Modifiable Lifestyle Recommendations and Mortality in Denmark: A Cohort Study

The contribution of avoidable mortality to life expectancy differences and lifespan disparities in the European Union: a population-based study

Background

Twenty years after the 2004 European Union (EU) enlargement, life expectancy differences between established (EMS) and new member states (NMS) remain large. Contributing to this gap are deaths that can be avoided through preventive services or adequate medical treatment. We estimate the impact of reducing avoidable mortality on life expectancy and lifespan disparities in the enlarged EU.

Methods

Using World Health Organization mortality database data, we analysed the potential of reducing avoidable mortality, as defined by Eurostat and the Organisation for Economic Cooperation and Development, to close the mortality gap between NMS and EMS. We decomposed the changes in life expectancy and lifespan disparity by age and cause using linear integral decomposition.

Findings

Averting all avoidable deaths across the EU from 2005 to 2019 would decrease the average life expectancy gap from 5.8 to 2.4 years in men and 3.3-2 years in women and eliminate the lifespan disparity gap. Had NMS achieved the average EMS avoidable mortality rates during the same period, the average life expectancy gap would have been reduced to 1.8 years in men and 1.6 years in women, and the lifespan disparities gap would have been reversed. Avoidable circulatory and injury-related deaths in middle and older age drove the observed mortality changes.

Interpretation

Our results suggest that the gap in life expectancy and lifespan disparity across the EU could be reduced by strengthening health systems and investing in averting circulatory and injury-related deaths in middle and older age in NMS.

Funding

None.

The impact of frailty on the use of social services, medication and mortality risk: a cross-sectional study

BACKGROUND

Frailty is a common condition in older people, and its prevalence increases with age. With an ageing population, the adverse consequences of frailty cause an increasing appeal to the health care system. The impact of frailty on population level is often assessed using adverse health outcomes, such as mortality and medication use. Use of community nursing services and services offered through the Social Support Act are hardly used in assessing the impact of frailty. However, these services are important types of care use, especially in relation to ageing in place. In this cross-sectional study, we aimed to assess the impact of frailty on use of Social Support Act services, use of community nursing services, medication use, and mortality.

METHODS

We used a frailty index, the FI-HM37, that was based on data from the Dutch Public Health Monitor 2016, for which respondents ≥ 65 years of age were included (n = 233,498). The association between frailty, the use of Social Support Act services, community nursing services and medication use was assessed using the Zero Inflated Poisson (ZIP) regression method. Survival analysis using Cox proportional hazards regression was conducted to estimate the hazard ratios for the association between frailty and mortality.

RESULTS

The ZIP regression with a final sample size of 181,350 showed that frailty affected care use even after correcting for several covariates mentioned in the literature. For each unit increase in frailty index (FI) score, the relative probability of using zero Social Support services decreased with 7.7 (p < 0.001). The relative chance of zero community nursing services decreased with 4.0 (p < 0.001) for each unit increase in FI score. Furthermore, for each unit increase in FI score, the likelihood of zero medication use decreased with 2.9 (p < 0.001). Finally, for each unit increase in FI score, the mortality risk was 3.8 times higher (CI = 3.4-4.3; p < 0.001).

CONCLUSIONS

We demonstrated that frailty negatively affects the use of Social Support Act services, the use of community nursing services, medication use, and mortality risk. This study is the first to demonstrate the impact of frailty on Social Support Act services and community nursing services in the Netherlands. Findings emphasize the importance of frailty prevention for older people and public health policy.

Genetic predisposition, modifiable lifestyles, and their joint effects on human lifespan: evidence from multiple cohort studies

OBJECTIVE

To investigate the associations across genetic and lifestyle factors with lifespan.

DESIGN

A longitudinal cohort study.

SETTING

UK Biobank.

PARTICIPANTS

353 742 adults of European ancestry, who were recruited from 2006 to 2010 and were followed up until 2021.

EXPOSURES

A polygenic risk score for lifespan with long (highest quintile) risk categories and a weighted healthy lifestyle score, including no current smoking, moderate alcohol consumption, regular physical activity, healthy body shape, adequate sleep duration, and a healthy diet, categorised into favourable, intermediate, and unfavourable lifestyles.

