Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.
Lassale C., Gunter MJ., Romaguera D., Peelen LM., Van der Schouw YT., Beulens JW., Freisling H., Muller DC., Ferrari P., Huybrechts I., Fagherazzi G., Boutron-Ruault MC., Affret A., Overvad K., Dahm CC., Olsen A., Roswall N., Tsilidis KK., Katzke VA., Kühn T., Buijsse B., Quirós JR., Sánchez-Cantalejo E., Etxezarreta N., Huerta JM., Barricarte A., Bonet C., Khaw KT., Key TJ., Trichopoulou A., Bamia C., Lagiou P., Palli D., Agnoli C., Tumino R., Fasanelli F., Panico S., Bueno-de-Mesquita HB., Boer JM., Sonestedt E., Nilsson LM., Renström F., Weiderpass E., Skeie G., Lund E., Moons KG., Riboli E., Tzoulaki I.
Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.