Can nutrient profiling help to identify foods which diet variety should be encouraged? Results from the Whitehall II cohort

Higher variety of recommended foods, identified arbitrarily based on dietary guidelines, has been associated with better health status. Nutrient profiling is designed to identify objectively, based on nutrient content, healthier foods whose consumption should be encouraged. The objective was to assess the prospective associations between total food variety (food variety score, FVS) and variety from selected recommended and non-recommended foods (RFV and NRFV, respectively) and risk of chronic disease and mortality. In 1991–3, 7251 participants of the Whitehall II study completed a 127-item FFQ. The FVS was defined as the number of foods consumed more than once a week. (N)RFV(Ofcom) and (N)RFV(SAIN,LIM) were similarly derived selecting healthier (or less healthier) foods as defined by the UK Ofcom and French SAIN,LIM nutrient profile models, respectively. Multi-adjusted Cox regressions were fitted with incident CHD, diabetes, CVD, cancer and all-cause mortality (318, 754, 137, 251 and 524 events, respectively – median follow-up time 17 years). RFV and NRFV scores were mutually adjusted. The FVS (fourthv.first quartile) was associated with a 39 and 26 % reduction of prospective CHD and all-cause mortality risk, respectively. The RFV(Ofcom) (thirdv.first quartile) was associated with a 27 and 35 % reduction of all-cause mortality and cancer mortality risk, respectively; similar associations were suggested, but not significant for the RFV(SAIN,LIM). No prospective associations were observed with NRFV scores. The results strengthen the rationale to promote total food variety and variety from healthy foods. Nutrient profiling can help in identifying those foods whose consumption should be encouraged.

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Food at checkouts in non-food stores: a cross-sectional study of a large indoor shopping mall

Public Health Nutrition ◽

10.1017/s1368980015000178 ◽

2015 ◽

Vol 18 (15) ◽

pp. 2786-2793 ◽

Cited By ~ 12

Author(s):

James Wright ◽

Erin Kamp ◽

Martin White ◽

Jean Adams ◽

Sarah Sowden

Keyword(s):

Nutrient Content ◽

Cross Sectional Study ◽

Shopping Mall ◽

Healthy Foods ◽

Cross Sectional Survey ◽

Price Promotions ◽

Cross Sectional ◽

Food Stores ◽

Child Height ◽

The Uk

AbstractObjectiveTo investigate the display of food at non-food store checkouts; and to classify foods by type and nutrient content, presence of price promotions and whether food was at child height.DesignCross-sectional survey of checkout displays at non-food stores. Foods were classified as ‘less healthy’ or healthier using the UK Food Standards Agency’s Nutrient Profile Model. Written price promotions were recorded. Child height was defined as the sight line of an 11-year-old approximated from UK growth charts.SettingA large indoor shopping mall, Gateshead, UK, February–March 2014.SubjectsTwo hundred and five out of 219 non-food stores in the shopping mall directory which were open for trading.ResultsThirty-two (15·6 %) of 205 non-food stores displayed food at the checkout. All displayed less healthy foods, and fourteen (43·8 %) had healthier foods. Overall, 5911 checkout foods were identified. Of these, 4763 (80·6 %) were ‘less healthy’. No fruits, vegetables, nuts or seeds were found. Of 4763 less healthy foods displayed, 195 (4·1 %) were subject to price promotions, compared with twelve of 1148 (1·0 %) healthier foods (χ2(df=1)=25·4, P<0·0001). There was no difference in the proportion of less healthy (95·1 %) and healthier (96·2 %) foods displayed at child height.ConclusionsAlmost one-sixth of non-food stores displayed checkout food, the majority of which was ‘less healthy’ and displayed at child height. Less healthy food was more likely to be subject to a written price promotion than healthier food. Further research into the drivers and consequences of checkout food in non-food stores is needed. Public health regulation may be warranted.

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Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition?

British Journal Of Nutrition ◽

10.1017/s0007114517001878 ◽

2017 ◽

Vol 118 (1) ◽

pp. 69-80 ◽

Cited By ~ 16

Author(s):

Sander Biesbroek ◽

W. M. Monique Verschuren ◽

Jolanda M. A. Boer ◽

Mirjam E. van de Kamp ◽

Yvonne T. van der Schouw ◽

...

