Introduction
Methods
Component of dietary pattern | Range of points | Criterion for lowest points | Criterion for highest points |
---|---|---|---|
AHEIa
| |||
Vegetables | 0–10 | 0 servings/dayb
| ≥5 servings/dayb
|
Fruits | 0–10 | 0 servings/dayb
| ≥4 servings/dayb
|
Nuts | 0–10 | 0 servings/dayb
| ≥1 serving/dayb
|
Ratio of white meat to red meat | 0–10 | 0 | ≥4 |
Cereal fibre | 0–10 | 0 g/day | ≥15 g/day |
Ratio of PUFA to SFA | 0–10 | ≤0.1 | ≥1 |
Alcohol | |||
Men | 0–10 | 0 or >3.5 drinks/dayb
| 1.5–2.5 drinks/dayb
|
Women | 0–10 | 0 or >2.5 drinks/dayb
| 0.5–1.5 drinks/dayb
|
DASHc
| |||
Grains | |||
Total grains | 0–5 | 0 servings/dayb
| ≥6 servings/dayb
|
Fibre content of grains | 0–5 | No grain intake | Quintile 5 of subcohort distribution |
Vegetables | 0–10 | 0 servings/dayb
| ≥4 servings/dayb
|
Fruits | 0–10 | 0 servings/dayb
| ≥4 servings/dayb
|
Dairy products | |||
Total dairy products | 0–5 | 0 servings/dayb
| ≥2 servings/dayb
|
Fat content of dairy products | 0–5 | No dairy intake | Quintile 1 of subcohort distribution |
Meat, poultry, fish | 0–10 | ≥4 servings/dayb
| ≤1 serving/dayb
|
Nuts, seeds, legumes | 0–10 | 0 servings/dayb
| ≥4 servings/dayb
|
Fats and oils | 0–10 | ≥6 servings/dayb
| ≤3 servings/dayb
|
Sweets | 0–10 | ≥10 servings/weekb
| ≤5 servings/weekb
|
RRR dietary pattern | Positive weighting | Negative weighting |
---|---|---|
RRR1 [20]a
| Wine | Sugar-sweetened soft drinks |
Coffee | Refined grains | |
Cabbages | Processed meat | |
Root vegetables | Diet soft drinks | |
RRR2 [18]a
| Fruits | Red meat |
Beer | ||
Poultry | ||
Legumes | ||
Sugar-sweetened soft drinks | ||
Processed meat | ||
White bread | ||
RRR3 [19]a
| Breakfast cereals | Diet soft drinks |
Honey, jam, sugar | Sugar-sweetened soft drinks | |
Dressing sauces | Processed meat | |
Non-white bread | Salty biscuits and crackers | |
White bread |
Results
Country |
n
| aHEI | DASH | RRR1 ([20]) | RRR2 ([18]) | RRR3 ([19]) |
---|---|---|---|---|---|---|
France | 532 | 0.20 (−0.45, 0.72) | 0.38 (−0.15, 0.97) | −0.05 (−0.49, 0.47) | 0.13 (−0.29, 0.66) | 0.51 (−0.02, 1.12) |
Spain | 3,508 | 0.20 (−0.45, 0.98) | 0.44 (−0.02, 0.97) | −0.57 (−1.01, −0.16) | −0.28 (−1.05, 0.34) | −0.52 (−0.95, −0.14) |
UKa
| ||||||
Norfolk | 844 | 0.07 (−0.58, 0.98) | – | 0.89 (0.32, 1.53) | 0.26 (−0.22, 0.70) | 0.19 (−0.48, 0.71) |
Oxford | 239 | 0.98 (0.07, 1.76) | – | 0.83 (0.31, 1.39) | 0.79 (0.31, 1.22) | 0.49 (−0.15, 0.98) |
