Table 2.
Associations between fifths of Food Standards Agency nutrient profiling system (FSAm-NPS) dietary index score and all cause and cause specific mortality, from multivariable Cox proportional hazards regression models, in participants of European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, 1992-2015. Values are hazard ratios (95% confidence intervals) unless stated otherwise
| Mortality | Continuous (per 1 SD increment) | P value | Fifths* | P for non-trend | |||||
|---|---|---|---|---|---|---|---|---|---|
| First (highest nutritional quality) | Second | Third | Fourth | Fifth (lowest nutritional quality) | P for trend | ||||
| All causes | |||||||||
| No/person years | 54 951/8 162 730 | 10 887/1 605 206 | 9934/1 585 846 | 10 275/1 626 056 | 11 098/1 662 098 | 12 757/1 683 523 | |||
| Sex adjusted model† | 1.04 (1.03 to 1.05) | <0.001 | 0.97 (0.94 to 1.00) | 0.98 (0.95 to 1.01) | 1.01 (0.98 to 1.04) | 1.10 (1.07 to 1.14) | <0.001 | <0.001 | |
| Main model‡ | 1.02 (1.01 to 1.03) | <0.001 | 1.00 (ref) | 0.98 (0.96 to 1.01) | 0.99 (0.96 to 1.02) | 1.01 (0.98 to 1.04) | 1.06 (1.03 to 1.09) | <0.001 | <0.001 |
| Cause specific | |||||||||
| Non-external: | |||||||||
| No/person years | 53 112/8 162 730 | 10 515/1 605 206 | 9605/1 585 846 | 9922/1 626 056 | 10 728/1 662 098 | 12 342/1 683 523 | |||
| Sex adjusted model | 1.04 (1.03 to 1.05) | <0.001 | 1.00 (ref) | 0.97 (0.94 to 1.00) | 0.98 (0.95 to 1.01) | 1.01 (0.98 to 1.04) | 1.10 (1.07 to 1.14) | <0.001 | <0.001 |
| Main model | 1.03 (1.02 to 1.04) | <0.001 | 1.00 (ref) | 0.99 (0.96 to 1.02) | 0.99 (0.96 to 1.02) | 1.01 (0.98 to 1.04) | 1.07 (1.03 to 1.1) | <0.001 | <0.001 |
| External: | |||||||||
| No/person years | 1839/7 783 132 | 372/1 568 430 | 329/1 538 426 | 353/1 556 361 | 370/1 562 787 | 415/1 557 129 | |||
| Sex adjusted model | 1.03 (0.98 to 1.09) | 0.23 | 0.95 (0.81 to 1.10) | 1.00 (0.86 to 1.17) | 1.00 (0.86 to 1.17) | 1.08 (0.92 to 1.27) | 0.21 | 0.54 | |
| Main model | 1.00 (0.95 to 1.05) | 0.93 | 1.00 (ref) | 0.94 (0.81 to 1.1) | 0.98 (0.84 to 1.15) | 0.96 (0.82 to 1.13) | 0.99 (0.84 to 1.16) | 0.98 | 0.93 |
| Cancer: | |||||||||
| No/person years | 23 143/7 783 132 | 4550/1 568 430 | 4288/1 538 426 | 4482/1 556 361 | 4700/1 562 787 | 5123/1 557 129 | |||
| Sex adjusted model | 1.06 (1.04 to 1.07) | <0.001 | 1.00 (ref) | 1.00 (0.96 to 1.04) | 1.04 (0.99 to 1.08) | 1.07 (1.03 to 1.12) | 1.16 (1.11 to 1.21) | <0.001 | <0.001 |
| Main model | 1.03 (1.01 to 1.04) | <0.001 | 1.00 (ref) | 0.99 (0.95 to 1.04) | 1.02 (0.98 to 1.07) | 1.03 (0.99 to 1.08) | 1.08 (1.03 to 1.13) | <0.001 | 0.003 |
| Circulatory diseases: | |||||||||
| No/person years | 13 246/7 783 132 | 2973/1 568 430 | 2432/1 538 426 | 2377/1 556 361 | 2526/1 562 787 | 2938/1 557 129 | |||
| Sex adjusted model | 1.02 (1.00 to 1.04) | 0.04 | 1.00 (ref) | 0.91 (0.86 to 0.96) | 0.92 (0.87 to 0.97) | 0.95 (0.90 to 1.01) | 1.03 (0.97 to 1.09) | 0.11 | <0.001 |
| Main model | 1.02 (1.00 to 1.04) | 0.03 | 1.00 (ref) | 0.96 (0.91 to 1.01) | 0.96 (0.91 to 1.02) | 1.00 (0.94 to 1.06) | 1.04 (0.98 to 1.11) | 0.06 | 0.02 |
| Respiratory diseases: | |||||||||
| No/person years | 2857/7 783 132 | 508/1 568 430 | 501/1 538 426 | 507/1 556 361 | 591/1 562 787 | 750/1 557 129 | |||
| Sex adjusted model | 1.16 (1.12 to 1.21) | <0.001 | 1.00 (ref) | 1.12 (0.98 to 1.27) | 1.15 (1.01 to 1.31) | 1.30 (1.14 to 1.47) | 1.56 (1.37 to 1.76) | <0.001 | <0.001 |
| Main model | 1.11 (1.06 to 1.15) | <0.001 | 1.00 (ref) | 1.15 (1.01 to 1.31) | 1.16 (1.01 to 1.32) | 1.27 (1.11 to 1.45) | 1.39 (1.22 to 1.59) | <0.001 | <0.001 |
| Digestive diseases: | |||||||||
| No/person years | 1561/7 783 132 | 294/1 568 430 | 286/1 538 426 | 282/1 556 361 | 326/1 562 787 | 373/1 557 129 | |||
| Sex adjusted model | 1.09 (1.03 to 1.15) | 0.002 | 1.00 (ref) | 1.06 (0.89 to 1.25) | 1.03 (0.87 to 1.22) | 1.15 (0.97 to 1.36) | 1.25 (1.06 to 1.48) | 0.005 | 0.05 |
| Main model | 1.08 (1.02 to 1.14) | 0.01 | 1.00 (ref) | 1.08 (0.91 to 1.28) | 1.05 (0.88 to 1.25) | 1.15 (0.97 to 1.37) | 1.22 (1.02 to 1.45) | 0.03 | 0.19 |
Cut-offs for sex specific fifths of the FSAm-NPS dietary index were 4.14, 5.35, 6.43, and 7.68 for women and 4.32, 5.55, 6.63, and 7.88 for men. A higher score indicates a lower nutritional quality of foods consumed.
Sex adjusted model was stratified for age (one year interval) and study centre and adjusted for age (time scale) and sex.
The main model was stratified for age (one year interval) and study centre and adjusted for age (time scale) sex, body mass index, height, educational level (longer education, including university degree, technical or professional school, secondary school, primary school, missing), combined total physical activity (sex specific categories: active, moderately active, moderately inactive, inactive, missing), smoking status and intensity of smoking (current, 1-15 cigarettes daily; 16-25 cigarettes daily; ≥26 cigarettes daily; pipe, cigar, occasional; current or former, missing; former, quit 11-19 years, quit ≥20 years, quit ≤10 years; non-smoker; missing), baseline alcohol intake, baseline energy intake, and history of cancer (yes, no), cardiovascular diseases (yes, no, missing) and diabetes (yes, no, missing).