Institute of Epidemiology & Health Care


Dietary factors and all-cause and cardiovascular mortality in Eastern European cohorts

Author D. Stefler
Author M. Bobak
Author E. Brunner
Author H. Pikhart
Abstract Background. Unhealthy diet, particularly low fruit and vegetable consumption, has been proposed as an important reason for the high cardiovascular disease (CVD) mortality in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). However, individual-level food and nutrient intake data in these regions and direct comparisons with Western European populations are sparse, and estimates of their health effects are not available. Aims. The aim of this thesis was to compare dietary intake habits between adults who live in Eastern and Western European countries, and to assess the relationships between selected dietary habits and all-cause and cause-specific mortality in Eastern Europeans. Methods. Data collected from the Czech, Polish and Russian participants of the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) prospective cohort study (n=28,947) were used. The comparison of food and nutrient intakes with British participants in the UK Whitehall II study was carried out using quantile regression analysis after dietary data harmonization. The associations between dietary habits and mortality outcomes in the Eastern European cohorts were assessed by Cox regression models. Missing data was imputed using multiple random imputation procedures. Results. Compared to the British participants, fruit and vegetable intakes were significantly lower in the pooled Eastern European sample but not in all country cohorts. In the pooled HAPIEE sample, the healthy diet indicator score and the Mediterranean diet score were significantly and inversely associated with CVD mortality even after multivariable adjustments. Regarding fruit and vegetable intake, the inverse association appeared to be the strongest with stroke mortality and especially among smokers. Discussion. The findings of this thesis support the hypothesis that unhealthy diet has played a role in the high CVD mortality in Eastern Europe. Public health interventions which target fruit and vegetable consumption and/or other dietary factors should be considered in this region.