Netherlands | 1,396 | −0.19 (−0.71, 0.33) | 0.18 (−0.61, 0.84) | 0.29 (−0.19, 0.67) | 0.51 (0.004, 0.89) | 0.14 (−0.32, 0.54) |
Germany | 2,041 | −0.45 (−0.97, 0.07) | −0.28 (−0.87, 0.38) | 0.004 (−0.43, 0.36) | 0.41 (−0.21, 0.79) | 0.13 (−0.27, 0.55) |
Sweden | 1,917 | −0.32 (−0.97, 0.20) | −0.55 (−1.33, 0.18) | 0.05 (−0.41, 0.52) | 0.39 (−0.12, 0.77) | 0.07 (−0.41, 0.57) |
Denmark | 2,118 | −0.06 (−0.71, 0.59) | −0.15 (−0.87, 0.51) | 0.53 (−0.03, 1.03) | 0.05 (−0.58, 0.54) | 0.59 (0.003, 1.25) |
Total | 12,595 | −0.06 (−0.71, 0.59) | 0.05 (−0.68, 0.70) | 0.01 (−0.56, 0.57) | 0.18 (−0.48, 0.68) | 0.01 (−0.54, 0.57) |
Characteristic | Total | aHEI | DASH | RRR 1 ([20]) | RRR 2 ([18]) | RRR 3 ([19]) | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
Q1 | Q5 | Q1 | Q5 | Q1 | Q5 | Q1 | Q5 | Q1 | Q5 | ||
Age (years) | 53.3 | 53.6 | 52.9* | 53.5 | 53.4 | 50.0 | 55.8* | 51.5 | 54.9* | 50.6 | 55.8* |
Men (%) | 37.8 | 45.1 | 35.5* | 59.4 | 23.3* | 47.8 | 35.7* | 72.2 | 13.4* | 52.3 | 40.7* |
BMI (kg/m2) | 25.7 | 25.8 | 25.8 | 25.6 | 25.8* | 26.9 | 24.9* | 26.9 | 24.7* | 27.1 | 24.4* |
WC (cm) | |||||||||||
Men | 95.0 | 95.8 | 95.0 | 94.0 | 96.0* | 97.0 | 94.0* | 97.0 | 92.0* | 97.0 | 92.0* |
Women | 80.0 | 80.0 | 80.0 | 78.0 | 81.0* | 84.0 | 77.3* | 83.5 | 78.0* | 83.5 | 76.0* |
Physically active (%) | 21.1 | 17.8 | 22.7* | 23.2 | 21.6* | 18.0 | 26.5* | 23.4 | 22.9 | 19.5 | 26.0* |
Never smoking (%) | 46.2 | 34.9 | 53.3* | 33.7 | 57.4* | 48.1 | 39.7* | 34.6 | 55.1* | 41.9 | 47.6* |
Post-secondary education (%) | 21.7 | 20.0 | 22.5* | 22.0 | 21.5* | 13.9 | 23.7* | 16.4 | 25.7* | 15.3 | 29.9* |
Dietary intake | |||||||||||
Total energy (kJ/day) | 8,581 | 8,017 | 9,343* | 9,958 | 8,079* | 9,899 | 8,372* | 11,125 | 7,255* | 9,996 | 9,025* |
Fat (% energy) | 35.1 | 35.6 | 34.0* | 37.7 | 32.3* | 36.1 | 33.2* | 35.3 | 33.3* | 35.8 | 33.5* |
Carbohydrates (% energy) | 43.3 | 40.1 | 45.0* | 41.7 | 45.5* | 43.3 | 43.4 | 39.5 | 47.5* | 41.6 | 46.1* |
Protein (% energy) | 17.0 | 16.2 | 17.8* | 15.3 | 17.9* | 17.9 | 17.0* | 17.9 | 16.0* | 17.7 | 16.3* |
Alcohol (g/day) | 7.1 | 10.7 | 7.6* | 11.3 | 3.7* | 3.8 | 11.4* | 20.0 | 3.3* | 9.9 | 7.9* |
Fibre (g/day) | 22.1 | 15.8 | 29.4* | 19.9 | 26.4* | 23.9 | 23.4* | 24.8 | 22.6* | 23.7 | 26.2* |
Red and processed meat (g/day) | 78.9 | 88.4 | 59.7* | 108.1 | 50.8* | 100.9 | 70.4* | 131.8 | 40.7* | 104.9 | 70.6* |
