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 references 37

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

Ahmedin Jemal, Lindsey A Torre, Rebecca Siegel … (2018)

This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.

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Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018

J Ferlay, M Colombet, I Soerjomataram … (2018)

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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Adjusting for multiple testing--when and how?

Ralf Bender, Stefan Lange (2001)

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:

ORCID: http://orcid.org/0000-0002-4482-148X

denes.stefler@ucl.ac.uk

Journal

Journal ID (nlm-ta): Eur J Nutr

Journal ID (iso-abbrev): Eur J Nutr

Title: European Journal of Nutrition

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1436-6207

ISSN (Electronic): 1436-6215

Publication date (Electronic): 1 July 2020

Publication date PMC-release: 1 July 2020

Publication date (Print): 2021

Volume: 60

Issue: 2

Pages: 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

Author information

Denes Stefler http://orcid.org/0000-0002-4482-148X

Article

Publisher ID: 2319

DOI: 10.1007/s00394-020-02319-9

PMC ID: 7900332

PubMed ID: 32613328

SO-VID: eda0aa66-233b-435a-97bc-7dd26a74d1e0

License:

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/.

History

Date received : 19 January 2020

Date accepted : 25 June 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;

Award ID: WT064947

Award ID: WT081081

Award Recipient : Martin Bobak

Funded by: National Institute of Aging (US)

Award ID: 1RO1AG23522

Award Recipient : Martin Bobak

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 : Martin Bobak

Funded by: Russian Scientific Foundation

Award ID: 14-45-00030

Award ID: 20-15-00371

Award Recipient : Sofia Malyutina

Funded by: Russian Academy of Science

Award ID: АААА-А17-117112850280-2

Award Recipient : Sofia Malyutina

Custom metadata

ScienceOpen disciplines: Nutrition & Dietetics

Keywords: eastern europe,dietary pattern,mortality,cardiovascular disease,cancer

Data availability:

ScienceOpen disciplines: Nutrition & Dietetics

Keywords: eastern europe, dietary pattern, mortality, cardiovascular disease, cancer

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

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Most cited references 37

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

Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018

Adjusting for multiple testing--when and how?

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