Keyword(s):

Land Use ◽

Environmental Impact ◽

Mortality Risk ◽

Dairy Product ◽

Ghg Emissions ◽

Dietary Guidelines ◽

Healthy Diet ◽

Dash Score ◽

All Cause Mortality ◽

Prospective Investigation

AbstractGuidelines for a healthy diet aim to decrease the risk of chronic diseases. It is unclear as to what extent a healthy diet is also an environmentally friendly diet. In the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition, the diet was assessed with a 178-item FFQ of 40 011 participants aged 20–70 years between 1993 and 1997. The WHO’s Healthy Diet Indicator (HDI), the Dietary Approaches to Stop Hypertension (DASH) score and the Dutch Healthy Diet index 2015 (DHD15-index) were investigated in relation to greenhouse gas (GHG) emissions, land use and all-cause mortality risk. GHG emissions were associated with HDI scores (−3·7 % per sd increase (95 % CI −3·4, −4·0) for men and −1·9 % (95 % CI −0·4, −3·4) for women), with DASH scores in women only (1·1 % per sd increase, 95 % CI 0·9, 1·3) and with DHD15-index scores (−2·5 % per sd increase (95 % CI −2·2, −2·8) for men and −2·0 % (95 % CI −1·9, −2·2) for women). For all indices, higher scores were associated with less land use (ranging from −1·3 to −3·1 %). Mortality risk decreased with increasing scores for all indices. Per sd increase of the indices, hazard ratios for mortality ranged from 0·88 (95 % CI 0·82, 0·95) to 0·96 (95 % CI 0·92, 0·99). Our results showed that adhering to the WHO and Dutch dietary guidelines will lower the risk of all-cause mortality and moderately lower the environmental impact. The DASH diet was associated with lower mortality and land use, but because of high dairy product consumption in the Netherlands it was also associated with higher GHG emissions.

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Combined Utility of 25 Disease and Risk Factor Polygenic Risk Scores for Stratifying Risk of All-Cause Mortality

10.1101/2020.03.13.20035527 ◽

2020 ◽

Author(s):

Allison Meisner ◽

Prosenjit Kundu ◽

Yan Dora Zhang ◽

Lauren V. Lan ◽

Sungwon Kim ◽

...

Keyword(s):

Risk Factors ◽

Mortality Risk ◽

Association Studies ◽

Risk Scores ◽

Genome Wide Association Studies ◽

Polygenic Risk ◽

Hazard Ratios ◽

Risk Of Mortality ◽

All Cause Mortality ◽

The Uk

ABSTRACTWhile genome-wide association studies have identified susceptibility variants for numerous traits, their combined utility for predicting broad measures of health, such as mortality, remains poorly understood. We used data from the UK Biobank to combine polygenic risk scores (PRS) for 13 diseases and 12 mortality risk factors into sex-specific composite PRS (cPRS). These cPRS were moderately associated with all-cause mortality in independent data: the estimated hazard ratios per standard deviation were 1.10 (95% confidence interval: 1.05, 1.16) and 1.15 (1.10, 1.19) for women and men, respectively. Differences in life expectancy between the top and bottom 5% of the cPRS were estimated to be 4.79 (1.76, 7.81) years and 6.75 (4.16, 9.35) years for women and men, respectively. These associations were substantially attenuated after adjusting for non-genetic mortality risk factors measured at study entry. The cPRS may be useful in counseling younger individuals at higher genetic risk of mortality on modification of non-genetic factors.

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Are the Eatwell Guide and Nutrient Profiling Models Consistent in the UK?

Nutrients ◽

10.3390/nu13082732 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2732

Author(s):

Ana-Catarina Pinho-Gomes ◽

Asha Kaur ◽

Peter Scarborough ◽

Mike Rayner

Keyword(s):

Dietary Guidelines ◽

Dietary Advice ◽

Nutrition Surveys ◽

The Public ◽

Dietary Index ◽

Nutrient Profiling ◽

Food Policies ◽

The Uk ◽

Dietary Score ◽

Good Agreement

A nutrient profiling model (NPM) was developed in 2005 in the UK to regulate the marketing of foods to children. It was revised in 2018, but the new version has not been finalised. The Eatwell Guide (EWG) is the UK’s official food-based dietary guidelines. The aim of this study was to evaluate the agreement between the 2005 and 2018 versions of the NPM and the EWG. Using recent National Diet and Nutrition Surveys, we estimated the healthiness of individual diets based on an EWG dietary score and a NPM dietary index. We then compared the percentage of agreement and Cohen’s kappa for each combination of the EWG score and NPM index across the range of observed values for the 2005 and 2018 versions. A total of 3028 individual diets were assessed. Individuals with a higher (i.e., healthier) EWG score consumed a diet with, on average, a lower (i.e., healthier) NPM index both for the 2005 and 2018 versions. Overall, there was good agreement between the EWG score and the NPM dietary index at assessing the healthiness of representative diets of the UK population, when a low cut-off for the NPM dietary index was used, irrespective of the version. This suggests that dietary advice to the public is broadly aligned with NPM-based food policies and vice-versa.

