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@ARTICLE{HanleyCook:177082,
      author       = {G. T. Hanley-Cook and I. Huybrechts and C. Biessy and R.
                      Remans and G. Kennedy and M. Deschasaux-Tanguy and K. A.
                      Murray and M. Touvier and G. Skeie and E. Kesse-Guyot and A.
                      Argaw and C. Casagrande and G. Nicolas and P. Vineis and C.
                      J. Millett and E. Weiderpass and P. Ferrari and C. C. Dahm
                      and H. B. Bueno-de-Mesquita and T. M. Sandanger and D. B.
                      Ibsen and H. Freisling and S. Ramne and F. Jannasch and Y.
                      T. van der Schouw and M. B. Schulze and K. K. Tsilidis and
                      A. Tjønneland and E. Ardanaz and S. Bodén and L. Cirera
                      and G. Gargano and J. Halkjær and P. Jakszyn and I.
                      Johansson and V. Katzke$^*$ and G. Masala and S. Panico and
                      M. Rodriguez-Barranco and C. Sacerdote and B. Srour$^*$ and
                      R. Tumino and E. Riboli and M. J. Gunter and A. D. Jones and
                      C. Lachat},
      title        = {{F}ood biodiversity and total and cause-specific mortality
                      in 9 {E}uropean countries: {A}n analysis of a prospective
                      cohort study.},
      journal      = {PLoS medicine},
      volume       = {18},
      number       = {10},
      issn         = {1549-1676},
      address      = {Lawrence, Kan.},
      publisher    = {PLoS},
      reportid     = {DKFZ-2021-02288},
      pages        = {e1003834 -},
      year         = {2021},
      abstract     = {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.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.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34662340},
      doi          = {10.1371/journal.pmed.1003834},
      url          = {https://inrepo02.dkfz.de/record/177082},
}