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Diet quality indices (DQIs) can be useful predictors of diet-disease relationships, including non-communicable disease (NCD) multimorbidity. We aimed to investigate whether overall diet quality (DQ) predicted NCD, multimorbidity, and all-cause mortality. Women from the 1945-51 cohort of the Australia Longitudinal Study on Women's Health (ALSWH) were included if they: responded to S3 in 2001 and at least one survey between 2004 (S4) and 2016 (S8), and had no NCD history and complete dietary data at S3. DQ was summarized by the Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), Mediterranean Diet Score (MDS), and Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included each NCD (diabetes mellitus (DM), coronary heart disease (CHD), hypertension (HT), asthma, cancer (except skin cancer), depression and/or anxiety) independently, multimorbidity, and all-cause mortality. Repeated multivariate logistic regressions were used to test associations between DQIs and NCD outcomes across the 15 years of follow-up. The mean (±sd) of DQIs of participants ( n = 5350) were 57.15 ± 8.16 (HEIFA-2013); 4.35 ± 1.75 (MDS), and 56.01 ± 10.32 (AHEI-2010). Multivariate regressions indicated that women reporting the highest quintile of AHEI-2010 had lower odds of DM (42-56% (S5-S8)), HT (26% (S8)), asthma (35-37% (S7, S8)), and multimorbidity (30-35% (S7, S8)). The highest quintile of HEIFA-2013 and MDS had lower odds of HT (26-35% (S7, S8); 24-27% (S6-S8), respectively) and depression and/or anxiety (30% (S6): 30-34% (S7, S8)). Our findings support evidence that DQ is an important predictor of some NCDs and a target for prevention in middle-aged women.

Lifestyle behaviours have an important role in preventing cancer, reducing treatment side effects, and improving survival and quality of life for cancer survivors. This study investigated adherence to multiple lifestyle behaviours among women with and without a cancer history. From the Australian Longitudinal Study on Women's Health (ALSWH) surveys, 2407 cancer survivors and 3896 controls (cancer free population) were identified. Based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations, adherence to six health behaviours (smoking, physical activity, fruit and vegetable intake, alcohol consumption, sugary drink intake, and Body Mass Index [BMI]) were assessed. Overall adherence was low, and there were no differences between survivors and controls on adherence to any of the six individual health behaviours. However, both recent and long-term cancer survivors were more likely than controls to adhere to multiple health behaviours ( p < 0.05). When participants with melanoma or non-melanoma skin cancer were excluded, adherence was less likely (but not significant) in the cancer group than controls. Higher education ( p < 0.01), being married ( p < 0.01), and lower comorbidity of chronic illnesses ( p < 0.01) were significantly associated with adherence to multiple lifestyle behaviours. Overall, the findings suggest that a cancer diagnosis may result in increased compliance with multiple health behaviour guidelines.