Table 4. Multivariate hazard ratios (Model 2)a for 10-year mortality risk by quartile of diet quality and for a 1SD increase of score among 451,256 participants of the EPIC study.
| HR | HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | P trendc | |
|---|---|---|---|---|---|---|
| All-cause mortality | Q1 | Q2 | Q3 | Q4 | Continuousb | |
| MDS | 1 (ref) | 0.90 (0.86–0.94) | 0.84 (0.81–0.88) | 0.79 (0.76–0.83) | 0.91 (0.90–0.93) | <0.0001 |
| rMED | 1 (ref) | 0.87 (0.83–0.91) | 0.81 (0.77–0.84) | 0.77 (0.73–0.81) | 0.89 (0.88–0.91) | <0.0001 |
| MSDPS | 1 (ref) | 0.92 (0.89–0.96) | 0.88 (0.84–0.92) | 0.80 (0.76–0.84) | 0.92 (0.90–0.93) | <0.0001 |
| DQI-I | 1 (ref) | 0.89 (0.85–0.93) | 0.81 (0.77–0.85) | 0.75 (0.72–0.79) | 0.90 (0.88–0.91) | <0.0001 |
| HNFI | 1 (ref) | 0.94 (0.90–0.98) | 0.87 (0.83–0.91) | 0.83 (0.79–0.87) | 0.93 (0.92–0.95) | <0.0001 |
| HEI 2010 | 1 (ref) | 0.89 (0.85–0.93) | 0.84 (0.80–0.88) | 0.82 (0.78–0.86) | 0.91 (0.90–0.93) | 0.0004 |
| WHO HDI | 1 (ref) | 0.93 (0.89–0.98) | 0.88 (0.84–0.92) | 0.88 (0.84–0.92) | 0.95 (0.94–0.97) | 0.01 |
| DASH | 1 (ref) | 0.90 (0.87–0.94) | 0.85 (0.81–0.89) | 0.82 (0.78–0.86) | 0.92 (0.90–0.93) | <0.0001 |
| HLI–diet | 1 (ref) | 0.91 (0.88–0.96) | 0.86 (0.83–0.90) | 0.83 (0.79–0.87) | 0.93 (0.92–0.95) | <0.0001 |
| HLI—totald | 1 (ref) | 0.75 (0.72–0.79) | 0.65 (0.62–0.68) | 0.55 (0.53–0.58) | 0.79 (0.78–0.80) | <0.0001 |
| WCRFe | 1 (ref) | 0.87 (0.83–0.91) | 0.78 (0.74–0.81) | 0.70 (0.67–0.74) | 0.86 (0.85–0.88) | <0.0001 |
| CVD mortality | ||||||
| MDS | 1 (ref) | 0.81 (0.74–0.88) | 0.80 (0.73–0.87) | 0.80 (0.73–0.88) | 0.91 (0.88–0.94) | 0.79 |
| rMED | 1 (ref) | 0.88 (0.81–0.96) | 0.80 (0.73–0.88) | 0.77 (0.71–0.85) | 0.89 (0.86–0.92) | 0.01 |
| MSDPS | 1 (ref) | 0.93 (0.85–1.01) | 0.90 (0.83–0.99) | 0.81 (0.74–0.89) | 0.92 (0.89–0.95) | 0.004 |
| DQI-I | 1 (ref) | 0.91 (0.83–0.99) | 0.80 (0.73–0.88) | 0.76 (0.69–0.83) | 0.90 (0.87–0.93) | 0.0002 |
| HNFI | 1 (ref) | 0.91 (0.83–1.00) | 0.88 (0.81–0.97) | 0.82 (0.74–0.90) | 0.93 (0.90–0.96) | 0.03 |
| HEI 2010 | 1 (ref) | 0.89 (0.82–0.97) | 0.85 (0.78–0.93) | 0.82 (0.75–0.90) | 0.93 (0.90–0.96) | 0.10 |
| WHO HDI | 1 (ref) | 0.95 (0.87–1.04) | 0.88 (0.80–0.96) | 0.84 (0.76–0.92) | 0.93 (0.90–0.96) | 0.01 |
| DASH | 1 (ref) | 0.86 (0.79–0.94) | 0.81 (0.74–0.88) | 0.77 (0.70–0.84) | 0.90 (0.87–0.93) | 0.02 |
| HLI–diet | 1 (ref) | 0.93 (0.85–1.01) | 0.85 (0.77–0.93) | 0.78 (0.71–0.86) | 0.91 (0.88–0.94) | 0.0003 |
