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      Review of a priori dietary quality indices in relation to their construction criteria


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          A multitude of indices measure the healthiness of dietary patterns. Because validation results with respect to health outcomes do not sufficiently facilitate the choice of a specific dietary quality index, the decision of which index to use for a particular research objective should be based on other criteria. This review aims to provide guidance on which criteria to focus upon when choosing a dietary index for a specific research question. A review of 57 existing specifications of dietary quality indices was conducted, taking explicitly into account relevant construction criteria explicated in the Organisation for Economic Co-operation and Development handbook on constructing composite indicators. Index construction choices regarding the following criteria were extracted: theoretical framework, indicator selection, normalization and valuation functions, and aggregation methods. Preferable features of dietary indices are discussed, and a summarizing toolbox is provided to help identify indices with the most appropriate construction features for the respective study aim and target region and with regard to the available database. Directions for future efforts in the specification of new diet quality indices are given.

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          Diet and overall survival in elderly people.

          To assess the influence of a specific dietary pattern on overall survival. Cohort study. Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life. 182 elderly residents of the three villages. Overall mortality. Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%). A diet meeting currently understood health criteria does predict survival among people.
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            A prospective study of egg consumption and risk of cardiovascular disease in men and women.

            Frank Hu (1999)
            Reduction in egg consumption has been widely recommended to lower blood cholesterol levels and prevent coronary heart disease (CHD). Epidemiologic studies on egg consumption and risk of CHD are sparse. To examine the association between egg consumption and risk of CHD and stroke in men and women. Two prospective cohort studies, the Health Professionals Follow-up Study (1986-1994) and the Nurses' Health Study (1980-1994). A total of 37851 men aged 40 to 75 years at study outset and 80082 women aged 34 to 59 years at study outset, free of cardiovascular disease, diabetes, hypercholesterolemia, or cancer. Incident nonfatal myocardial infarction, fatal CHD, and stroke corresponding to daily egg consumption as determined by a food-frequency questionnaire. We documented 866 incident cases of CHD and 258 incident cases of stroke in men during 8 years of follow-up and 939 incident cases of CHD and 563 incident cases of stroke in women during 14 years of follow-up. After adjustment for age, smoking, and other potential CHD risk factors, we found no evidence of an overall significant association between egg consumption and risk of CHD or stroke in either men or women. The relative risks (RRs) of CHD across categories of intake were less than 1 per week (1.0), 1 per week (1.06), 2 to 4 per week (1.12), 5 to 6 per week (0.90), and > or =1 per day (1.08) (P for trend = .75) for men; and less than 1 per week (1.0), 1 per week (0.82), 2 to 4 per week (0.99), 5 to 6 per week (0.95), and > or =1 per day (0.82) (P for trend = .95) for women. In subgroup analyses, higher egg consumption appeared to be associated with increased risk of CHD only among diabetic subjects (RR of CHD comparing more than 1 egg per day with less than 1 egg per week among diabetic men, 2.02 [95% confidence interval, 1.05-3.87; P for trend = .04], and among diabetic women, 1.49 [0.88-2.52; P for trend = .008]). These findings suggest that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy men and women. The apparent increased risk of CHD associated with higher egg consumption among diabetic participants warrants further research.
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              A prospective study of diet quality and mortality in women.

              Most studies of diet and health care have focused on the role of single nutrients, foods, or food groups in disease prevention or promotion. Few studies have addressed the health effects of dietary patterns, which include complex mixtures of foods containing multiple nutrients and nonnutrients. To examine the association of mortality with a multifactorial diet quality index. Data from phase 2 (1987-1989) of a prospective cohort study of breast cancer screening, the Breast Cancer Detection Demonstration Project, with a median follow-up of 5.6 years. A total of 42,254 women (mean age, 61.1 years) who completed the food frequency questionnaire portion of the survey. All-cause mortality by quartile of Recommended Food Score (RFS; the sum of the number of foods recommended by current dietary guidelines [fruits, vegetables, whole grains, low-fat dairy, and lean meats and poultry] that were reported on the questionnaire to be consumed at least once a week, for a maximum score of 23). There were 2065 deaths due to all causes in the cohort. The RFS was inversely associated with all-cause mortality. Compared with those in the lowest quartile, subjects in the upper quartiles of the RFS had relative risks for all-cause mortality of 0.82 (95% confidence interval [CI], 0.73-0.92) for quartile 2, 0.71 (95% CI, 0.62-0.81) for quartile 3, and 0.69 (95% CI, 0.61-0.78) for quartile 4 adjusted for education, ethnicity, age, body mass index, smoking status, alcohol use, level of physical activity, menopausal hormone use, and history of disease (chi2 for trend = 35.64, P<.001 for trend). These data suggest that a dietary pattern characterized by consumption of foods recommended in current dietary guidelines is associated with decreased risk of mortality in women.

                Author and article information

                Nutr Rev
                Nutr. Rev
                Nutrition Reviews
                Oxford University Press
                October 2018
                24 July 2018
                24 July 2018
                : 76
                : 10
                : 747-764
                [1 ]Leibniz-Institute of Agricultural Development in Transition Economies, Halle, Germany
                [2 ]Martin Luther University Halle-Wittenberg, Halle, Germany
                [3 ]Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark
                [4 ]Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
                [5 ]Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena-Halle-Leipzig, Germany
                Author notes
                S. Brosig, Leibniz-Institute of Agricultural Development in Transition Economies, Theodor-Lieser-Strasse 2, 06112 Halle, Germany. E-mail: brosig@ 123456iamo.de .
                © The Author(s) 2018. Published by Oxford University Press on behalf of the International Life Sciences Institute.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com

                Page count
                Pages: 18
                Funded by: German Federal Ministry of Education and Research
                Funded by: Determinants of Diets and Physical Activity
                Funded by: Healthy Diet for a Healthy Life
                Special Articles

                Nutrition & Dietetics
                diet quality,dietary quality index,index specification
                Nutrition & Dietetics
                diet quality, dietary quality index, index specification


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