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A simple food quality index predicts mortality in Elderly Taiwanese

  • JNHA: Nutrition
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older.

Design

Prospective cohort.

Setting

The Elderly Nutrition and Health Survey in Taiwan during 1999–2000.

Participants

One thousand seven hundred forty three (860 men and 883 women).

Measurements

Dietary quality measures, the ODI-R (0–100) and DDS (0–6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure.

Results

During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42–0.97), 0.71 (0.49–1.04) and 0.53 (0.37–0.76) for those whose ODI-R scores were 60–65, 65–70, >70, respectively, compared to those whose ODI-R scores were £ 50 (P for trend <0.001). For DDS, the multi-variable HRs (95% CI) were 0.74 (0.55–1.00), 0.52 (0.38–0.72) and 0.50 (0.31–0.81) for those whose DDS were 4, 5, 6, respectively, compared to those whose DDS were <3 (P for trend<0.001). Total cancer, diabetes mortalities and pneumonia were similarly benefited according to trends.

Conclusion

ODIR ≥ 60, and DDS ≥ 4 are predictors of all-cause and cause-specific mortalities. Of the two, DDS is the more predictive. Nutrition policy could be informed and clinical practice enhanced by these population relevant foodhealth relationships.

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References

  1. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, et al. Diet and overall survival in elderly people. BMJ 1995; 311:1489–1460

    Article  Google Scholar 

  2. Hodgson JM, Hsu-Hage BH-H, Wahlqvist ML. Food variety as a quantitative descriptor of food intake. Ecol Food Nutr 1994; 32:137–148.

    Article  Google Scholar 

  3. Kant AK. Indexes of overall diet quality: a review. J Am Diet Assoc 1996; 96:785–791.

    Article  PubMed  CAS  Google Scholar 

  4. Kant AK, Block G, Schatzkin A, et al. Dietary diversity in the US population, NHANES II, 1976–1980. J Am Diet Assoc 1991; 91:1526–1531.

    PubMed  CAS  Google Scholar 

  5. Wahlqvist ML, Lo CS, Myers KA. Food variety is associated with less macrovascular disease in those with type II diabetes and their healthy controls. J Am Coll Nutr 1989; 8:515–523.

    PubMed  CAS  Google Scholar 

  6. Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index revised: a measurement instrument for populations. J Am Diet Assoc 1999; 99:697–704.

    Article  PubMed  CAS  Google Scholar 

  7. Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: design and applications. J Am Diet Assoc 1995; 95:1103–1108.

    Article  PubMed  CAS  Google Scholar 

  8. Shannon J, Shikany JM, Barrett-Connor E, et al. Demographic factors associated with the diet quality of older US men: baseline data from the Osteoporotic Fractures in Men (MrOS) study. Public Health Nutr 2007; 10:810–818.

    Article  PubMed  CAS  Google Scholar 

  9. Fung TT, Stampfer MJ, Manson JE, et al. Prospective study of major dietary patterns and stroke risk in women. Stroke 2004; 35:2014–2019.

    Article  PubMed  Google Scholar 

  10. Iqbal R, Anand S, Ounpuu S, et al. Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation 2008, 118:1929–1937.

    Article  PubMed  CAS  Google Scholar 

  11. McNaughton SA, Dunstan DW, Ball K, et al. Dietary quality is associated with diabetes and cardio-metabolic risk factors. J Nutr 2009; 139:734–742.

    Article  PubMed  CAS  Google Scholar 

  12. Bamia C, Trichopoulos D, Ferrai P, et al. Dietary patterns and survival of elder Europeans: The EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr 2007; 10:590–598.

    Article  PubMed  Google Scholar 

  13. Cai H, Shu XO, Gao Y-T, et al. A prospective study of dietary patterns and mortality in Chinese women. Epidemiology 2007; 18:393–401.

    Article  PubMed  Google Scholar 

  14. Heidemann C, Schulze MB, Franco OH, et al. Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women. Circulation 2008; 118:230–237.

    Article  PubMed  Google Scholar 

  15. Kant AK, Schatzkin A, Harris TB, et al. Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiology Follow-up Study. Am J Clin Nutr 1993; 57:434–440.

    PubMed  CAS  Google Scholar 

  16. Kant AK, Leitzmann MF, Park Y, et al. Patterns of recommended dietary behaviors predict subsequent risk of mortality in a large cohort of men and women in the United States. J Nutr 2009; 139:1374–1380.