MAIN OUTCOME MEASURES

Lifespan defined as the date of death or the censor date minus the date of birth.

RESULTS

Of the included 353 742 participants of European ancestry with a median follow-up of 12.86 years, 24 239 death cases were identified. Participants were grouped into three genetically determined lifespan categories including long (20.1%), intermediate (60.1%), and short (19.8%), and into three lifestyle score categories including favourable (23.1%), intermediate (55.6%), and unfavourable (21.3%). The hazard ratio (HR) of death for individuals with a genetic predisposition to a short lifespan was 1.21 (95% CI 1.16 to 1.26) compared to those with a genetic predisposition to a long lifespan. The HR of death for individuals in the unfavourable lifestyle category was 1.78 (95% CI 1.71 to 1.85), compared with those in the favourable lifestyle category. Participants with a genetic predisposition to a short lifespan and an unfavourable lifestyle had 2.04 times (95% CI 1.87 to 2.22) higher rates of death compared with those with a genetic predisposition to a long lifespan and a favourable lifestyle. No multiplicative interaction was detected between the polygenic risk score of lifespan and the weighted healthy lifestyle score (p=0.10). The optimal combination of healthy lifestyles, including never smoking, regular physical activity, adequate sleep duration, and a healthy diet, was derived to decrease risk of premature death (death before 75 years).

CONCLUSION

Genetic and lifestyle factors were independently associated with lifespan. Adherence to healthy lifestyles could largely attenuate the genetic risk of a shorter lifespan or premature death. The optimal combination of healthy lifestyles could convey better benefits for a longer lifespan, regardless of genetic background.

On the use of the healthy lifestyle index to investigate specific disease outcomes

The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell's C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

Lifestyle behaviors and risk of cardiovascular disease and prognosis among individuals with cardiovascular disease: a systematic review and meta-analysis of 71 prospective cohort studies

BACKGROUND

Healthy lifestyle behaviors (LBs) have been widely recommended for the prevention and management of cardiovascular disease (CVD). Despite a large number of studies exploring the association between combined LBs and CVD, a notable gap exists in integration of relevant literatures. We conducted a systematic review and meta-analysis of prospective cohort studies to analyze the correlation between combined LBs and the occurrence of CVD, as well as to estimate the risk of various health complications in individuals already diagnosed with CVD.

METHODS

Articles published up to February 10, 2023 were sourced through PubMed, EMBASE and Web of Science. Eligible prospective cohort studies that reported the relations of combined LBs with pre-determined outcomes were included. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using either a fixed or random-effects model. Subgroup analysis, meta-regression, publication bias, and sensitivity analysis were as well performed.

RESULTS

In the general population, individuals with the healthiest combination of LBs exhibited a significant risk reduction of 58% for CVD and 55% for CVD mortality. For individuals diagnosed with CVD, adherence to the healthiest combination of LBs corresponded to a significant risk reduction of 62% for CVD recurrence and 67% for all-cause mortality, when compared to those with the least-healthy combination of LBs. In the analysis of dose-response relationship, for each increment of 1 healthy LB, there was a corresponding decrease in risk of 17% for CVD and 19% for CVD mortality within the general population. Similarly, among individuals diagnosed with CVD, each additional healthy LB was associated with a risk reduction of 27% for CVD recurrence and 27% for all-cause mortality.

CONCLUSIONS

Adopting healthy LBs is associated with substantial risk reduction in CVD, CVD mortality, and adverse outcomes among individuals diagnosed with CVD. Rather than focusing solely on individual healthy LB, it is advisable to advocate for the adoption of multiple LBs for the prevention and management of CVD.

TRIAL REGISTRATION

PROSPERO: CRD42023431731.

Diet quality and cardiovascular outcomes: A systematic review and meta-analysis of cohort studies

AIMS

To evaluate relationships between diet quality and cardiovascular outcomes.

METHODS

Six databases were searched for studies published between January 2007 and October 2021. Eligible studies included cohort studies that assessed the relationship between a priori diet quality and cardiovascular disease mortality and morbidity in adults. The Academy of Nutrition and Dietetics Checklist was used to assess the risk of bias. Study characteristics and outcomes were extracted from eligible studies using standardised processes. Data were summarised using risk ratios for cardiovascular disease incidence and mortality with difference compared for highest versus lowest diet quality synthesised in meta-analyses using a random effects model.

