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Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries

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Abstract
Our aim was to estimate and rank 12 food groups according to disability-adjusted life years (DALYs) from coronary heart disease (CHD), stroke, type 2 diabetes (T2D), and colorectal cancer (CRC) in 16 European countries. De novo published non-linear dose–response meta-analyses of prospective studies (based on 297 primary reports), and food consumption data from the European Food Safety Authority Comprehensive European Food Consumption Database in Exposure Assessment, and DALY estimates from the Institute for Health Metrics and Evaluation were used. By implementing disease-specific counterfactual scenarios of theoretical minimum risk exposure level (TMRELs), the proportion of DALYs attributed to 12 food groups was estimated. In addition, a novel modelling approach was developed to obtain a single (optimized) TMREL across diseases. Four scenarios were analysed (A: disease-specific TMRELs/all food-disease associations; B: disease-specific TMRELs/only significant food-disease associations; C: single TMREL/all food-disease associations; D: single TMREL/only significant food-disease associations). Suboptimal food intake was associated with the following proportions of DALYs; Scenario A (highest-estimate) and D (lowest-estimate): CHD (A: 67%, D: 52%), stroke (A: 49%, D: 30%), T2D (A: 57%, D: 51%), and CRC (A: 54%, D: 40%). Whole grains (10%) had the highest impact on DALYs, followed by nuts (7.1%), processed meat (6.4%), fruit (4.4%) and fish and legumes (4.2%) when combining all scenarios. The contribution to total DALYs of all food groups combined in the different scenarios ranged from 41–52% in Austria to 51–69% in the Czech-Republic. These findings could have important implications for planning future food-based dietary guidelines as a public health nutrition strategy.
Keywords
Disability-adjusted life years, Food groups, Comparative risk assessment, Population health-impact, Type 2 diabetes, Coronary heart disease, Stroke, Colorectal cancer, DOSE-RESPONSE METAANALYSIS, RISK, BURDEN, HYPERTENSION, MORTALITY, DEATH

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MLA
Schwingshackl, Lukas et al. “Intake of 12 Food Groups and Disability-adjusted Life Years from Coronary Heart Disease, Stroke, Type 2 Diabetes, and Colorectal Cancer in 16 European Countries.” EUROPEAN JOURNAL OF EPIDEMIOLOGY 34.8 (2019): 765–775. Print.
APA
Schwingshackl, L., Knüppel, S., Michels, N., Schwedhelm, C., Hoffmann, G., Iqbal, K., De Henauw, S., et al. (2019). Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries. EUROPEAN JOURNAL OF EPIDEMIOLOGY, 34(8), 765–775.
Chicago author-date
Schwingshackl, Lukas, Sven Knüppel, Nathalie Michels, Carolina Schwedhelm, Georg Hoffmann, Khalid Iqbal, Stefaan De Henauw, Heiner Boeing, and Brecht Devleesschauwer. 2019. “Intake of 12 Food Groups and Disability-adjusted Life Years from Coronary Heart Disease, Stroke, Type 2 Diabetes, and Colorectal Cancer in 16 European Countries.” European Journal of Epidemiology 34 (8): 765–775.
Chicago author-date (all authors)
Schwingshackl, Lukas, Sven Knüppel, Nathalie Michels, Carolina Schwedhelm, Georg Hoffmann, Khalid Iqbal, Stefaan De Henauw, Heiner Boeing, and Brecht Devleesschauwer. 2019. “Intake of 12 Food Groups and Disability-adjusted Life Years from Coronary Heart Disease, Stroke, Type 2 Diabetes, and Colorectal Cancer in 16 European Countries.” European Journal of Epidemiology 34 (8): 765–775.
Vancouver
1.
Schwingshackl L, Knüppel S, Michels N, Schwedhelm C, Hoffmann G, Iqbal K, et al. Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries. EUROPEAN JOURNAL OF EPIDEMIOLOGY. 2019;34(8):765–75.
IEEE
[1]
L. Schwingshackl et al., “Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries,” EUROPEAN JOURNAL OF EPIDEMIOLOGY, vol. 34, no. 8, pp. 765–775, 2019.
@article{8622572,
  abstract     = {Our aim was to estimate and rank 12 food groups according to disability-adjusted life years (DALYs) from coronary heart disease (CHD), stroke, type 2 diabetes (T2D), and colorectal cancer (CRC) in 16 European countries. De novo published non-linear dose–response meta-analyses of prospective studies (based on 297 primary reports), and food consumption data from the European Food Safety Authority Comprehensive European Food Consumption Database in Exposure Assessment, and DALY estimates from the Institute for Health Metrics and Evaluation were used. By implementing disease-specific counterfactual scenarios of theoretical minimum risk exposure level (TMRELs), the proportion of DALYs attributed to 12 food groups was estimated. In addition, a novel modelling approach was developed to obtain a single (optimized) TMREL across diseases. Four scenarios were analysed (A: disease-specific TMRELs/all food-disease associations; B: disease-specific TMRELs/only significant food-disease associations; C: single TMREL/all food-disease associations; D: single TMREL/only significant food-disease associations). Suboptimal food intake was associated with the following proportions of DALYs; Scenario A (highest-estimate) and D (lowest-estimate): CHD (A: 67%, D: 52%), stroke (A: 49%, D: 30%), T2D (A: 57%, D: 51%), and CRC (A: 54%, D: 40%). Whole grains (10%) had the highest impact on DALYs, followed by nuts (7.1%), processed meat (6.4%), fruit (4.4%) and fish and legumes (4.2%) when combining all scenarios. The contribution to total DALYs of all food groups combined in the different scenarios ranged from 41–52% in Austria to 51–69% in the Czech-Republic. These findings could have important implications for planning future food-based dietary guidelines as a public health nutrition strategy.},
  author       = {Schwingshackl, Lukas and Knüppel, Sven and Michels, Nathalie and Schwedhelm, Carolina and Hoffmann, Georg and Iqbal, Khalid and De Henauw, Stefaan and Boeing, Heiner and Devleesschauwer, Brecht},
  issn         = {0393-2990},
  journal      = {EUROPEAN JOURNAL OF EPIDEMIOLOGY},
  keywords     = {Disability-adjusted life years,Food groups,Comparative risk assessment,Population health-impact,Type 2 diabetes,Coronary heart disease,Stroke,Colorectal cancer,DOSE-RESPONSE METAANALYSIS,RISK,BURDEN,HYPERTENSION,MORTALITY,DEATH},
  language     = {eng},
  number       = {8},
  pages        = {765--775},
  title        = {Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries},
  url          = {http://dx.doi.org/10.1007/s10654-019-00523-4},
  volume       = {34},
  year         = {2019},
}

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