TABLE 3.
Weighted and multivariable-adjusted HRs and bootstrapped 95% CIs of cardiovascular disease events (incidence and mortality) according to the midpoints of quintiles of usual intake of the DASH index, revised PDI, revised hPDI, revised uPDI, ERD score, and DGAI 2020 in Canadian adults (45–80 y), CCHS-Nutrition 2004 linked to Canadian Vital Statistics—Death Database and Discharge Abstract Database, 2004–20171
| Midpoint of quintile of estimated usual dietary score, HR (95% CI) | |||||
|---|---|---|---|---|---|
| Dietary indices | 1 | 2 | 3 | 4 | 5 |
| DASH index | |||||
| Median score2 | 37.62 | 41.80 | 44.93 | 47.95 | 52.44 |
| Median score3 | 37.21 | 41.74 | 45.04 | 48.17 | 52.46 |
| Base model4 | |||||
| Women | 1 (Reference) | 0.86 (0.74, 1.00) | 0.77 (0.59, 1.00) | 0.67 (0.47, 0.99) | 0.58 (0.34, 0.99) |
| Men | 1 (Reference) | 0.89 (0.75, 1.05) | 0.81 (0.60, 1.09) | 0.74 (0.48, 1.13) | 0.65 (0.36, 1.19) |
| Multivariable-adjusted model5 | |||||
| Women | 1 (Reference) | 0.91 (0.76, 1.08) | 0.85 (0.62, 1.15) | 0.79 (0.52, 1.21) | 0.72 (0.40, 1.31) |
| Men | 1 (Reference) | 0.87 (0.72, 1.06) | 0.79 (0.57, 1.10) | 0.72 (0.45, 1.14) | 0.63 (0.33, 1.21) |
| Revised PDI | |||||
| Median score2 | 34.77 | 37.15 | 38.99 | 40.75 | 43.26 |
| Median score3 | 34.13 | 37.07 | 38.99 | 40.94 | 43.53 |
| Base model4 | |||||
| Women | 1 (Reference) | 0.97 (0.84, 1.13) | 0.95 (0.73, 1.24) | 0.94 (0.65, 1.35) | 0.91 (0.54, 1.54) |
| Men | 1 (Reference) | 0.92 (0.79, 1.07) | 0.86 (0.66, 1.12) | 0.81 (0.55, 1.18) | 0.74 (0.43, 1.26) |
| Multivariable-adjusted model5 | |||||
| Women | 1 (Reference) | 1.04 (0.86, 1.27) | 1.07 (0.78, 1.48) | 1.10 (0.70, 1.73) | 1.14 (0.61, 2.13) |
| Men | 1 (Reference) | 0.91 (0.75, 1.12) | 0.86 (0.61, 1.21) | 0.81 (0.51, 1.30) | 0.75 (0.39, 1.44) |
| Revised hPDI | |||||
| Median score2 | 39.14 | 41.87 | 43.74 | 45.62 | 48.32 |
| Median score3 | 38.33 | 41.42 | 44.06 | 46.04 | 49.23 |
| Base model4 | |||||
| Women | 1 (Reference) | 0.91 (0.80, 1.04) | 0.86 (0.68, 1.07) | 0.80 (0.59, 1.10) | 0.73 (0.47, 1.14) |
| Men | 1 (Reference) | 0.92 (0.79, 1.07) | 0.87 (0.67, 1.12) | 0.82 (0.57, 1.17) | 0.75 (0.45, 1.25) |
| Multivariable-adjusted model5 | |||||
| Women | 1 (Reference) | 0.96 (0.83, 1.11) | 0.93 (0.71, 1.22) | 0.91 (0.63, 1.31) | 0.88 (0.52, 1.46) |
| Men | 1 (Reference) | 0.91 (0.77, 1.08) | 0.84 (0.62, 1.15) | 0.79 (0.52, 1.21) | 0.72 (0.40, 1.30) |
| Revised uPDI | |||||
| Median score2 | 34.68 | 37.37 | 39.25 | 41.13 | 43.87 |
| Median score3 | 33.78 | 36.97 | 38.95 | 41.57 | 44.66 |
| Base model4 | |||||
| Women | 1 (Reference) | 1.10 (0.96, 1.25) | 1.17 (0.94, 1.46) | 1.25 (0.91, 1.70) | 1.37 (0.88, 2.13) |
| Men | 1 (Reference) | 1.09 (0.94, 1.26) | 1.15 (0.89, 1.48) | 1.22 (0.85, 1.74) | 1.33 (0.80, 2.21) |
| Multivariable-adjusted model5 | |||||
| Women | 1 (Reference) | 1.04 (0.89, 1.21) | 1.07 (0.83, 1.36) | 1.10 (0.76, 1.59) | 1.14 (0.68, 1.91) |
| Men | 1 (Reference) | 1.10 (0.93, 1.31) | 1.17 (0.88, 1.55) | 1.27 (0.83, 1.94) | 1.39 (0.77, 2.52) |
| ERD score | |||||
| Median score2 | 7.10 | 7.34 | 7.53 | 7.71 | 7.94 |