RESULTS

Of the 4780 studies identified, 159 studies (n = 6 272 676 adults) were included. Meta-analyses identified a significantly lower cardiovascular disease incidence (n = 42 studies, relative risk 0.83, 95% CI 0.82-0.84, p < 0.001) and mortality risk (n = 49 studies, relative risk 0.83, 95% CI 0.82-0.84, p < 0.001) among those with highest versus lowest diet quality. In sensitivity analyses of a high number of pooled studies (≥13 studies) the Mediterranean style diet patterns and adherence to the heart healthy diet guidelines were significantly associated with a risk reduction of 15% and 14% for cardiovascular disease incidence and 17% and 20% for cardiovascular disease mortality respectively (p < 0.05).

CONCLUSIONS

Higher diet quality is associated with lower incidence and risk of mortality for cardiovascular disease however, significant study heterogeneity was identified for these relationships.

Long-term lifestyle change and risk of mortality and Type 2 diabetes in patients with cardiovascular disease

AIMS

To quantify the relationship between self-reported, long-term lifestyle changes (smoking, waist circumference, physical activity, and alcohol consumption) and clinical outcomes in patients with established cardiovascular disease (CVD).

METHODS AND RESULTS

Data were used from 2011 participants (78% male, age 57 ± 9 years) from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort who returned for a re-assessment visit (SMART2) after ∼10 years. Self-reported lifestyle change was classified as persistently healthy, improved, worsened, or persistently unhealthy. Cox proportional hazard models were used to quantify the relationship between lifestyle changes and the risk of (cardiovascular) mortality and incident Type 2 diabetes (T2D). Fifty-seven per cent of participants was persistently healthy, 17% improved their lifestyle, 8% worsened, and 17% was persistently unhealthy. During a median follow-up time of 6.1 (inter-quartile range 3.6-9.6) years after the SMART2 visit, 285 deaths occurred, and 99 new T2D diagnoses were made. Compared with a persistently unhealthy lifestyle, individuals who maintained a healthy lifestyle had a lower risk of all-cause mortality [hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.36-0.63], cardiovascular mortality (HR 0.57, 95% CI 0.38-0.87), and incident T2D (HR 0.46, 95% CI 0.28-0.73). Similarly, those who improved their lifestyle had a lower risk of all-cause mortality (HR 0.52, 95% CI 0.37-0.74), cardiovascular mortality (HR 0.46, 95% CI 0.26-0.81), and incident T2D (HR 0.50, 95% CI 0.27-0.92).

CONCLUSION

These findings suggest that maintaining or adopting a healthy lifestyle can significantly lower mortality and incident T2D risk in CVD patients. This study emphasizes the importance of ongoing lifestyle optimization in CVD patients, highlighting the potential for positive change regardless of previous lifestyle habits.

Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009-2010

OBJECTIVE

To investigate the association between a lifestyle score and all-cause mortality in the Chilean population.

DESIGN

Prospective study.

SETTINGS

The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0-2 points), moderately healthy (3-4 points) and the healthiest (5-7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated.

PARTICIPANTS

2706 participants from the Chilean National Health Survey 2009-2010.

RESULTS

After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality.

CONCLUSION

Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.

Behavior-related health risk factors, mental disorders and mortality after 20 years in a working aged general population sample

Mortality is predicted by the sum of behavior-related health risk factors (BRFs: tobacco smoking, alcohol drinking, body overweight, and physical inactivity). We analyzed degrees and combinations of BRFs in their relation to mortality and adjusted for mental disorders. In a random sample of the general population in northern Germany aged 18-64, BRFs and mental disorders had been assessed in 1996-1997 by the Munich Composite International Diagnostic Interview. A sum score including eight ranks of the behavior-related health risk factors was built. Death and its causes were ascertained 2017-2018 using residents' registration files and death certificates. Relations of the sum score and combinations of the BRFs at baseline with all-cause, cancer, and cardiovascular mortality 20 years later were analyzed. The sum score and combinations predicted all-cause, cardiovascular and cancer mortality. The odds ratio of the sum score was 1.38 (95% confidence interval 1.31-1.46) after adjustment for age, gender, and mental disorder. In addition to the BRFs, mood, anxiety or somatoform disorders were not related to mortality. We concluded that the sum score and combinations of behavior-related health risk factors predicted mortality, even after adjustment for mental disorders.

