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Food biodiversity and total and cause-specific mortality in 9 European countries : an analysis of a prospective cohort study

(2021) PLOS MEDICINE. 18(10).
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Abstract
Background: Food biodiversity, encompassing the variety of plants, animals, and other organisms consumed as food and drink, has intrinsic potential to underpin diverse, nutritious diets and improve Earth system resilience. Dietary species richness (DSR), which is recommended as a crosscutting measure of food biodiversity, has been positively associated with the micronutrient adequacy of diets in women and young children in low- and middle-income countries (LMICs). However, the relationships between DSR and major health outcomes have yet to be assessed in any population. Methods and findings: We examined the associations between DSR and subsequent total and cause-specific mortality among 451,390 adults enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) study (1992 to 2014, median follow-up: 17 years), free of cancer, diabetes, heart attack, or stroke at baseline. Usual dietary intakes were assessed at recruitment with country-specific dietary questionnaires (DQs). DSR of an individual’s yearly diet was calculated based on the absolute number of unique biological species in each (composite) food and drink. Associations were assessed by fitting multivariable-adjusted Cox proportional hazards regression models. In the EPIC cohort, 2 crops (common wheat and potato) and 2 animal species (cow and pig) accounted for approximately 45% of self-reported total dietary energy intake [median (P10–P90): 68 (40 to 83) species consumed per year]. Overall, higher DSR was inversely associated with all-cause mortality rate. Hazard ratios (HRs) and 95% confidence intervals (CIs) comparing total mortality in the second, third, fourth, and fifth (highest) quintiles (Qs) of DSR to the first (lowest) Q indicate significant inverse associations, after stratification by sex, age, and study center and adjustment for smoking status, educational level, marital status, physical activity, alcohol intake, and total energy intake, Mediterranean diet score, red and processed meat intake, and fiber intake [HR (95% CI): 0.91 (0.88 to 0.94), 0.80 (0.76 to 0.83), 0.69 (0.66 to 0.72), and 0.63 (0.59 to 0.66), respectively; PWald < 0.001 for trend]. Absolute death rates among participants in the highest and lowest fifth of DSR were 65.4 and 69.3 cases/10,000 person-years, respectively. Significant inverse associations were also observed between DSR and deaths due to cancer, heart disease, digestive disease, and respiratory disease. An important study limitation is that our findings were based on an observational cohort using self-reported dietary data obtained through single baseline food frequency questionnaires (FFQs); thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions: In this large Pan-European cohort, higher DSR was inversely associated with total and cause-specific mortality, independent of sociodemographic, lifestyle, and other known dietary risk factors. Our findings support the potential of food (species) biodiversity as a guiding principle of sustainable dietary recommendations and food-based dietary guidelines.
Keywords
CORONARY-HEART-DISEASE, ENVIRONMENTAL IMPACTS, MEDITERRANEAN DIET, CANCER, RISK, DIVERSITY, NUTRITION, HEALTH, GUIDELINES, CONSUMPTION

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MLA
Hanley-Cook, dr. Giles, et al. “Food Biodiversity and Total and Cause-Specific Mortality in 9 European Countries : An Analysis of a Prospective Cohort Study.” PLOS MEDICINE, vol. 18, no. 10, 2021, doi:10.1371/journal.pmed.1003834.
APA
Hanley-Cook, dr. G., Huybrechts, I., Biessy, C., Remans, R., Kennedy, G., Deschasaux-Tanguy, M., … Lachat, C. (2021). Food biodiversity and total and cause-specific mortality in 9 European countries : an analysis of a prospective cohort study. PLOS MEDICINE, 18(10). https://doi.org/10.1371/journal.pmed.1003834
Chicago author-date
Hanley-Cook, dr. Giles, Inge Huybrechts, Carine Biessy, Roseline Remans, Gina Kennedy, Mélanie Deschasaux-Tanguy, Kris A. Murray, et al. 2021. “Food Biodiversity and Total and Cause-Specific Mortality in 9 European Countries : An Analysis of a Prospective Cohort Study.” PLOS MEDICINE 18 (10). https://doi.org/10.1371/journal.pmed.1003834.
Chicago author-date (all authors)
Hanley-Cook, dr. Giles, Inge Huybrechts, Carine Biessy, Roseline Remans, Gina Kennedy, Mélanie Deschasaux-Tanguy, Kris A. Murray, Mathilde Touvier, Guri Skeie, Emmanuelle Kesse-Guyot, Corinne Casagrande, Geneviève Nicolas, Paolo Vineis, Alemayehu Argaw, Christopher J. Millett, Elisabete Weiderpass, Pietro Ferrari, Christina C. Dahm, H. Bas Bueno-de-Mesquita, Torkjel M. Sandanger, Daniel B. Ibsen, Heinz Freisling, Stina Ramne, Franziska Jannasch, Yvonne T. van der Schouw, Matthias B. Schulze, Konstantinos K. Tsilidis, Anne Tjønneland, Eva Ardanaz, Stina Bodén, Lluís Cirera, Giuliana Gargano, Jytte Halkjær, Paula Jakszyn, Ingegerd Johansson, Verena Katzke, Giovanna Masala, Salvatore Panico, Miguel Rodriguez-Barranco, Carlotta Sacerdote, Bernard Srour, Rosario Tumino, Elio Riboli, Marc J. Gunter, Andrew D. Jones, and Carl Lachat. 2021. “Food Biodiversity and Total and Cause-Specific Mortality in 9 European Countries : An Analysis of a Prospective Cohort Study.” PLOS MEDICINE 18 (10). doi:10.1371/journal.pmed.1003834.
Vancouver
1.
Hanley-Cook dr. G, Huybrechts I, Biessy C, Remans R, Kennedy G, Deschasaux-Tanguy M, et al. Food biodiversity and total and cause-specific mortality in 9 European countries : an analysis of a prospective cohort study. PLOS MEDICINE. 2021;18(10).
IEEE
[1]
dr. G. Hanley-Cook et al., “Food biodiversity and total and cause-specific mortality in 9 European countries : an analysis of a prospective cohort study,” PLOS MEDICINE, vol. 18, no. 10, 2021.
@article{8725369,
  abstract     = {{Background: Food biodiversity, encompassing the variety of plants, animals, and other organisms consumed as food and drink, has intrinsic potential to underpin diverse, nutritious diets and improve Earth system resilience. Dietary species richness (DSR), which is recommended as a crosscutting measure of food biodiversity, has been positively associated with the micronutrient adequacy of diets in women and young children in low- and middle-income countries (LMICs). However, the relationships between DSR and major health outcomes have yet to be assessed in any population.

