Introduction
Methods
Study design and subjects
Dietary assessment
Components | Scoring criteria of MDS components | % of participants with maximuma component scores | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Czech | Polish | Russian | Total | ||||||||
0 point | 1 point | 2 points | Males (n = 2648) | Females (n = 3319) | Males (n = 3083) | Females (n = 3460) | Males (n = 3056) | Females (n = 3767) | Males (n = 8787) | Females (n = 10,546) | |
Vegetables (g/day) | <100 | 100–250 | >250 | 21.3 | 35.9 | 29.5 | 32.8 | 39.0 | 41.4 | 30.4 | 36.9 |
Fruits and nuts (g/day) | <150 | 150–300 | >300 | 37.9 | 59.1 | 33.0 | 45.5 | 8.2 | 15.0 | 25.9 | 38.9 |
Legumes (g/week) | <70 | 70–140 | >140 | 60.1 | 58.4 | 42.9 | 38.0 | 29.6 | 29.6 | 29.7 | 27.1 |
Cereals (g/day) | <130 | 130–195 | >195 | 67.9 | 59.1 | 80.3 | 75.7 | 87.9 | 73.2 | 79.2 | 69.6 |
Fish (g/week) | <100 | 100–250 | >250 | 34.1 | 31.1 | 42.6 | 33.0 | 36.9 | 33.1 | 38.0 | 32.4 |
Meat and meat products (g/day) | >120 | 80–120 | <80 | 15.1 | 30.1 | 9.5 | 22.6 | 9.7 | 21.0 | 11.3 | 24.4 |
Dairy products (g/day) | >270 | 180–270 | <180 | 55.9 | 40.3 | 46.8 | 34.3 | 52.7 | 49.0 | 51.6 | 41.4 |
Alcohol (g/day) | >24 | <12 | 12–24 | 16.7 | 5.9 | 10.4 | 1.5 | 19.9 | 2.0 | 15.6 | 3.0 |
Olive oil usage | Not used for cooking | Used for cooking | – | 5.6 | 6.0 | 41.7 | 40.0 | 0.3 | 0.3 | 16.4 | 15.1 |
Mortality follow-up
Analytical sample
Multiple imputation of missing covariate data
Statistical analysis
Results
MDS components
MDS categories and bivariate results
MDS categories |
p value (trend)b
| |||
---|---|---|---|---|
Low (0–7 points) | Moderate (8–10 points) | High (11–17 points) | ||
Number of participantsa
| 4790 | 8941 | 4589 | |
Cohorts | ||||
Czech (%) | 26.1 | 28.0 | 36.8 | <0.001 |
Polish (%) | 23.9 | 33.9 | 41.8 | <0.001 |
Russian (%) | 50.0 | 38.1 | 21.5 | <0.001 |
Socio-demographic characteristics | ||||
Mean age (SD), years | 56.9 (7.1) | 57.1 (7.0) | 56.7 (6.9) | 0.216 |
Sex: females (%) | 49.8 | 55.8 | 58.5 | <0.001 |
Marital status: married (%) | 73.8 | 75.4 | 77.1 | <0.001 |
Education: primary or less (%) | 10.3 | 10.1 | 9.1 | 0.045 |
Education: university (%) | 25.8 | 25.5 | 27.5 | 0.068 |
Household amenities score: low (%) | 24.3 | 21.7 | 17.1 | <0.001 |
Household amenities score: high (%) | 29.2 | 33.0 | 38.5 | <0.001 |
Lifestyle characteristics | ||||
Mean energy intake (SD), MJ/day | 9.3 (3.1) | 9.7 (3.1) | 10.0 (3.1) | <0.001 |
Smoking: current smokers (%) | 33.7 | 30.0 | 27.2 | <0.001 |
Physical activity: low (%) | 49.8 | 48.8 | 48.4 | 0.188 |
Vitamin suppl. intake: regular (%) | 13.9 | 17.5 | 22.7 | <0.001 |
Mean healthy diet indicator (SD) | 50.9 (8.4) | 54.9 (8.6) | 57.4 (8.8) | <0.001 |
CVD risk factors | ||||
Mean BMI (SD), kg/m2
| 27.8 (4.8) | 27.8 (4.7) | 27.7 (4.6) | 0.260 |