The impact of high-risk lifestyle factors on all-cause mortality in the US non-communicable disease population

BACKGROUND

Previous studies have suggested that lifestyle factors are associated with mortality in different population. However, little is known about the impact of lifestyle factors on all-cause mortality in non-communicable disease (NCD) population.

METHODS

This study included 10,111 NCD patients from the National Health Interview Survey. The potential high-risk lifestyle factors were defined as smoking, excessive drinking, abnormal body mass index, abnormal sleep duration, insufficient physical activity (PA), overlong sedentary behavior (SB), high dietary inflammatory index (DII) and low diet quality. Cox proportional hazard model was used to evaluate the impact of the lifestyle factors and the combination on all-cause mortality. The interaction effects and all combinations of lifestyle factors were also analyzed.

RESULTS

During 49,972 person-years of follow-up, 1040 deaths (10.3%) were identified. Among eight potential high-risk lifestyle factors, smoking (HR = 1.25, 95% CI 1.09-1.43), insufficient PA (HR = 1.86, 95% CI 1.61-2.14), overlong SB (HR = 1.33, 95% CI 1.17-1.51) and high DII (HR = 1.24, 95% CI 1.07-1.44) were risk factors for all-cause mortality in the multivariable Cox proportional regression. The risk of all-cause mortality was increased linearly as the high-risk lifestyle score increased (P for trend < 0.01). The interaction analysis showed that lifestyle had stronger impact on all-cause mortality among patients with higher education and income level. The combinations of lifestyle factors involving insufficient PA and overlong SB had stronger associations with all-cause mortality than those with same number of factors.

CONCLUSION

Smoking, PA, SB, DII and their combination had significant impact on all-cause mortality of NCD patients. The synergistic effects of these factors were observed, suggesting some combinations of high-risk lifestyle factor may be more harmful than others.

Associations of types of grains and lifestyle with all-cause mortality among Chinese adults aged 65 years or older: a prospective cohort study

BACKGROUND

Little is known on the association of types of grains with mortality and the moderating effect of lifestyle on this association. This study aims to evaluate the single or joint associations of types of grains and lifestyle with all-cause mortality among Chinese older adults.

METHODS

Data were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018. Subjects aged ≥ 65 years were eligible. The types of grains included wheat, total rice, and coarse cereals. Lifestyle was derived using smoking, alcohol consumption, physical activity, and dietary pattern. All-cause mortality was the primary outcome.

RESULTS

This study included 30275 participants with a mean age 87 ± 11 years and documented 19261 deaths during a mean follow-up of 4.8 years. Compared to wheat, in those with healthy and intermediate lifestyle, total rice was associated with a 13% (HR: 0.87, 95% CI 0.80, 0.93) and 6% (HR: 0.94, 95% CI 0.90, 1.00) lower risk of mortality, respectively, and coarse cereals were associated with a 14% (HR: 0.86, 95% CI 0.74, 1.00) and 12% (HR: 0.88, 95% CI 0.79, 0.97) lower risk of mortality, respectively. Meanwhile, an increase per SD in intakes of wheat and coarse cereals was associated with a 10% (HR: 1.10, 95% CI 1.03, 1.18) and 25% (HR: 1.25, 95% CI 1.08, 1.44) higher mortality rate in those with healthy lifestyle, and a 13% (HR: 1.13, 95% CI 1.08, 1.19) and 29% (HR: 1.29, 95% CI 1.17, 1.44) higher mortality in females but not males. In addition, a U-shaped association of intake of total grains with all- cause mortality was observed (P for non-linearity = 0.002), and a J-shaped association of intake of total rice with all- cause mortality was observed (P for non-linearity = 0.003).

CONCLUSIONS

Specific types of grains and lifestyle were separately or jointly associated with all-cause mortality. Compared to wheat, total rice and coarse cereals were advanced grains for participants with a relatively healthy lifestyle. Intake of total rice was related to all-cause mortality in a dose-response manner. Therefore, a combination of intermediate intake of total rice and healthy lifestyle should be encouraged in older adults.