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Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-sani Study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa299 ◽

2020 ◽

Author(s):

Marialaura Bonaccio ◽

Augusto Di Castelnuovo ◽

Simona Costanzo ◽

Amalia De Curtis ◽

Mariarosaria Persichillo ◽

...

Keyword(s):

Mortality Risk ◽

Adult Population ◽

Sugar Content ◽

Processed Food ◽

Biological Mechanisms ◽

Nutritional Factors ◽

Total Food ◽

Increased Risk ◽

All Cause Mortality ◽

Cvd Mortality

ABSTRACT Background Consumption of ultra-processed food (UPF) is gaining growing attention in relation to disease/mortality risk, but less is known on the main nutritional factors or biological mechanisms potentially underlying such associations. Objectives We aimed to assess the association between UPF and mortality risk in a large sample of the Italian adult population and test which nutritional factors were on the pathway of this relation. Established risk factors for cardiovascular disease (CVD) were analyzed as potential biological mechanisms linking UPF to mortality. Methods Longitudinal analysis was conducted on 22,475 men and women (mean ± SD age: 55 ± 12 y) recruited in the Moli-sani Study (2005–2010, Italy) and followed for 8.2 y. Food intake was assessed using a semiquantitative FFQ. UPF was defined using the NOVA classification according to degree of processing, and UPF intakes were categorized as quartiles of the ratio (%) of UPF (g/d) to total food consumed (g/d). Results Individuals reporting the highest intake of UPF (Q4, >14.6% of total food), as opposed to the lowest (Q1, UPF < 6.6%), experienced increased risks of CVD mortality (HR: 1.58; 95% CI: 1.23, 2.03), death from ischemic heart disease (IHD)/cerebrovascular disease (HR: 1.52; 95% CI: 1.10, 2.09), and all-cause mortality (HR: 1.26; 95% CI: 1.09, 1.46). High sugar content explained 36.3% of the relation of UPF with IHD/cerebrovascular mortality, whereas other nutritional factors (e.g., saturated fats) were unlikely to be on the pathway. Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality, and 12.0% for that of UPF with CVD mortality. Conclusions A high proportion of UPF in the diet was associated with increased risk of CVD and all-cause mortality, partly through its high dietary content of sugar. Some established biomarkers of CVD risk were likely to be on the pathway of such associations. These findings should serve as an incentive for limiting consumption of UPF, and encouraging natural or minimally processed foods, as several national nutritional policies recommend.

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Mortality risk in atrial fibrillation: the role of aspirin, vitamin K and non-vitamin K antagonists

International Journal of Clinical Pharmacy ◽

10.1007/s11096-019-00916-1 ◽

2019 ◽

Vol 41 (6) ◽

pp. 1536-1544

Author(s):

Emilie Gieling ◽

Frank de Vries ◽

Rachael Williams ◽

Hein A. W. van Onzenoort ◽

Anthonius de Boer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Mortality Risk ◽

Stroke Risk ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Vitamin K Antagonist ◽

Low Dose Aspirin ◽

All Cause Mortality ◽

The Uk

Abstract Background As an alternative to vitamin K antagonist and low-dose aspirin (< 325 mg), non-vitamin K oral anticoagulants are available for the prevention of stroke in patients with atrial fibrillation. However, the mortality risk associated with these drugs in daily practice remains unclear. Objective To evaluate the risk of all-cause mortality associated with non-Vitamin K antagonist oral anticoagulants, vitamin K antagonists or aspirin in patients with atrial fibrillation. Setting A cohort study conducted among atrial fibrillation patients using the UK Clinical Practice Research Datalink (March 2008–October 2014). Method New users of vitamin K antagonists, non vitamin K oral anticoagulants, low-dose aspirin, or combination therapy were followed from the date of first prescription to the date of death, as recorded in the UK datalink. Cox proportional hazard models estimated the hazard ratio (HR) of all-cause mortality for users of NOACs, aspirin, or combination use, as compared to vitamin K antagonist. Analyses were adjusted for confounders. Main outcome measure All-cause mortality. Results We identified 31,497 patients. Non vitamin K antocoagulant use (adjusted HR [aHR] = 1.42; 95% Confidence Interval [CI] 1.18–1.71) and aspirin use (aHR = 1.64; 95% CI 1.57–1.77) were both significantly associated with a higher mortality risk than use of vitamin K antagonists. The higher mortality risk for the non vitamin K anticoagulant use was observed in men (aHR = 1.72; 95% CI 1.25–2.36), but not in women (aHR = 1.28; 95% CI 0.92–1.79. Compared to vitamin K antagonists, mortality risk associated with the non vitamin K anticoagulants and aspirin use was significantly increased in patients with higher stroke risk (CHA2DS2-VASc > 2). Conclusion Non vitamin K oral anticoagulants are associated with a higher risk on all-cause mortality, particularly in men and in patients with higher stroke risk.