    Article  PubMed  CAS  Google Scholar 

  17. Hoddinott J, Yohannes Y. Dietary diversity as a food security indicator Washington, DC: Food consumption and Nutrition Division, International Food Policy Research Institute, 2002.

    Google Scholar 

  18. Ruel MT. Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr 2003; 133:3911S–3926S.

    PubMed  CAS  Google Scholar 

  19. Lee MS, Lai CJ, Yang FY, et al. A global overall dietary index: ODI-R revised to emphasize quality and over quantity. Asia Pac J Clin Nutr 2008; 17(S1):82–86.

    PubMed  Google Scholar 

  20. Pan WH, Lee MS, Chuang SY, et al. Obesity pandemic, correlated factors and guidelines to define, screen and manage obesity in Taiwan. Obes Rev 2008; 9: 22–31.

    Article  PubMed  Google Scholar 

  21. Savige GS, Hsu-Hage BH-H, Wahlqvist ML. Food variety as nutritional therapy. In: Current Therapeutics1997, p. 57–67.

  22. Pan WH, Hung YT, Shaw NS, et al. Elderly Nutrition and Health Survey in Taiwan (1999–2000): research design, methodology and content. Asia Pac J Clin Nutr 2005; 14:203–210.

    PubMed  Google Scholar 

  23. Lee MS, Huang YC, Wahlqvist ML. Chewing ability in conjunction with food intake and energy status in later life affects srvival in Taiwanese with the metabolic syndrome. J Am Geriatr Soc 2010; 58:1072–1080.

    Article  PubMed  Google Scholar 

  24. Pan WH, Chang YH, Chen JY, et al. Nutrition and health survey in Taiwan (NAHSIT) 1993–1996: dietary nutrient intakes assessed by 24-hour recall. Nutr Sci J 1999; 24:11–39. (in Chinese)

    CAS  Google Scholar 

  25. Pearce N, Foliaki S, Sporle A, Cunningham C. Genetics, race, ethnicity, and health. Br Med J 2004; 328:1070–1072.

    Article  Google Scholar 

  26. Knoops KTB, de Groot LCPGM, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly: European men and women. JAMA 2004; 292:1433–1439.

    Article  PubMed  Google Scholar 

  27. Clausen T, Charlton KE, Gobotswang KSM, Holmboe-Ottesen G. Predictors of food variety and dietary diversity among older persons in Botswana. Nutrition 2005; 21:86–95.

    Article  PubMed  Google Scholar 

  28. Oldewage-Theron WH, Kruger R. Impact of food aid on food variety and dietary diversity of an elderly community in Sharpeville, South Africa. J Nutr Health Aging 2009; 13:300–308.

    Article  PubMed  CAS  Google Scholar 

  29. Savy M, Martin-Prével Y, Traissac P, et al. Dietary diversity scores and nutritional status of women change during the seasonal food shortage in rural Burkina Faso. J Nutr 2006; 136:2625–2632.

    PubMed  CAS  Google Scholar 

  30. Bernstein MA, Tucker KL, Ryan ND, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc 2002; 102:1096–1104.

    PubMed  Google Scholar 

  31. Haveman-Nies A, de Groot LC, van Staveren WA. Dietary quality, lifestyle factors and healthy ageing in Europe: the SENECA study. Age Ageing 2003; 32:427–434.

    Article  PubMed  Google Scholar 

  32. Marlow HJ, Hayes WK, Soret S, et al. Diet and the environment: does what you eat matter? Am J Clin Nutr 2009; 89:1699S–1703S.

    Article  PubMed  CAS  Google Scholar 

  33. Darmadi-Blackberry I, Wahlqvist ML, Kouris-Blazos A, et al. Legumes: the most important dietary predictor of survival in older people of different ethnicities. Asia Pac J Clin Nutr 2004; 13:217–220.

    PubMed  Google Scholar 

  34. Nishio K, Niwa Y, Toyoshima H, et al. Consumption of soy foods and the risk of breast cancer: findings from the Japan Collaborative Cohort (JACC) Study. Cancer Causes Control 2007; 18:801–808.

    Article  PubMed  Google Scholar 

  35. Wu AH, Ziegler RG, Nomura AMY, et al. Soy intake and risk of breast cancer in Asians and Asian Americans. Am J Clin Nutr 1998; 68:1437S–1443S.

