Xiong-Fei Pan1, Dianna J Magliano2, Miaobing Zheng3, Maria Shahid1, Fraser Taylor1, Chantal Julia4, Cliona Ni Mhurchu1, An Pan5, Jonathan E Shaw2, Bruce Neal1, Jason H Y Wu1. 1. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia. 2. Diabetes and Population Health Unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. 3. Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia. 4. Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, France. 5. Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Abstract
BACKGROUND: The Health Star Rating (HSR) is the government-endorsed front-of-pack labeling system in Australia and New Zealand. OBJECTIVES: We aimed to examine prospective associations of a dietary index (DI) based on the HSR, as an indicator of overall diet quality, with all-cause and cardiovascular disease (CVD) mortality. METHODS: We utilized data from the national population-based Australian Diabetes, Obesity and Lifestyle Study. The HSR-DI at baseline (1999-2000) was constructed by 1) calculation of the HSR points for individual foods in the baseline FFQ, and 2) calculation of the HSR-DI for each participant based on pooled HSR points across foods, weighted by the proportion of energy contributed by each food. Vital status was ascertained by linkage to the Australian National Death Index. Associations of HSR-DI with mortality risk were assessed by Cox proportional hazards regression. RESULTS: Among 10,025 eligible participants [baseline age: 51.6 ± 14.3 y (mean ± standard deviation)] at entry, higher HSR-DI (healthier) was associated with higher consumption of healthy foods such as fruits, vegetables, and nuts, and lower consumption of discretionary foods such as processed meats and confectionery (P-trend < 0.001 for each). During a median follow-up of 16.9 y, 1682 deaths occurred with 507 CVD deaths. In multivariable models adjusted for demographic characteristics, lifestyle factors, and medical conditions, higher HSR-DI was associated with lower risk of all-cause mortality, with a hazard ratio (95% confidence interval) of 0.80 (0.69, 0.94; P-trend < 0.001) comparing the fifth with the first HSR-DI quintile. A corresponding inverse association was observed for CVD mortality (0.71; 0.54, 0.94; P-trend = 0.008). CONCLUSIONS: Better diet quality as defined by the HSR-DI was associated with lower risk of all-cause and CVD mortality among Australian adults. Our findings support the use of the HSR nutrient profiling algorithm as a valid tool for guiding consumer food choices.
BACKGROUND: The Health Star Rating (HSR) is the government-endorsed front-of-pack labeling system in Australia and New Zealand. OBJECTIVES: We aimed to examine prospective associations of a dietary index (DI) based on the HSR, as an indicator of overall diet quality, with all-cause and cardiovascular disease (CVD) mortality. METHODS: We utilized data from the national population-based Australian Diabetes, Obesity and Lifestyle Study. The HSR-DI at baseline (1999-2000) was constructed by 1) calculation of the HSR points for individual foods in the baseline FFQ, and 2) calculation of the HSR-DI for each participant based on pooled HSR points across foods, weighted by the proportion of energy contributed by each food. Vital status was ascertained by linkage to the Australian National Death Index. Associations of HSR-DI with mortality risk were assessed by Cox proportional hazards regression. RESULTS: Among 10,025 eligible participants [baseline age: 51.6 ± 14.3 y (mean ± standard deviation)] at entry, higher HSR-DI (healthier) was associated with higher consumption of healthy foods such as fruits, vegetables, and nuts, and lower consumption of discretionary foods such as processed meats and confectionery (P-trend < 0.001 for each). During a median follow-up of 16.9 y, 1682 deaths occurred with 507 CVD deaths. In multivariable models adjusted for demographic characteristics, lifestyle factors, and medical conditions, higher HSR-DI was associated with lower risk of all-cause mortality, with a hazard ratio (95% confidence interval) of 0.80 (0.69, 0.94; P-trend < 0.001) comparing the fifth with the first HSR-DI quintile. A corresponding inverse association was observed for CVD mortality (0.71; 0.54, 0.94; P-trend = 0.008). CONCLUSIONS: Better diet quality as defined by the HSR-DI was associated with lower risk of all-cause and CVD mortality among Australian adults. Our findings support the use of the HSR nutrient profiling algorithm as a valid tool for guiding consumer food choices.
Authors: Elizabeth K Dunford; Jason H Y Wu; Lyndal Wellard-Cole; Wendy Watson; Michelle Crino; Kristina Petersen; Bruce Neal Journal: Appetite Date: 2017-06-08 Impact factor: 3.868
Authors: Jason H Y Wu; Matti Marklund; Fumiaki Imamura; Nathan Tintle; Andres V Ardisson Korat; Janette de Goede; Xia Zhou; Wei-Sin Yang; Marcia C de Oliveira Otto; Janine Kröger; Waqas Qureshi; Jyrki K Virtanen; Julie K Bassett; Alexis C Frazier-Wood; Maria Lankinen; Rachel A Murphy; Kalina Rajaobelina; Liana C Del Gobbo; Nita G Forouhi; Robert Luben; Kay-Tee Khaw; Nick Wareham; Anya Kalsbeek; Jenna Veenstra; Juhua Luo; Frank B Hu; Hung-Ju Lin; David S Siscovick; Heiner Boeing; Tzu-An Chen; Brian Steffen; Lyn M Steffen; Allison Hodge; Gudny Eriksdottir; Albert V Smith; Vilmunder Gudnason; Tamara B Harris; Ingeborg A Brouwer; Claudine Berr; Catherine Helmer; Cecilia Samieri; Markku Laakso; Michael Y Tsai; Graham G Giles; Tarja Nurmi; Lynne Wagenknecht; Matthias B Schulze; Rozenn N Lemaitre; Kuo-Liong Chien; Sabita S Soedamah-Muthu; Johanna M Geleijnse; Qi Sun; William S Harris; Lars Lind; Johan Ärnlöv; Ulf Riserus; Renata Micha; Dariush Mozaffarian Journal: Lancet Diabetes Endocrinol Date: 2017-10-12 Impact factor: 32.069
Authors: Oliver T Mytton; Nita G Forouhi; Peter Scarborough; Marleen Lentjes; Robert Luben; Mike Rayner; Kay Tee Khaw; Nicholas J Wareham; Pablo Monsivais Journal: PLoS Med Date: 2018-01-04 Impact factor: 11.069