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Objective: To examine how different scoring models for a diet quality index influence associations with mortality outcomes.Design: A study within the Malmö Diet and Cancer cohort. Food and nutrient intakes were estimated using a diet history method. The index included six components: SFA, PUFA, fish and shellfish, fibre, fruit and vegetables, and sucrose. Component scores were assigned using predefined (based on dietary recommendations) and population-based cut-offs (based on median or quintile intakes). Multivariate Cox regression was used to model associations between index scores (low, medium, high) and all-cause and cause-specific mortality by sex.Setting: Malmö, the third largest city in Sweden.Subjects: Men (n 6940) and women (n 10,186) aged 44-73 years. During a mean follow-up of 14.2 years, 2450 deaths occurred, 1221 from cancer and 709 from CVD.Results: The predictive capability of the index for mortality outcomes varied with type of scoring model and by sex. Stronger associations were seen among men using predefined cut-offs. In contrast, the quintile-based scoring model showed greater predictability for mortality outcomes among women. The scoring model using median-based cut-offs showed low predictability for mortality among both men and women.Conclusions: The scoring model used for dietary indices may have a significant impact on observed associations with disease outcomes. The rationale for selection of scoring model should be included in studies investigating the association between dietary indices and disease. Adherence to the current dietary recommendations was in the present study associated with decreased risk of all-cause and cause-specific mortality, particularly among men. [ABSTRACT FROM AUTHOR]

Objective: To develop a diet quality index (DQI) that assesses adherence to the Swedish nutrition recommendations (SNR) and the Swedish dietary guidelines (SDG).Design: A cross-sectional study within the Malmö Diet and Cancer (MDC) cohort. A diet history method collected dietary data, a structured questionnaire lifestyle and socio-economic information, and anthropometric data were collected by direct measurements. The index (DQI-SNR) included six components: SFA, PUFA, fish and shellfish, dietary fibre, fruit and vegetables, and sucrose.Setting: Malmö, Sweden.Subjects: Men (n 4525) and women (n 8491) of the MDC cohort enrolled from September 1994 to October 1996.Results: For participants with high DQI-SNR scores, nutrient and food intakes were close to recommendations. However, most of the study population exceeded the recommended intake for SFA (98%) and few reached recommended intakes for dietary fibre (24%), fruit and vegetables (32%), vitamin D (18%) and folate (2%). A high DQI-SNR score was positively associated with age, physical activity, not smoking, past food habit change, education and socio-economic status. Individuals with high scores were more likely to have a diabetes diagnosis or experienced a cardiovascular event.Conclusions: Results suggest that the DQI-SNR is a useful tool for assessing adherence to the SNR 2005 and the SDG in the MDC cohort. No index has previously been developed with the aim of evaluating adherence to the current dietary recommendations in Sweden. Further validation of the DQI-SNR, and evaluation of its utility, is needed. [ABSTRACT FROM AUTHOR]