Associations Between Physical Activity Vital Sign in Patients and Health Care Utilization in a Health Care System, 2018-2020

BACKGROUND

Physical inactivity is a risk factor for many chronic conditions. This retrospective cohort study examined associations between physical activity (PA) with health care utilization (HU).

METHODS

A PA vital sign was recorded in clinics from January 2018 to December 2020. Patients were categorized as inactive, insufficiently active, or sufficiently active by US PA aerobic guidelines. Associations between PA vital sign and visits (inpatient admissions, emergency department, urgent care, and primary care) were estimated using population average regression by visit type.

RESULTS

23,721 patients had at least one PA vital sign recorded, with a mean age of 47.3 years and mean body mass index (BMI) of 28; 52% were female and 63% were White. Sufficiently active patients were younger, male, White, and had lower BMI than insufficiently active patients. Achieving 150 minutes per week of moderate to vigorous PA per 1000 patient years was associated with 34 fewer emergency department visits (P < .001), 19 fewer inpatient admissions (P < .001), and 38 fewer primary care visits (P < .001) compared with inactive patients. Stronger associations between lower PA and higher HU were present among those who were older or had a higher comorbidity. BMI, sex, ethnicity, and race did not modify the association between PA and HU.

CONCLUSIONS

Meeting aerobic guidelines was associated with reduced HU for inpatient, primary care, and emergency department visits.

Investigating the Association Between the Co-Occurrence of Behavioral Health Risk Factors and Sick Days in General Hospital Patients

Objectives: To investigate the co-occurrence of 4 behavioral health risk factors (BHRFs), namely tobacco smoking, alcohol at-risk drinking, physical inactivity and unhealthy diet and their association with sick days prior to hospitalization in general hospital patients.

Methods: Over 10 weeks (11/2020-04/2021), all 18-64-year-old patients admitted to internal medicine, general and trauma surgery, and otorhinolaryngology wards of a tertiary care hospital were systematically approached. Among 355 eligible patients, 278 (78.3%) participated, and 256 (72.1%) were analyzed. Three BHRF sum scores were determined, including current tobacco smoking, alcohol use, physical inactivity and 1 of 3 indicators of unhealthy diet. Associations between BHRF sum scores and sick days in the past 6 months were analyzed using multivariate zero-inflated negative binomial regressions.

Results: Sixty-two percent reported multiple BHRFs (≥2). The BHRF sum score was related to the number of sick days if any (p = 0.009) with insufficient vegetable and fruit intake as diet indicator.

Conclusion: The majority of patients disclosed multiple BHRFs. These were associated with sick days prior to admission. The findings support the need to implement interventions targeting multiple BHRFs in general hospitals.

Association of Adherence to Healthy Lifestyle Recommendations With All-Cause and Cause-Specific Mortality Among Former Smokers

IMPORTANCE

The benefits of smoking cessation are well known, but former smokers have a higher health risk than never smokers. The impact of former smokers' engaging in other aspects of a healthy lifestyle is unclear.

OBJECTIVE

To assess the association between adherence to evidence-based lifestyle recommendations and mortality among former smokers.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study included 159 937 participants in the National Institutes of Health-AARP Diet and Health Study of older US adults who completed the baseline and risk factor questionnaires and self-identified as former smokers. Baseline questionnaires were mailed from 1995 to 1996. Data analysis was performed from November 2020 to November 2021.

EXPOSURES

Adherence to evidence-based lifestyle recommendations was scored for body weight (scores, 0-2), diet (scores, 0-3), physical activity (scores, 0-2), and alcohol intake (scores, 0-1) recommendations, with higher scores indicating better adherence. Individual lifestyle adherence scores were summed to make a total adherence score (scores, 0-8).

MAIN OUTCOMES AND MEASURES

The primary outcomes were all-cause and cause-specific mortality through December 31, 2019, with a mean (SD) follow-up of 18.9 (6.3) years. Hazard ratios (HRs) and 95% CIs were computed using a multivariable Cox proportional hazards regression model.