BMI > 30 kg/m2 (%) | 28.9 | 28.2 | 27.1 | 0.042 |
Mean arterial pressure (SD), mmHg | 105.3 (15.6) | 104.8 (15.0) | 104.2 (15.5) | 0.001 |
Hypertensionc (%) | 46.6 | 47.1 | 45.1 | 0.148 |
Mean total cholesterol (SD), mmol/l | 6.0 (1.2) | 6.0 (1.2) | 5.9 (1.2) | <0.001 |
Hypercholesterolemiad (%) | 76.5 | 76.8 | 75.9 | 0.507 |
Mortality outcomes | ||||
All-cause, per 1000 person-years | 12.2 | 9.0 | 7.3 | <0.001 |
CVD, per 1000 person-years | 4.3 | 3.3 | 1.9 | <0.001 |
CHD, per 1000 person-years | 2.4 | 1.7 | 0.9 | <0.001 |
Stroke, per 1000 person-years | 1.2 | 0.8 | 0.4 | <0.001 |
Cox regression results
Cause of death | dead/n
| Model | MDS categoriesa
| PP (%)b
| Per 1SDc increase in MDS score | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Low | Moderate | High | Trend p value | |||||||||
HR | HR | (95 % CI) | HR | (95 % CI) | HR | (95 % CI) |
p value | |||||
Any-cause | 1314/19,333 | model1 | 1.0 | 0.79 | (0.70–0.90) | 0.72 | (0.62–0.85) | <0.001 | 11.2 | 0.87 | (0.82–0.92) | <0.001 |
model2 | 1.0 | 0.85 | (0.75–0.96) | 0.85 | (0.73–1.00) | 0.027 | 5.6 | 0.93 | (0.88–0.98) | 0.012 | ||
CVD | 438/19,263 | model1 | 1.0 | 0.87 | (0.70–1.07) | 0.64 | (0.48–0.86) | 0.003 | 14.3 | 0.83 | (0.75–0.92) | <0.001 |
model2 | 1.0 | 0.94 | (0.76–1.16) | 0.78 | (0.58–1.05) | 0.118 | 8.1 | 0.90 | (0.81–0.99) | 0.036 | ||
CHD | 226/19,263 | model1 | 1.0 | 0.88 | (0.66–1.17) | 0.64 | (0.42–0.96) | 0.038 | 14.3 | 0.82 | (0.71–0.94) | 0.004 |
model2 | 1.0 | 0.97 | (0.72–1.29) | 0.81 | (0.53–1.23) | 0.376 | 6.8 | 0.90 | (0.78–1.03) | 0.132 | ||
Stroke | 109/19,263 | model1 | 1.0 | 0.86 | (0.57–1.30) | 0.64 | (0.35–1.16) | 0.146 | 14.4 | 0.84 | (0.69–1.03) | 0.093 |
model2 | 1.0 | 0.88 | (0.58–1.34) | 0.71 | (0.39–1.30) | 0.273 | 11.2 | 0.87 | (0.71–1.07) | 0.201 |
Components | Mortality outcomes | |||||||
---|---|---|---|---|---|---|---|---|
All-cause | CVD | CHD | Stroke | |||||
HRa
| (95 % CI) | HRa
| (95 % CI) | HRa
| 95 % CI | HRa
| 95 % CI | |
Vegetables | 0.95 | (0.87–1.04) | 0.88 | (0.76–1.03) | 0.90 | (0.73–1.11) | 0.75 | (0.55–1.03) |
Fruits and nuts | 0.97 | (0.90–1.05) | 0.82 | (0.71–0.95) | 0.87 | (0.70–1.07) | 0.68 | (0.50–0.94) |
Legumes | 0.95 | (0.89–1.01) | 0.96 | (0.86–1.08) | 1.04 | (0.89–1.22) | 0.84 | (0.66–1.05) |
Cereals | 0.91 | (0.82–1.00) | 0.94 | (0.79–1.12) | 0.90 | (0.70–1.16) | 1.13 | (0.76–1.66) |
Fish | 0.95 | (0.88–1.03) | 0.96 | (0.83–1.10) | 0.87 | (0.72–1.05) | 1.12 | (0.85–1.49) |
Meat and meat products | 1.00 | (0.93–1.09) | 1.07 | (0.93–1.22) | 1.02 | (0.84–1.23) | 1.25 | (0.95–1.62) |
Dairy products | 0.98 | (0.92–1.05) | 0.97 | (0.86–1.09) | 0.98 | (0.83–1.16) | 0.92 | (0.73–1.16) |
Alcohol | 0.90 | (0.80–1.00) | 0.89 | (0.74–1.07) | 0.82 | (0.64–1.05) | 0.86 | (0.58–1.28) |
Olive oil usage | 1.11 | (0.92–1.34) | 1.07 | (0.73–1.55) | 1.23 | (0.71–2.16) | 1.58 | (0.72–3.50) |