 2012, Sofi et al., 2010, Stricker et al., 2013, Waijers et al., 2006). Adherence to healthier dietary patterns has been associated with lower risk of cardiovascular disease, cancer, and overall mortality in several (Mente et al., 2009, Romaguera et al., 2012, Sofi et al., 2010, Stricker et al., 2013, Waijers et al., 2006), but not all (Berentzen et al., 2013) studies.

Studies thus far have mainly focused on associations with the occurrence or mortality of a specific disease. However, diet affects several diseases and even opposing effects may occur. The net effect of diet on disease burden in the population is thus not always clear. We previously used quality-adjusted life years (QALYs) to summarize effects and to account for opposing effects in a prospective cohort (Fransen et al., 2014). This health measure estimates disease burden by including both mortality and morbidity from different diseases while also taking into account severity and duration of the disease. The health status of an individual is reflected in a number between 0 and 1 (utility weight), which represents quality of life associated with disease. QALYs have become popular in cost-effectiveness analyses that compare different health interventions (Sassi, 2006). In the present analysis, we computed QALYs in the EPIC-NL cohort and related them to several a priori and a posteriori dietary patterns that are relevant for the Dutch population. The aim of the study was to investigate which dietary pattern is associated with the lowest disease burden.

Section snippets

Study population

We investigated the association between dietary pattern adherence and QALYs in the EPIC-NL cohort (Beulens et al., 2010). This cohort consists of EPIC-MORGEN and EPIC-Prospect, the two Dutch cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC) (Riboli and Kaaks, 1997). Between 1993 and 1997, 40,011 men and women aged 20–70 years were recruited. At recruitment, we administered a lifestyle questionnaire and a validated food frequency questionnaire (FFQ) and body

Results

Characteristics of the study population are shown in Table 3. Mean expected QALYs of the participants were 74.9 (SD 4.4), which indicates that on average participants are expected to live 74.9 years in good health. More than half (53%) of the population was overweight or obese, almost one-third (30%) were current smokers at recruitment, and 21% had a high educational level.

Components of the five dietary patterns are presented in Table 1, Table 2. Patterns differ in their included components

Discussion

Our results show that two of the five studied dietary patterns, the modified Mediterranean Diet Score and the Healthy Diet Indicator, were statistically significantly associated with approximately two months longer healthy life.

The association between dietary patterns and single chronic diseases has been investigated before in EPIC-NL (Berentzen et al., 2013, Stricker et al., 2013, Waijers et al., 2006) and other populations (Mente et al., 2009, Romaguera et al., 2012, Sofi et al., 2010,

Author contributions

HPF, JWJB, AMM and PHMP designed the research; HPF, JWJB, AMM, PHMP, EAS, JMAB, GAW, NCO-M, YTS, HBB-M, and JH conducted the research; HPF analyzed the data; HPF, JWJB, AMM, and PHMP wrote the paper; EAS, JMAB, GAW, NCO-M, YTS, HBB-M, and JH provided critical review of the manuscript; HPF, JWJB, AMM, and PHMP had primary responsibility for the final content. All authors have read and approved the final manuscript.

Conflict of interest

The authors declare there is no conflict of interest.

Acknowledgments

We thank the National Cancer registry, PHARMO Institute and Statistics Netherlands for follow-up data. We thank the Netherlands institute for health services research (NIVEL) for providing the data of the second Dutch National Survey of General Practice.

This study was supported by a grant of the Dutch research council (NWO-ZonMW; grant no 40-00812-98-10040). The recruitment, data and blood collection for EPIC-NL study was funded by several grants of the ‘Europe against Cancer’ Program of the

References (36)

  • M. Ezzati et al.

    Behavioral and dietary risk factors for noncommunicable diseases

    N. Engl. J. Med.

    (2013)
  • H.P. Fransen et al.

    Association between Lifestyle Factors and Quality-Adjusted Life Years in the EPIC-NL Cohort

    PLoS One

    (2014)
  • M.R. Gold et al.

    Measure-dependent variation in burden of disease estimates: implications for policy

    Med. Care

    (2002)
  • F.B. Hu

    Dietary pattern analysis: a new direction in nutritional epidemiology

    Curr. Opin. Lipidol.

    (2002)
  • P. Huijbregts et al.

    Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study

    BMJ

    (1997)
  • K.T. Knoops et al.

    Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project

    JAMA

    (2004)
  • K.T. Knoops et al.

    Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project

    Eur. J. Clin. Nutr.

    (2006)
  • L.M. Lamers et al.

    Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff

    Ned. Tijdschr. Geneeskd.

    (2005)
  • Cited by (23)

    • Dietary patterns

      2018, Encyclopedia of Food Security and Sustainability
    View all citing articles on Scopus
    View full text