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      Traditional Eastern European diet and mortality: prospective evidence from the HAPIEE study

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          Abstract

          Purpose

          Cardiovascular disease (CVD) and cancer mortality rates in Eastern Europe are among the highest in the world. Although diet is an important risk factor, traditional eating habits in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European cohorts.

          Methods

          Data from the Health, Alcohol and Psychosocial factors in Eastern Europe prospective cohort were used, including participants from Russia, Poland and the Czech Republic. Based on food frequency questionnaire data, we constructed an Eastern European diet score (EEDS) from nine food groups which can be considered as traditional in this region. The relationship between categorical (low, moderate, high) and continuous (range 0–18) EEDS and mortality was estimated with Cox-regression.

          Results

          From 18,852 eligible participants, 2234 died during follow-up. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.23; 95% CI 1.08–1.42) and CVD (1.34; 1.08–1.66) deaths compared to those with low adherence. The association with cancer mortality was only significant in Poland (high vs. low EEDS: 1.41; 1.00–1.98). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while preserved fruit and vegetable consumption showed consistent inverse associations.

          Conclusion

          Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential.

          Electronic supplementary material

          The online version of this article (10.1007/s00394-020-02319-9) contains supplementary material, which is available to authorized users.

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          Most cited references35

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          Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

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            Europe contains 9% of the world population but has a 25% share of the global cancer burden. Up-to-date cancer statistics in Europe are key to cancer planning. Cancer incidence and mortality estimates for 25 major cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for Europe and the European Union (EU-28) for 2018.
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              Multiplicity of data, hypotheses, and analyses is a common problem in biomedical and epidemiological research. Multiple testing theory provides a framework for defining and controlling appropriate error rates in order to protect against wrong conclusions. However, the corresponding multiple test procedures are underutilized in biomedical and epidemiological research. In this article, the existing multiple test procedures are summarized for the most important multiplicity situations. It is emphasized that adjustments for multiple testing are required in confirmatory studies whenever results from multiple tests have to be combined in one final conclusion and decision. In case of multiple significance tests a note on the error rate that will be controlled for is desirable.
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                Author and article information

                Contributors
                denes.stefler@ucl.ac.uk
                Journal
                Eur J Nutr
                Eur J Nutr
                European Journal of Nutrition
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1436-6207
                1436-6215
                1 July 2020
                1 July 2020
                2021
                : 60
                : 2
                : 1091-1100
                Affiliations
                [1 ]GRID grid.83440.3b, ISNI 0000000121901201, Department of Epidemiology and Public Health, , University College London, ; 1-19 Torrington Place, London, WC1E 7HB UK
                [2 ]GRID grid.83440.3b, ISNI 0000000121901201, School of Slavonic and East European Studies, , University College London, ; London, UK
                [3 ]Department of Nutritional Epidemiology, National Institute of Pharmacy and Nutrition, Budapest, Hungary
                [4 ]GRID grid.5522.0, ISNI 0000 0001 2162 9631, Institute of Sociology, , Jagiellonian University, ; Krakow, Poland
                [5 ]GRID grid.17041.33, ISNI 0000 0004 0387 4723, Department of History, , South-West University, ; Blagoevgrad, Bulgaria
                [6 ]GRID grid.481823.4, Institute of Ethnology, , MTA Research Centre for the Humanities, ; Budapest, Hungary
                [7 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Department of Liberal Arts and Natural Sciences, , University of Birmingham, ; Birmingham, UK
                [8 ]GRID grid.415877.8, ISNI 0000 0001 2254 1834, Research Institute of Internal and Preventive Medicine, Branch of the Institute of Cytology and Genetics, , Siberian Branch of Russian Academy of Sciences, ; Novosibirsk, Russia
                [9 ]GRID grid.445341.3, ISNI 0000 0004 0467 3915, Novosibirsk State Medical University, ; Novosibirsk, Russia
                [10 ]GRID grid.425485.a, ISNI 0000 0001 2184 1595, National Institute of Public Health, ; Prague, Czech Republic
                [11 ]GRID grid.5522.0, ISNI 0000 0001 2162 9631, Department of Epidemiology and Population Studies, , Jagiellonian University Collegium Medicum, ; Krakow, Poland
                Article
                2319
                10.1007/s00394-020-02319-9
                7900332
                32613328
                eda0aa66-233b-435a-97bc-7dd26a74d1e0
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: WT064947
                Award ID: WT081081
                Award Recipient :
                Funded by: National Institute of Aging (US)
                Award ID: 1RO1AG23522
                Award Recipient :
                Funded by: MacArthur Foundation Initiative on Social Upheaval and Health
                Funded by: UCL Grand Challenges Small Grant
                Funded by: Horizon 2020 Research and Innovation Programme
                Award ID: 635316
                Award Recipient :
                Funded by: Russian Scientific Foundation
                Award ID: 14-45-00030
                Award ID: 20-15-00371
                Award Recipient :
                Funded by: Russian Academy of Science
                Award ID: АААА-А17-117112850280-2
                Award Recipient :
                Categories
                Original Contribution
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                Nutrition & Dietetics
                eastern europe,dietary pattern,mortality,cardiovascular disease,cancer
                Nutrition & Dietetics
                eastern europe, dietary pattern, mortality, cardiovascular disease, cancer

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