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Consumer perception of food variety in the UK: an exploratory mixed-methods analysis

BMC Public Health ◽

10.1186/s12889-020-09548-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rochelle Embling ◽

Aimee E. Pink ◽

Michelle D. Lee ◽

Menna Price ◽

Laura L. Wilkinson

Keyword(s):

Mixed Methods ◽

Food Intake ◽

Dietary Guidelines ◽

Obesogenic Environment ◽

Multiple Forms ◽

Mixed Methods Approach ◽

Online Study ◽

Increase Food Intake ◽

Food Variety ◽

The Uk

Abstract Background ‘Food variety’ is a key term that is frequently used in dietary guidelines around the world. Consuming a variety of foods – be it within a meal, across meals, or as part of the whole diet – is one factor that has been shown to increase food intake. However, little is known about consumer understanding of variety, and this may be a potential barrier to the success of dietary guidelines in today’s ‘obesogenic’ environment. This research sought to explore 1) consumer recognition of different forms of variety, and 2) consumer definitions of variety. Methods In an online study (N = 240), participants were asked to discuss a range of photographs depicting different forms of variety, and to directly define the term ‘food variety’. They were unaware of the research aim. Results Using a mixed methods approach, directed content analysis of these data showed that individuals referenced multiple forms of variety in the presence of food photographs. However, when asked to define variety, participants tended to only discuss variety in the context of the whole diet. Conclusions These findings emphasise a need to educate consumers about variety to encourage adherence to dietary guidelines and help consumers better manage their own food intake.

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486 Clinical composite endpoint classification of REVIVE II corresponds to all-cause mortality risk

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60295-1 ◽

2007 ◽

Vol 6 (1) ◽

pp. 106-107

Author(s):

J TEERLINK ◽

L DELGADOHERRERA ◽

R THAKKAR ◽

B HUANG ◽

R PADLEY

Keyword(s):

Mortality Risk ◽

Composite Endpoint ◽

All Cause Mortality

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699 Sleep Health Traits and COVID-19: Mortality Risk from the UK Biobank

SLEEP ◽

10.1093/sleep/zsab072.697 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A273-A273

Author(s):

Xi Zheng ◽

Ma Cherrysse Ulsa ◽

Peng Li ◽

Lei Gao ◽

Kun Hu

Keyword(s):