| Median score3 | 7.01 | 7.28 | 7.50 | 7.73 | 8.13 |
| Base model4 | |||||
| Women | 1 (Reference) | 0.92 (0.80, 1.07) | 0.87 (0.67, 1.13) | 0.82 (0.56, 1.19) | 0.76 (0.46, 1.27) |
| Men | 1 (Reference) | 0.76 (0.61, 0.96) | 0.62 (0.42, 0.93) | 0.51 (0.29, 0.90) | 0.40 (0.18, 0.87) |
| Multivariable-adjusted model5 | |||||
| Women | 1 (Reference) | 0.91 (0.71, 1.17) | 0.84 (0.54, 1.32) | 0.78 (0.41, 1.50) | 0.68 (0.25, 1.89) |
| Men | 1 (Reference) | 0.76 (0.57, 1.01) | 0.61 (0.36, 1.01) | 0.48 (0.23, 1.02) | 0.32 (0.10, 1.03) |
| DGAI 2020 | |||||
| Median score2 | 6.84 | 7.54 | 8.03 | 8.47 | 9.17 |
| Median score3 | 6.77 | 7.55 | 8.06 | 8.55 | 9.20 |
| Base model4 | |||||
| Women | 1 (Reference) | 0.91 (0.77, 1.07) | 0.85 (0.64, 1.12) | 0.80 (0.55, 1.17) | 0.73 (0.42, 1.24) |
| Men | 1 (Reference) | 1.15 (0.96, 1.39) | 1.27 (0.93, 1.74) | 1.39 (0.90, 2.14) | 1.60 (0.87, 2.95) |
| Multivariable-adjusted model5 | |||||
| Women | 1 (Reference) | 1.03 (0.85, 1.25) | 1.05 (0.76, 1.44) | 1.07 (0.69, 1.64) | 1.09 (0.60, 1.97) |
| Men | 1 (Reference) | 1.13 (0.92, 1.38) | 1.21 (0.87, 1.70) | 1.31 (0.82, 2.08) | 1.44 (0.76, 2.72) |
n = 6771. Weighted HRs were calculated using regression calibration (Cox proportional hazards model) and the 95% CIs calculated by bootstrapping the usual intake estimating models B = 500 times at each step. All Cox models used sex interaction to test for effect modification by sex (P-interaction < 0.0001 for all). CCHS: Canadian Community Health Survey; DASH, Dietary Approaches to Stop Hypertension; DGAI, Dietary Guidelines for Americans Adherence Index; ERD, EAT– Lancet Reference Diet; hPDI, healthful Plant-based Diet Index; PDI, Plant-based Diet Index; uPDI, unhealthful Plant-based Diet Index.
Weighted and error-adjusted usual intake median of the diet quality index score; corresponds to base model (midpoint of quintiles).
Weighted and error-adjusted usual intake median of the diet quality index score; corresponds to multivariable-adjusted model (midpoint of quintiles).
Base model: adjusted for day of the week on which 24-h dietary recall was collected [weekday/weekend (Friday–Sunday)], sequence of dietary recall (first or second), and baseline age (continuous).
Multivariable-adjusted model: adjusted for base model covariates in addition to education (less than secondary school graduation; secondary school graduation; some postsecondary; postsecondary graduation), smoking (daily/occasional smoker with 20 ≤ cigarettes/d < 90; daily/occasional smoker with <20 cigarettes/d; former daily/occasional smoker and those who smoked a total of ≥100 cigarettes in lifetime; never smoked), misreporting (under-reporter; plausible reporter and over-reporter), physical activity (daily energy expenditure ≥3; 1.5 ≤ daily energy expenditure < 3; and 0 ≤ daily energy expenditure < 1.5), marital status (married/common-law partner; widowed/separated/divorced/single; never married), immigrant (yes/no), and alcohol consumption (none; less than once a month/once a month/2–3 times a month; once a week/2–3 times a week; 4–6 times a week/every day).