Methods and findings: We examined the associations between DSR and subsequent total and cause-specific mortality among 451,390 adults enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) study (1992 to 2014, median follow-up: 17 years), free of cancer, diabetes, heart attack, or stroke at baseline. Usual dietary intakes were assessed at recruitment with country-specific dietary questionnaires (DQs). DSR of an individual’s yearly diet was calculated based on the absolute number of unique biological species in each (composite) food and drink. Associations were assessed by fitting multivariable-adjusted Cox proportional hazards regression models. In the EPIC cohort, 2 crops (common wheat and potato) and 2 animal species (cow and pig) accounted for approximately 45% of self-reported total dietary energy intake [median (P10–P90): 68 (40 to 83) species consumed per year]. Overall, higher DSR was inversely associated with all-cause mortality rate. Hazard ratios (HRs) and 95% confidence intervals (CIs) comparing total mortality in the second, third, fourth, and fifth (highest) quintiles (Qs) of DSR to the first (lowest) Q indicate significant inverse associations, after stratification by sex, age, and study center and adjustment for smoking status, educational level, marital status, physical activity, alcohol intake, and total energy intake, Mediterranean diet score, red and processed meat intake, and fiber intake [HR (95% CI): 0.91 (0.88 to 0.94), 0.80 (0.76 to 0.83), 0.69 (0.66 to 0.72), and 0.63 (0.59 to 0.66), respectively; PWald < 0.001 for trend]. Absolute death rates among participants in the highest and lowest fifth of DSR were 65.4 and 69.3 cases/10,000 person-years, respectively. Significant inverse associations were also observed between DSR and deaths due to cancer, heart disease, digestive disease, and respiratory disease. An important study limitation is that our findings were based on an observational cohort using self-reported dietary data obtained through single baseline food frequency questionnaires (FFQs); thus, exposure misclassification and residual confounding cannot be ruled out.

Conclusions: In this large Pan-European cohort, higher DSR was inversely associated with total and cause-specific mortality, independent of sociodemographic, lifestyle, and other known dietary risk factors. Our findings support the potential of food (species) biodiversity as a guiding principle of sustainable dietary recommendations and food-based dietary guidelines.}},
  articleno    = {{e1003834}},
  author       = {{Hanley-Cook, Giles and Huybrechts, Inge and Biessy, Carine and Remans, Roseline and Kennedy, Gina and Deschasaux-Tanguy, Mélanie and Murray, Kris A. and Touvier, Mathilde and Skeie, Guri and Kesse-Guyot, Emmanuelle and Casagrande, Corinne and Nicolas, Geneviève and Vineis, Paolo and Argaw, Alemayehu and Millett, Christopher J. and Weiderpass, Elisabete and Ferrari, Pietro and Dahm, Christina C. and Bueno-de-Mesquita, H. Bas and Sandanger, Torkjel M. and Ibsen, Daniel B. and Freisling, Heinz and Ramne, Stina and Jannasch, Franziska and van der Schouw, Yvonne T. and Schulze, Matthias B. and Tsilidis, Konstantinos K. and Tjønneland, Anne and Ardanaz, Eva and Bodén, Stina and Cirera, Lluís and Gargano, Giuliana and Halkjær, Jytte and Jakszyn, Paula and Johansson, Ingegerd and Katzke, Verena and Masala, Giovanna and Panico, Salvatore and Rodriguez-Barranco, Miguel and Sacerdote, Carlotta and Srour, Bernard and Tumino, Rosario and Riboli, Elio and Gunter, Marc J. and Jones, Andrew D. and Lachat, Carl}},
  issn         = {{1549-1277}},
  journal      = {{PLOS MEDICINE}},
  keywords     = {{CORONARY-HEART-DISEASE,ENVIRONMENTAL IMPACTS,MEDITERRANEAN DIET,CANCER,RISK,DIVERSITY,NUTRITION,HEALTH,GUIDELINES,CONSUMPTION}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{23}},
  title        = {{Food biodiversity and total and cause-specific mortality in 9 European countries : an analysis of a prospective cohort study}},
  url          = {{http://doi.org/10.1371/journal.pmed.1003834}},
  volume       = {{18}},
  year         = {{2021}},
}

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