Diet quality scores and prediction of all-cause, cardiovascular and cancer mortality in a pan-european cohort study

Research output: Contribution to journalArticle


Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.


  • Camille Lassale
  • Marc J. Gunter
  • Dora Romaguera
  • Linda M. Peelen
  • Yvonne T. Van Der Schouw
  • Joline W J Beulens
  • Heinz Freisling
  • David C. Muller
  • Pietro Ferrari
  • Inge Huybrechts
  • Guy Fagherazzi
  • Marie Christine Boutron-Ruault
  • Aurélie Affret
  • Kim Overvad
  • Christina C. Dahm
  • Anja Olsen
  • Nina Roswall
  • Konstantinos K. Tsilidis
  • Verena A. Katzke
  • Tilman Kühn
  • Brian Buijsse
  • José Ramón Quirós
  • Emilio Sánchez-Cantalejo
  • Nerea Etxezarreta
  • José María Huerta
  • Aurelio Barricarte
  • Catalina Bonet
  • Kay Tee Khaw
  • Timothy J. Key
  • Antonia Trichopoulou
  • Christina Bamia
  • Pagona Lagiou
  • Domenico Palli
  • Claudia Agnoli
  • Rosario Tumino
  • Francesca Fasanelli
  • Salvatore Panico
  • H. Bas Bueno-de-Mesquita
  • Jolanda M A Boer
  • Lena Maria Nilsson
  • Elisabete Weiderpass
  • Guri Skeie
  • Eiliv Lund
  • Karel G M Moons
  • Elio Riboli
  • Ioanna Tzoulaki
External organisations
  • Imperial College London
  • Carlos III Health Institute
  • University Medical Center Utrecht
  • International Agency for Research on Cancer, World Health Organization
  • University of Paris-Sud
  • Aarhus University
  • Institute of Cancer Epidemiology - Denmark
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • University of Ioannina
  • Public Health Directorate
  • Instituto de Investigación Biosanitaria de Granada (Granada.ibs)
  • Biodonostia Health Research Institute
  • Murcia Regional Health Council
  • Health Research Institute of Navarra (IDISNA)
  • Catalan Institute of Oncology
  • University of Cambridge
  • University of Oxford
  • Hellenic Health Foundation, Athens
  • Cancer Research and Prevention Institute (ISPO)
  • Carlo Besta Neurological Institute, IRCCS
  • Civic and M.P Arezzo Hospital
  • Human Genetics Foundation (HuGeF)
  • University of Naples Federico II
  • National Institute for Public Health and the Environment (RIVM)
  • Folkhälsan Research Center
  • UiT The Arctic University of Norway, Tromsø
  • Umeå University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Clinical Medicine
Original languageEnglish
Article numbere0159025
JournalPLoS ONE
Issue number7
Publication statusPublished - 2016 Jul 1
Publication categoryResearch