| HLI—totald | 1 (ref) | 0.72 (0.66–0.79) | 0.59 (0.54–0.65) | 0.47 (0.42–0.52) | 0.74 (0.72–0.77) | <0.0001 |
| WCRFe | 1 (ref) | 0.81 (0.74–0.88) | 0.76 (0.69–0.84) | 0.63 (0.57–0.70) | 0.83 (0.81–0.86) | <0.0001 |
| Cancer mortality | ||||||
| MDS | 1 (ref) | 0.95 (0.89–1.01) | 0.91 (0.85–0.96) | 0.82 (0.77–0.88) | 0.93 (0.91–0.95) | <0.0001 |
| rMED | 1 (ref) | 0.92 (0.86–0.97) | 0.86 (0.81–0.92) | 0.82 (0.77–0.88) | 0.92 (0.90–0.94) | 0.001 |
| MSDPS | 1 (ref) | 0.96 (0.91–1.02) | 0.93 (0.87–0.99) | 0.84 (0.79–0.90) | 0.94 (0.92–0.96) | <0.0001 |
| DQI-I | 1 (ref) | 0.88 (0.83–0.94) | 0.83 (0.78–0.88) | 0.78 (0.73–0.83) | 0.91 (0.89–0.93) | 0.0003 |
| HNFI | 1 (ref) | 0.98 (0.92–1.05) | 0.92 (0.86–0.98) | 0.86 (0.80–0.92) | 0.95 (0.92–0.97) | <0.0001 |
| HEI 2010 | 1 (ref) | 0.94 (0.88–1.00) | 0.86 (0.81–0.92) | 0.87 (0.81–0.92) | 0.93 (0.90–0.95) | 0.02 |
| WHO HDI | 1 (ref) | 0.95 (0.89–1.02) | 0.90 (0.84–0.96) | 0.91 (0.85–0.97) | 0.97 (0.94–0.99) | 0.16 |
| DASH | 1 (ref) | 0.94 (0.89–1.01) | 0.94 (0.88–1.00) | 0.87 (0.81–0.93) | 0.94 (0.92–0.96) | 0.01 |
| HLI–diet | 1 (ref) | 0.91 (0.85–0.97) | 0.88 (0.83–0.94) | 0.86 (0.81–0.92) | 0.94 (0.92–0.97) | 0.10 |
| HLI—totald | 1 (ref) | 0.75 (0.70–0.80) | 0.67 (0.63–0.72) | 0.57 (0.53–0.61) | 0.80 (0.78–0.82) | <0.0001 |
| WCRFe | 1 (ref) | 0.88 (0.82–0.94) | 0.81 (0.76–0.87) | 0.77 (0.72–0.83) | 0.90 (0.88–0.92) | 0.0003 |
Abbreviations: MDS, Mediterranean Diet Scale; rMED, relative Mediterranean diet score; MSDPS, Mediterranean Style Dietary Pattern Score; DQI-I, Diet Quality Index–International; HNFI, Healthy Nordic Food Index; HEI-2010, Healthy Eating Index 2010; WHO HDI, World Health Organization Healthy Diet Index; DASH, Dietary Approaches to Stop Hypertension; HLI, Healthy Lifestyle Index; HLI-diet, diet component of the HLI; WCRF, World Cancer Research Fund / American Institute for Cancer Research; Q, quartile of diet quality score
a Model including the following predictors: dietary score and age at baseline, BMI (continuous), Physical activity (Cambridge index), smoking status (3 categories) and educational level, unless otherwise stated. Stratified by sex and study center.
b HR for the increase of 1 SD of score
c p-value for linear trend across quartiles
d Model only including HLI, age and educational level because BMI, physical activity, smoking are components of the Healthy Lifestyle Index, n = 376,553
e Model only including WCRF score, age, smoking and educational level as BMI and physical activity are components of the WCRF score, n = 363,207