Fruits and vegetables (g/day) | 362 | 200 | 623* | 227 | 587* | 386 | 431* | 335 | 450* | 400 | 383 |
Coffee (g/day) | 300 | 400 | 192* | 500 | 188* | 130 | 556* | 205 | 362* | 162 | 500* |
Dietary pattern | Quintile |
p for trenda
| ||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | ||
aHEI | ||||||
Score | <−0.96 | −0.96 to −0.44 | −0.43 to 0.08 | 0.09 to 0.73 | >0.74 | |
n cases | 2,088 | 1,996 | 2,015 | 1,845 | 1,738 | |
Model 1b
| 1.00 (ref) | 0.88 (0.81, 0.97) | 0.81 (0.74, 0.88) | 0.78 (0.72, 0.86) | 0.73 (0.67, 0.80) | <0.0001 |
Model 2c
| 1.00 (ref) | 0.93 (0.85, 1.02) | 0.88 (0.80, 0.96) | 0.88 (0.80, 0.96) | 0.83 (0.75, 0.92) | 0.0001 |
Model 3d
| 1.00 (ref) | 0.90 (0.82, 1.00) | 0.91 (0.83, 1.01) | 0.90 (0.81, 1.00) | 0.89 (0.80, 1.00) | 0.07 |
Model 4e
| 1.00 (ref) | 0.92 (0.82, 1.02) | 0.95 (0.86, 1.06) | 0.95 (0.85, 1.05) | 0.96 (0.86, 1.07) | 0.65 |
DASH | ||||||
Score | <−0.87 | −0.87 to −0.28 | −0.27 to 0.24 | 0.25 to 0.77 | >0.77 | |
n cases | 2,165 | 1,666 | 1,772 | 1,677 | 1,603 | |
Model 1b
| 1.00 (ref) | 0.86 (0.79, 0.95) | 0.89 (0.81, 0.98) | 0.84 (0.76, 0.92) | 0.75 (0.68, 0.83) | <0.0001 |
Model 2c
| 1.00 (ref) | 0.87 (0.79, 0.95) | 0.88 (0.80, 0.97) | 0.85 (0.77, 0.94) | 0.78 (0.71, 0.87) | 0.006 |
Model 3d
| 1.00 (ref) | 0.95 (0.86, 1.06) | 0.94 (0.84, 1.04) | 0.90 (0.81, 1.01) | 0.91 (0.81, 1.02) | 0.07 |
Model 4e
| 1.00 (ref) | 0.96 (0.86, 1.07) | 0.94 (0.84, 1.05) | 0.93 (0.83, 1.04) | 0.95 (0.84, 1.07) | 0.24 |
RRR1 ([20]) | ||||||
Score | <−0.71 | −0.71 to −0.20 | −0.20 to 0.22 | 0.22 to 0.73 | >0.73 | |
n cases | 2,296 | 1,999 | 1,979 | 1,739 | 1,669 | |
Model 1b
| 1.00 (ref) | 0.83 (0.76, 0.91) | 0.75 (0.69, 0.82) | 0.64 (0.59, 0.71) | 0.57 (0.52, 0.63) | <0.0001 |
Model 2c
| 1.00 (ref) | 0.84 (0.77, 0.92) | 0.77 (0.70, 0.85) | 0.66 (0.60, 0.73) | 0.58 (0.52, 0.65) | <0.0001 |
Model 3d
| 1.00 (ref) | 0.91 (0.82, 1.01) | 0.88 (0.79, 0.98) | 0.80 (0.71, 0.90) | 0.73 (0.65, 0.83) | <0.0001 |
Model 4e
| 1.00 (ref) | 0.92 (0.83, 1.02) | 0.91 (0.82, 1.02) | 0.81 (0.72, 0.91) | 0.76 (0.67, 0.86) | <0.0001 |
RRR2 ([18]) | ||||||
Score | <−0.68 | −0.68 to −0.06 | −0.06 to 0.39 | 0.39 to 0.78 | >0.78 | |
n cases | 2,454 | 2,115 | 1,982 | 1,721 | 1,410 | |
Model 1b
| 1.00 (ref) | 0.87 (0.80, 0.95) | 0.84 (0.77, 0.92) | 0.74 (0.67, 0.82) | 0.61 (0.55, 0.68) | <0.0001 |
Model 2c
| 1.00 (ref) | 0.88 (0.81, 0.96) | 0.85 (0.77, 0.93) | 0.76 (0.68, 0.84) | 0.65 (0.58, 0.73) | <0.0001 |
Model 3d
