TY - JOUR

T1 - Food biodiversity and total and cause-specific mortality in 9 European countries

T2 - An analysis of a prospective cohort study

AU - Hanley-Cook, Giles T.

AU - Huybrechts, Inge

AU - Biessy, Carine

AU - Remans, Roseline

AU - Kennedy, Gina

AU - Deschasaux-Tanguy, Mélanie

AU - Murray, Kris A.

AU - Touvier, Mathilde

AU - Skeie, Guri

AU - Kesse-Guyot, Emmanuelle

AU - Argaw, Alemayehu

AU - Casagrande, Corinne

AU - Nicolas, Geneviève

AU - Vineis, Paolo

AU - Millett, Christopher J.

AU - Weiderpass, Elisabete

AU - Ferrari, Pietro

AU - Dahm, Christina C.

AU - Bueno-De-Mesquita, H. Bas

AU - Sandanger, Torkjel M.

AU - Ibsen, Daniel B.

AU - Freisling, Heinz

AU - Ramne, Stina

AU - Jannasch, Franziska

AU - van der Schouw, Yvonne T.

AU - Schulze, Matthias B.

AU - Tsilidis, Konstantinos K.

AU - Tjønneland, Anne

AU - Ardanaz, Eva

AU - Bodén, Stina

AU - Cirera, Lluís

AU - Gargano, Giuliana

AU - Halkjær, Jytte

AU - Jakszyn, Paula

AU - Johansson, Ingegerd

AU - Katzke, Verena

AU - Masala, Giovanna

AU - Panico, Salvatore

AU - Rodriguez-Barranco, Miguel

AU - Sacerdote, Carlotta

AU - Srour, Bernard

AU - Tumino, Rosario

AU - Riboli, Elio

AU - Gunter, Marc J.

AU - Jones, Andrew D.

AU - Lachat, Carl

N1 - Publisher Copyright: © 2021 Hanley-Cook et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2021

Y1 - 2021

N2 - 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) updated food and :Pleaseverifythatallentriesarecorrect 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, AU : PleasenotethatasperPLO 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.

AB - 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) updated food and :Pleaseverifythatallentriesarecorrect 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, AU : PleasenotethatasperPLO 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.

U2 - 10.1371/journal.pmed.1003834

DO - 10.1371/journal.pmed.1003834

M3 - Journal article

C2 - 34662340

AN - SCOPUS:85117612291

VL - 18

JO - P L o S Medicine (Online)

JF - P L o S Medicine (Online)

SN - 1549-1277

IS - 10

M1 - e1003834

ER -