Mortality attributable to poor dietary patterns in Canada: Evidence from the nationally-representative nutrition survey linked with health administrative data

Main Article Content

Mahsa Jessri
Deirdre Hennessy
Claudia Sanmartin
Anan Bader Eddeen
Doug Manuel

Abstract

Introduction
Dietary pattern modeling and linkage with health outcomes is essential for development of evidence-based dietary guidelines to support reduction of chronic diseases. National nutrition surveys are not routinely linked with health administrative databases, resulting in a lack of evidence on the health impact of unhealthy diets at the population level.


Objectives and Approach
This study is the first to use a nationally-representative nutrition survey (i.e., Canadian Community Health Survey-Nutrition-2004) linked with health administrative databases to examine the association of 5 key dietary quality indices with mortality risk. In total, 16,212 adults ≥20 years were followed for an average of 7.3 years. Two 24-hour dietary recalls were used to estimate the usual dietary intakes using the National Cancer Institute’s method. Weighted regression calibration was performed to obtain a true parameter relating diet (continuous) to mortality. Population Attributable Fractions were calculated to estimate the burden of all-cause mortality attributable to poor dietary patterns in Canada.


Results
The 5  dietary quality indices examined were Dietary Approaches to Stop Hypertension(DASH); Dietary Guidelines for Americans Adherence Index 2015(DGAI); Healthy Eating Index-2010(HEI); Alternative HEI-2010(AHEI); and Mediterranean Style Dietary Pattern Score(MSDPS). Having a better diet quality (90%ile vs. 10%ile of index score) was associated with a significant 31-51% reduction in all-cause mortality hazard ratio among adults 45 to 80 years and 10-35% reduction in those ≥20 years (in order of significance: DASH, DGAI, HEI, AHEI and MSDPS). Survival benefit was incrementally greater for higher diet quality scores; however, even the 90%ile scores (Reference) were notably lower than the recommended levels (45.99% of recommended score). On average, 26.42% of all mortality in Canada was attributable to poor dietary patterns (range: 19.01% for MSDPS to 31.39% for DGAI).


Conclusion/Implications
The diet-attributable burden of mortality was higher than those reported for other behavioural risks (e.g., smoking). This research informs future formulation of nutrition interventions and policies with a focus on dietary patterns. This project demonstrates the importance of leveraging linked data and analytical capacity to inform future evidence-based nutrition policies.

Introduction

Dietary pattern modeling and linkage with health outcomes is essential for development of evidence-based dietary guidelines to support reduction of chronic diseases. National nutrition surveys are not routinely linked with health administrative databases, resulting in a lack of evidence on the health impact of unhealthy diets at the population level.

Objectives and Approach

This study is the first to use a nationally-representative nutrition survey (i.e., Canadian Community Health Survey-Nutrition-2004) linked with health administrative databases to examine the association of 5 key dietary quality indices with mortality risk. In total, 16,212 adults \(\geq\)20 years were followed for an average of 7.3 years. Two 24-hour dietary recalls were used to estimate the usual dietary intakes using the National Cancer Institute’s method. Weighted regression calibration was performed to obtain a true parameter relating diet (continuous) to mortality. Population Attributable Fractions were calculated to estimate the burden of all-cause mortality attributable to poor dietary patterns in Canada.

Results

The 5 dietary quality indices examined were Dietary Approaches to Stop Hypertension(DASH); Dietary Guidelines for Americans Adherence Index 2015(DGAI); Healthy Eating Index-2010(HEI); Alternative HEI-2010(AHEI); and Mediterranean Style Dietary Pattern Score(MSDPS). Having a better diet quality (90%ile vs. 10%ile of index score) was associated with a significant 31-51% reduction in all-cause mortality hazard ratio among adults 45 to 80 years and 10-35% reduction in those \(\geq\)20 years (in order of significance: DASH, DGAI, HEI, AHEI and MSDPS). Survival benefit was incrementally greater for higher diet quality scores; however, even the 90%ile scores (Reference) were notably lower than the recommended levels (45.99% of recommended score). On average, 26.42% of all mortality in Canada was attributable to poor dietary patterns (range: 19.01% for MSDPS to 31.39% for DGAI).

Conclusion/Implications

The diet-attributable burden of mortality was higher than those reported for other behavioural risks (e.g., smoking). This research informs future formulation of nutrition interventions and policies with a focus on dietary patterns. This project demonstrates the importance of leveraging linked data and analytical capacity to inform future evidence-based nutrition policies.

Article Details

How to Cite
Jessri, M., Hennessy, D., Sanmartin, C., Eddeen, A. B. and Manuel, D. (2018) “Mortality attributable to poor dietary patterns in Canada: Evidence from the nationally-representative nutrition survey linked with health administrative data”, International Journal of Population Data Science, 3(4). doi: 10.23889/ijpds.v3i4.672.

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