| 1.00 (ref) | 0.96 (0.87, 1.07) | 0.94 (0.84, 1.05) | 0.87 (0.78, 0.98) | 0.81 (0.71, 0.91) | 0.001 |
Model 4e
| 1.00 (ref) | 0.98 (0.89, 1.09) | 0.95 (0.85, 1.06) | 0.90 (0.79, 1.01) | 0.85 (0.75, 0.97) | 0.02 |
RRR3 ([19]) | ||||||
Score | <−0.68 | −0.68 to −0.20 | −0.20 to 0.21 | 0.21 to 0.72 | >0.72 | |
n cases | 2,493 | 2,009 | 1,945 | 1,814 | 1,421 | |
Model 1b
| 1.00 (ref) | 0.81 (0.74, 0.88) | 0.73 (0.66, 0.79) | 0.63 (0.58, 0.70) | 0.42 (0.38, 0.47) | <0.0001 |
Model 2c
| 1.00 (ref) | 0.80 (0.73, 0.87) | 0.72 (0.66, 0.79) | 0.65 (0.59, 0.72) | 0.46 (0.42, 0.51) | <0.0001 |
Model 3d
| 1.00 (ref) | 0.84 (0.76, 0.93) | 0.83 (0.74, 0.92) | 0.80 (0.72, 0.89) | 0.62 (0.56, 0.70) | <0.0001 |
Model 4e
| 1.00 (ref) | 0.84 (0.76, 0.93) | 0.84 (0.76, 0.94) | 0.82 (0.73, 0.91) | 0.65 (0.58, 0.73) | <0.0001 |
Dietary variable | HR (95% CI) | CIE (%) |
---|---|---|
RRR1 ([20]) | ||
Original RRR1 score | 0.91 (0.86, 0.96) | |
RRR1 without sugar-sweetened soft drinks | 0.92 (0.87, 0.96) | +1.1 |
RRR1 without refined grains | 0.91 (0.86, 0.96) | 0 |
RRR1 without processed meat | 0.93 (0.88, 0.98) | +2.2 |
RRR1 without diet soft drinks | 0.90 (0.85, 0.96) | −1.1 |
RRR1 without wine | 0.91 (0.87, 0.94) | 0 |
RRR1 without coffee | 0.94 (0.88, 0.99) | +3.3 |
RRR1 without cabbages | 0.89 (0.84, 0.95) | −2.2 |
RRR1 without root vegetables | 0.91 (0.86, 0.97) | 0 |
RRR2 ([18]) | ||
Original RRR2 score | 0.92 (0.84, 1.01) | |
RRR2 without fruits | 0.96 (0.91, 1.00) | +4.3 |
RRR2 without red meat | 0.94 (0.87, 1.02) | +2.2 |
RRR2 without beer | 0.90 (0.84, 0.97) | −2.2 |
RRR2 without poultry | 0.92 (0.84, 1.02) | 0 |
RRR2 without legumes | 0.93 (0.86, 1.01) | +1.1 |
RRR2 without sugar-sweetened soft drinks | 0.95 (0.85, 1.05) | +3.3 |
RRR2 without processed meat | 0.95 (0.88, 1.03) | +3.3 |
RRR2 without white bread | 0.93 (0.86, 1.01) | +1.1 |
RRR3 ([19]) | ||
Original RRR3 score | 0.87 (0.82, 0.92) | |
RRR3 without diet soft drinks | 0.86 (0.81, 0.91) | −1.1 |
RRR3 without sugar-sweetened soft drinks | 0.87 (0.83, 0.91) | 0 |
RRR3 without processed meat | 0.88 (0.84, 0.93) | +1.1 |
RRR3 without salty biscuits | 0.87 (0.82, 0.91) | 0 |
RRR3 without white bread | 0.88 (0.84, 0.92) | +1.1 |
RRR3 without breakfast cereals | 0.87 (0.81, 0.92) | 0 |
RRR3 without honey/jam/sugar | 0.90 (0.84, 0.96) | +3.4 |
RRR3 without dressing sauces | 0.88 (0.83, 0.93) | +1.1 |
RRR3 without non-white bread | 0.87 (0.82, 0.92) | 0 |