Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort

Ellen A. Struijk, Anne M. May, Nick L.W. Wezenbeek, Heidi P. Fransen, Sabita S. Soedamah-Muthu, Anouk Geelen, Jolanda M.A. Boer, Yvonne T. Van Der Schouw, H. Bas Bueno-De-Mesquita, Joline W.J. Beulens

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Background: Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke. Methods: A prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20-70 years recruited into the EPIC-NL study during 1993-1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk. Results: After an average follow-up of 12.2 years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk. Conclusion: The HDI and theDHD-indexwere not associated with CVD risk,while the DASH dietwas significantly associated with a lower risk of developing CVD, CHD and stroke.

Original languageEnglish
Pages (from-to)354-359
Number of pages6
JournalInternational journal of cardiology
Issue number2
Publication statusPublished - 1 Jan 2014


  • CVD
  • DASH diet
  • DHD-index
  • Dietary guidelines
  • HDI

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