Objective: Valid dietary data are essential when trying to identify whether or not one or more dietary exposures are responsible for disease. We examined diet composition in women who reported dietary change in the past compared with non-changers, and how the associations between dietary factors and postmenopausal breast cancer are influenced by dietary change, obesity status and misreporting of energy.Design: A population-based prospective cohort study. Data were obtained by a diet history method, anthropometrical measurements and an extensive lifestyle questionnaire including items on past food habit change.Setting: The Malmö Diet and Cancer (MDC) study, conducted in Malmö, Sweden.Subjects: A subsample of 12,781 women from the MDC cohort recruited from 1991 to 1996. A total of 428 postmenopausal women were diagnosed with incident breast cancer, during 9.2 years of follow-up.Results: Past food habit changers reported healthier food habits and lower energy intake compared with non-changers, a finding that raises issues regarding possible reporting biases. When excluding diet changers, the trend of increased breast cancer risk across omega-6 fatty acid quintiles was stronger, and a tendency of decreased risk emerged for 'fruit, berries and vegetables'. When excluding individuals with non-adequate reports of energy intake, risk estimates were similar to that of the whole sample. In women with body mass index < 27 kg m- 2, significant trends of increased breast cancer risk were seen for total fat and omega-6 fatty acids, and of decreased risk for 'fruit, berries and vegetables'.Conclusions: This study indicates that both obesity and self-reported past food habit change may be important confounders of diet-breast cancer relationships. The study demonstrates that sensitivity analysis, through stratification, may facilitate interpretation of risk relationships and study results. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the dietary intakes of heterocyclic amines (HCAs), to examine the intakes in relation to socio-economics, lifestyle and other dietary factors and to compare the classification of subjects by intake of HCA versus intake of meat and fish.Design: Cross-sectional analysis within the Malmö Diet and Cancer (MDC) cohort. Data were obtained from a modified diet history, a structured questionnaire on socio-economics and lifestyle, anthropometric measurements and chemical analysis of HCAs. HCA intake was cross-classified against meat and fish intake. The likelihood of being a high consumer of HCAs was estimated by logistic regression analysis. Dietary intakes were examined across quintiles of HCA intake using analysis of variance.Setting: Baseline examinations conducted in 1991-1994 in Malmö, Sweden.Subjects: A sub-sample of 8599 women and 6575 men of the MDC cohort.Results: The mean daily HCA intake was 583 ng for women and 821 ng for men. Subjects were ranked differently with respect to HCA intake compared with intake of fried and baked meat and fish (kappa = 0.13). High HCA intake was significantly associated with lower age, overweight, sedentary lifestyle and smoking. Intakes of dietary fibre, fruits and fermented milk products were negatively associated with HCA intake, while intakes of selenium, vegetables, potatoes, alcohol (among men) and non-milk-based margarines (among women) were positively associated with HCA intake.Conclusions: The estimated daily HCA intake of 690 ng is similar to values obtained elsewhere. The present study suggests that lifestyle factors (e.g. smoking, physical activity, fruit and vegetable intakes, and types of milk products and margarines) may confound associations between HCA intake and disease. The poor correlation between HCA intake and intakes of fried meat and fish facilitates an isolation of the health effects of HCAs. [ABSTRACT FROM AUTHOR]

Objectives: To examine if obesity status and socio-economic and lifestyle factors are associated with self-reported past food habit change, and also whether the level of obesity depends on the reason for change.Design: Cross-sectional analysis within the Malmo Diet and Cancer (MDC) study using data from the baseline examination and the extensive socio-economic and lifestyle questionnaire including questions of past food habit change. The risk of having changed food habits in the past was examined using logistic regression. Mean differences in obesity status across categories of reasons for past food habit change were examined using analysis of variance.Setting: Malmö, the third largest city in Sweden.Subjects: A sub-sample (15 282 women and 9867 men) from the MDC cohort recruited from 1992 to 1996.Results: Individuals with body mass index (BMI) >30 kg m(-2) had an increased risk of having reported past food habit change compared with individuals with BMI <25 kg m(-2) (odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.48-1.83 for women; OR = 1.53, 95% CI = 1.32-1.76 for men). The highest level of obesity was observed among individuals who had changed their diet due to reasons related to the metabolic syndrome. Changers were more likely to be highly educated and to live alone, be retired, ex-smokers and non-drinkers at baseline.Conclusions: Because past food habit change is related to obesity and other lifestyle and socio-economic factors, a complex confounding situation may exist that could seriously influence observed relationships between diet and disease. Studies need to collect information on past food habit change and take this information into account in the analysis and when interpreting study outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To identify food sources of fat, to compare food and nutrient intakes at different levels of relative fat intake, and to examine the contribution of different food groups to the variation in relative fat intake. Relative fat intake was expressed as energy contributed by fat in percentage of non-alcohol energy.Design: Cross-sectional analysis of baseline data from the Malmö Diet and CancerStudy: An interview-based diet history method, a structured questionnaire and anthropometric measurements were used to obtain data. Analysis of variance compared food and nutrient intakes across quintiles of relative fat intake. Stepwise regression examined the contribution of food groups to the variation in relative fat intake.Setting: Baseline examinations were conducted between 1991 and 1996 in the city of Malmö, southern Sweden.Subjects: A sub-sample of 7055 women and 3240 men of the Malmö Diet and Cancer cohort.Results: The major fat sources were dairy products, margarines, meat & meat products, and cakes & buns. Most plant foods, especially fruit, vegetables and breakfast cereals, were negatively associated with fat intake. Low fat consumers had significantly higher intakes of dietary fibre, vitamin C, beta-carotene, folic acid, iron, zinc and calcium. Intakes of all types of fatty acids and fat-soluble vitamins were positively associated with fat consumption.Conclusions: The results suggest that many food groups and nutrients may confound the associations between relative fat intake and disease. Plant foods, especially, are important to consider in studies of fat intake and disease risk. [ABSTRACT FROM AUTHOR]