Risk Factors ◽

Sleep Apnea ◽

Sleep Duration ◽

Sex Education ◽

Mortality Risk ◽

Self Report ◽

Severe Illness ◽

Uk Biobank ◽

Sleep Health ◽

The Uk

Abstract Introduction While there is emerging evidence for acute sleep disruption in the aftermath of coronavirus disease 2019 (COVID-19), it is unknown whether sleep traits contribute to mortality risk. In this study, we tested whether earlier-life sleep duration, chronotype, insomnia, napping or sleep apnea were associated with increased 30-day COVID-19 mortality. Methods We included 34,711 participants from the UK Biobank, who presented for COVID-19 testing between March and October 2020 (mean age at diagnosis: 69.4±8.3; range 50.2–84.6). Self-reported sleep duration (less than 6h/6-9h/more than 9h), chronotype (“morning”/”intermediate”/”evening”), daytime dozing (often/rarely), insomnia (often/rarely), napping (often/rarely) and presence of sleep apnea (ICD-10 or self-report) were obtained between 2006 and 2010. Multivariate logistic regression models were used to adjust for age, sex, education, socioeconomic status, and relevant risk factors (BMI, hypertension, diabetes, respiratory diseases, smoking, and alcohol). Results The mean time between sleep measures and COVID-19 testing was 11.6±0.9 years. Overall, 5,066 (14.6%) were positive. In those who were positive, 355 (7.0%) died within 30 days (median = 8) after diagnosis. Long sleepers (>9h vs. 6-9h) [20/103 (19.4%) vs. 300/4,573 (6.6%); OR 2.09, 95% 1.19–3.64, p=0.009), often daytime dozers (OR 1.68, 95% 1.04–2.72, p=0.03), and nappers (OR 1.52, 95% 1.04–2.23, p=0.03) were at greater odds of mortality. Prior diagnosis of sleep apnea also saw a two-fold increased odds (OR 2.07, 95% CI: 1.25–3.44 p=0.005). No associations were seen for short sleepers, chronotype or insomnia with COVID-19 mortality. Conclusion Data across all current waves of infection show that prior sleep traits/disturbances, in particular long sleep duration, daytime dozing, napping and sleep apnea, are associated with increased 30-day mortality after COVID-19, independent of health-related risk factors. While sleep health traits may reflect unmeasured poor health, further work is warranted to examine the exact underlying mechanisms, and to test whether sleep health optimization offers resilience to severe illness from COVID-19. Support (if any) NIH [T32GM007592 and R03AG067985 to L.G. RF1AG059867, RF1AG064312, to K.H.], the BrightFocus Foundation A2020886S to P.L. and the Foundation of Anesthesia Education and Research MRTG-02-15-2020 to L.G.

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Advanced cardiometabolic & inflammatory markers for prediction of cardiovascular disease and cancer

European Heart Journal ◽

10.1093/ehjci/ehaa946.2921 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Radenkovic ◽

S.C Chawla ◽

G Botta ◽

A Boli ◽

M.B Banach ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Score ◽

Cancer Incidence ◽

Risk Function ◽

Patient Characteristics ◽

Risk Scores ◽

Uk Biobank ◽

Training Set ◽

All Cause Mortality ◽

The Uk

Abstract The two leading causes of mortality worldwide are cardiovascular disease (CVD) and cancer. The annual total cost of CVD and cancer is an estimated $844.4 billion in the US and is projected to double by 2030. Thus, there has been an increased shift to preventive medicine to improve health outcomes and development of risk scores, which allow early identification of individuals at risk to target personalised interventions and prevent disease. Our aim was to define a Risk Score R(x) which, given the baseline characteristics of a given individual, outputs the relative risk for composite CVD, cancer incidence and all-cause mortality. A non-linear model was used to calculate risk scores based on the participants of the UK Biobank (= 502548). The model used parameters including patient characteristics (age, sex, ethnicity), baseline conditions, lifestyle factors of diet and physical activity, blood pressure, metabolic markers and advanced lipid variables, including ApoA and ApoB and lipoprotein(a), as input. The risk score was defined by normalising the risk function by a fixed value, the average risk of the training set. To fit the non-linear model >400,000 participants were used as training set and >45,000 participants were used as test set for validation. The exponent of risk function was represented as a multilayer neural network. This allowed capturing interdependent behaviour of covariates, training a single model for all outcomes, and preserving heterogeneity of the groups, which is in contrast to CoxPH models which are traditionally used in risk scores and require homogeneous groups. The model was trained over 60 epochs and predictive performance was determined by the C-index with standard errors and confidence intervals estimated with bootstrap sampling. By inputing the variables described, one can obtain personalised hazard ratios for 3 major outcomes of CVD, cancer and all-cause mortality. Therefore, an individual with a risk Score of e.g. 1.5, at any time he/she has 50% more chances than average of experiencing the corresponding event. The proposed model showed the following discrimination, for risk of CVD (C-index = 0.8006), cancer incidence (C-index = 0.6907), and all-cause mortality (C-index = 0.7770) on the validation set. The CVD model is particularly strong (C-index >0.8) and is an improvement on a previous CVD risk prediction model also based on classical risk factors with total cholesterol and HDL-c on the UK Biobank data (C-index = 0.7444) published last year (Welsh et al. 2019). Unlike classically-used CoxPH models, our model considers correlation of variables as shown by the table of the values of correlation in Figure 1. This is an accurate model that is based on the most comprehensive set of patient characteristics and biomarkers, allowing clinicians to identify multiple targets for improvement and practice active preventive cardiology in the era of precision medicine. Figure 1. Correlation of variables in the R(x) Funding Acknowledgement Type of funding source: None

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