    PubMed  CAS  Google Scholar 

  36. World Cancer Research Fund / AmericanInstitute forCancer Research (WCRF/AICR): “Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective”. Washington DC: AICR, 2007.

    Google Scholar 

  37. Nettleton JA, Diez-Roux A, Jenny NS, et al. Dietary patterns, food groups, and telomere length in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 2008; 88:1408–1412.

    Google Scholar 

  38. Lo YT, Chang YH, Lee MS, Wahlqvist ML. Health and nutrition economics: diet costs are associated with diet quality? Asia Pac J Clin Nutr 2009; 18:598–604.

    PubMed  Google Scholar 

  39. Pelchat ML, Schaefer S. Dietary monotony and food cravings in young and elderly adults. Physiol Behav 2000; 68:353–359.

    Article  PubMed  CAS  Google Scholar 

  40. Roberts SB, Hajduk CL, Howarth NC, et al. Dietary variety predicts low body mass index and inadequate macronutrient and micronutrient intakes in communitydwelling older adults. J Gerontol A Biol Sci Med Sci 2005; 60:613–621.

    Article  PubMed  Google Scholar 

  41. Wahlqvist ML. Connected Community and Household Food Based Strategy (CCHFBS): its importance for health, food safety, sustainability and security in diverse localities. Ecol Food Nutr 2009; 48:457–481.

    Article  PubMed  Google Scholar 

  42. Wahlqvist ML, Kouris-Blazos A, Savige GS. Food security and the Aged. In: Not by Bread Alone, edited by Ogunrinade A, Oniang’o R, and May J. South Africa: Witwatersrand University Press, 1999, p. 206–221.

    Google Scholar 

  43. World Health Organization & Food and Agriculture Organization: “Preparation and use of food-based dietary guidelines. Report of a joint FAO/WHO consultation Nicosia, Cyprus”. Geneva: WHO, 1996.

    Google Scholar 

  44. Nagura J, Iso H, Watanabe Y, et al. Fruit, vegetable and bean intake and mortality from cardiovascular disease among Japanese men and women: the JACC Study. Br J Nutr 2009; 102:285–292.

    Article  PubMed  CAS  Google Scholar 

  45. Boffetta P, Couto E, Wichmann J, et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2010; 102:529–537.

    Article  PubMed  CAS  Google Scholar 

  46. Bailey RL, Mitchell DC, Miller CK, et al. A dietary screening questionnaire identifies dietary patterns in older adults. J Nutr 2007; 137;421–426.

    PubMed  CAS  Google Scholar 

  47. Chen J. Has the rapid dietary transition in China affected cancer risks in the population? Global Health & Environment Monitor. http://www.ceche.org/mol/inside.html. [1 May 2010].

  48. Ahn BC, Engelhard K, Joung H. Diet variety is associated with socio-economic factors. Ecol Food Nutr 2006; 45:417–430.

    Article  Google Scholar 

  49. Hirayama F, Lee AH, Binns CW. Dietary factors for chronic obstructive pulmonary disease: epidemiological evidence. Expert Rev Respir Med 2008; 2:645–653.

    Article  PubMed  Google Scholar 

  50. Drewnowski A, Henderson SA, Driscoll A, Rolls BJ. The Dietary Variety Score: assessing diet quality in healthy young and older adults. J Am Diet Assoc 1997; 97:266–271.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. School of Public Health, National Defense Medical Center, 161 Minchuan East Road, Sec. 6, Taipei, Taiwan, 114, ROC

    Meei-Shyuan Lee, H. -H. Su, M. -Z. Lee & Mark L. Wahlqvist

  2. Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, Taiwan, 350, ROC

    Meei-Shyuan Lee, Y. -C. Huang & Mark L. Wahlqvist

  3. Monash Asia Institute, Monash University, 5th Floor, H Building, 900 Dandenong Road, Caulfield East, Victoria, 3145, Australia

    Mark L. Wahlqvist

  4. Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, Taiwan, 350, ROC

    Mark L. Wahlqvist

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  1. Meei-Shyuan Lee
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  2. Y. -C. Huang
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Correspondence to Meei-Shyuan Lee or Mark L. Wahlqvist.

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Lee, MS., Huang, Y.C., Su, H.H. et al. A simple food quality index predicts mortality in Elderly Taiwanese. J Nutr Health Aging 15, 815–821 (2011). https://doi.org/10.1007/s12603-011-0081-x

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  • DOI: https://doi.org/10.1007/s12603-011-0081-x

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