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000177082 1001_ $$00000-0001-9907-594X$$aHanley-Cook, Giles T$$b0
000177082 245__ $$aFood biodiversity and total and cause-specific mortality in 9 European countries: An analysis of a prospective cohort study.
000177082 260__ $$aLawrence, Kan.$$bPLoS$$c2021
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000177082 520__ $$aFood 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.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) food and 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, 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.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.
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000177082 7001_ $$00000-0003-3838-855X$$aHuybrechts, Inge$$b1
000177082 7001_ $$00000-0003-3950-0929$$aBiessy, Carine$$b2
000177082 7001_ $$00000-0003-3659-8529$$aRemans, Roseline$$b3
000177082 7001_ $$aKennedy, Gina$$b4
000177082 7001_ $$00000-0002-3359-420X$$aDeschasaux-Tanguy, Mélanie$$b5
000177082 7001_ $$aMurray, Kris A$$b6
000177082 7001_ $$00000-0002-8322-8857$$aTouvier, Mathilde$$b7
000177082 7001_ $$00000-0003-2476-4251$$aSkeie, Guri$$b8
000177082 7001_ $$00000-0002-9715-3534$$aKesse-Guyot, Emmanuelle$$b9
000177082 7001_ $$00000-0003-3982-5408$$aArgaw, Alemayehu$$b10
000177082 7001_ $$aCasagrande, Corinne$$b11
000177082 7001_ $$00000-0001-7871-7149$$aNicolas, Geneviève$$b12
000177082 7001_ $$aVineis, Paolo$$b13
000177082 7001_ $$00000-0002-0793-9884$$aMillett, Christopher J$$b14
000177082 7001_ $$00000-0003-2237-0128$$aWeiderpass, Elisabete$$b15
000177082 7001_ $$aFerrari, Pietro$$b16
000177082 7001_ $$00000-0003-0481-2893$$aDahm, Christina C$$b17
000177082 7001_ $$aBueno-de-Mesquita, H Bas$$b18
000177082 7001_ $$aSandanger, Torkjel M$$b19
000177082 7001_ $$00000-0002-7038-4770$$aIbsen, Daniel B$$b20
000177082 7001_ $$00000-0001-8648-4998$$aFreisling, Heinz$$b21
000177082 7001_ $$00000-0003-1291-4494$$aRamne, Stina$$b22
000177082 7001_ $$00000-0003-3478-4758$$aJannasch, Franziska$$b23
000177082 7001_ $$00000-0002-4605-435X$$avan der Schouw, Yvonne T$$b24
000177082 7001_ $$00000-0002-0830-5277$$aSchulze, Matthias B$$b25
000177082 7001_ $$aTsilidis, Konstantinos K$$b26
000177082 7001_ $$00000-0003-4385-2097$$aTjønneland, Anne$$b27
000177082 7001_ $$aArdanaz, Eva$$b28
000177082 7001_ $$00000-0002-8958-975X$$aBodén, Stina$$b29
000177082 7001_ $$aCirera, Lluís$$b30
000177082 7001_ $$00000-0002-0813-3022$$aGargano, Giuliana$$b31
000177082 7001_ $$aHalkjær, Jytte$$b32
000177082 7001_ $$00000-0003-0672-8847$$aJakszyn, Paula$$b33
000177082 7001_ $$00000-0002-9227-8434$$aJohansson, Ingegerd$$b34
000177082 7001_ $$0P:(DE-He78)fb68a9386399d72d84f7f34cfc6048b4$$aKatzke, Verena$$b35$$udkfz
000177082 7001_ $$00000-0002-5758-9069$$aMasala, Giovanna$$b36
000177082 7001_ $$aPanico, Salvatore$$b37
000177082 7001_ $$00000-0002-9972-9779$$aRodriguez-Barranco, Miguel$$b38
000177082 7001_ $$00000-0002-8008-5096$$aSacerdote, Carlotta$$b39
000177082 7001_ $$0P:(DE-He78)0644671d309776d45e0fc705d1156cac$$aSrour, Bernard$$b40$$udkfz
000177082 7001_ $$00000-0003-2666-414X$$aTumino, Rosario$$b41
000177082 7001_ $$00000-0001-6795-6080$$aRiboli, Elio$$b42
000177082 7001_ $$aGunter, Marc J$$b43
000177082 7001_ $$aJones, Andrew D$$b44
000177082 7001_ $$00000-0002-1389-8855$$aLachat, Carl$$b45
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