RESULTS

Among 159 937 former smokers (mean [SD] age, 62.6 [5.2] years; 106 912 [66.9%] male; 149 742 [93.6%] White), 86 127 deaths occurred. A higher total adherence score was associated with lower all-cause mortality (HR per unit increase, 0.95; 95% CI, 0.94-0.95). Compared with the lowest total adherence score category (scores, 0-2), the HRs for all-cause mortality were 0.88 (95% CI, 0.86-0.90) for scores of 3 to 4, 0.80 (95% CI, 0.79-0.82) for scores of 5 to 6, and 0.73 (95% CI, 0.71-0.75) for scores of 7 to 8. Associations were observed regardless of health status, comorbid conditions, the number of cigarettes participants used to smoke per day, years since cessation, and age at smoking initiation. When examined individually, the HRs for highest vs lowest adherence score were 0.86 (95% CI, 0.84-0.88) for body weight, 0.91 (95% CI, 0.90-0.93) for diet, 0.83 (95% CI, 0.81-0.85) for physical activity, and 0.96 (95% CI, 0.94-0.97) for alcohol intake recommendations. Participants with a higher total adherence score also had a lower risk of mortality from cancer, cardiovascular disease, and respiratory disease.

CONCLUSIONS AND RELEVANCE

In a large US cohort of former smokers, better adherence to healthy lifestyle recommendations was associated with lower mortality risk. These results provide evidence that former smokers may benefit from adhering to lifestyle recommendations, as do other groups.

Dietary changes based on food purchase patterns following a type 2 diabetes diagnosis

OBJECTIVE

The study explores whether type 2 diabetes (T2D) diagnosis affects food consumption patterns in line with the dietary recommendations provided to individuals in relation to a diagnosis.

DESIGN

Based on detailed food purchase data, we explore which dietary changes are most common following a T2D diagnosis. Changes are investigated for several energy-adjusted nutrients and food groups and overall adherence to dietary guidelines.

SETTING

We use data on diagnosis of T2D and hospitalisation in relation to T2D for a sample of adult Danes registered in the official patient register. This is combined with detailed scanner data on food purchases, which are used as a proxy for dietary intake.

PARTICIPANTS

We included 274 individuals in Denmark who are diagnosed during their participation in a consumer panel where they report their food purchases and 16 395 individuals who are not diagnosed.

RESULTS

Results suggest some changes in dietary composition following diagnosis, as measured by a Healthy Eating Index and for specific food groups and nutrients, although the long-term effects are limited. Socio-economic characteristics are poor predictors of dietary changes following diagnosis. Change in diet following diagnosis vary with the pre-diagnosis consumption patterns, where individuals with relatively unhealthy overall diets prior to diagnosis improve overall healthiness more compared to individuals with relatively healthy diets prior to diagnosis.

CONCLUSIONS

Adherence to dietary advice is low, on average, but there is large variation in behavioural change between the diagnosed individuals. Our results stress the difficulty for diagnosed individuals to shift dietary habits, particularly in the long term.

The Dietary Approach to Stop Hypertension (DASH) diet is associated with a lower risk of heart failure: A cohort study

AIMS

Trials demonstrate that following the DASH diet lowers blood pressure, which may prevent development of heart failure (HF). We investigated the association between long-term adherence to the DASH diet and food substitutions within the DASH diet on the risk of HF.

METHODS

Men and women aged 45-83 years without previous HF, ischemic heart disease or cancer at baseline in 1998 from the Cohort of Swedish Men (n = 41,118) and the Swedish Mammography Cohort (n = 35,004) were studied. The DASH diet emphasizes intake of fruit, vegetables, whole grains, nuts and legumes and low-fat dairy and deemphasizes red and processed meat, sugar-sweetened beverages and sodium. DASH diet scores were calculated based on diet assessed by food frequency questionnaires in late 1997 and 2009. Incidence of HF was ascertained using the Swedish Patient Register. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

During the median 22 years of follow-up (1998-2019) 12,164 participants developed HF. Those with the greatest adherence to the DASH diet had a lower risk of HF compared to those with the lowest adherence (HR 0.85, 95% CI 0.80, 0.91 for baseline diet and HR 0.83, 95% CI 0.78, 0.89 for long-term diet, comparing quintiles). Replacing 1 serving/day of red and processed meat with emphasized DASH diet foods was associated with an 8-12% lower risk of HF.

CONCLUSION

Long-term adherence to the DASH diet and relevant food substitutions within the DASH diet were associated with a lower risk of HF.