Abstract
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Background.
Unhealthy diet, particularly low fruit and vegetable consumption, has been
proposed as an important reason for the high cardiovascular disease (CVD)
mortality in Central and Eastern Europe (CEE) and the former Soviet Union
(FSU). However, individual-level food and nutrient intake data in these
regions and direct comparisons with Western European populations are sparse,
and estimates of their health effects are not available. Aims. The aim of
this thesis was to compare dietary intake habits between adults who live in
Eastern and Western European countries, and to assess the relationships
between selected dietary habits and all-cause and cause-specific mortality in
Eastern Europeans. Methods. Data collected from the Czech, Polish and Russian
participants of the Health, Alcohol and Psychosocial Factors in Eastern
Europe (HAPIEE) prospective cohort study (n=28,947) were used. The comparison
of food and nutrient intakes with British participants in the UK Whitehall II
study was carried out using quantile regression analysis after dietary data
harmonization. The associations between dietary habits and mortality outcomes
in the Eastern European cohorts were assessed by Cox regression models.
Missing data was imputed using multiple random imputation procedures.
Results. Compared to the British participants, fruit and vegetable intakes
were significantly lower in the pooled Eastern European sample but not in all
country cohorts. In the pooled HAPIEE sample, the healthy diet indicator
score and the Mediterranean diet score were significantly and inversely
associated with CVD mortality even after multivariable adjustments. Regarding
fruit and vegetable intake, the inverse association appeared to be the
strongest with stroke mortality and especially among smokers. Discussion. The
findings of this thesis support the hypothesis that unhealthy diet has played
a role in the high CVD mortality in Eastern Europe. Public health
interventions which target fruit and vegetable consumption and/or other
dietary factors should be considered in this region.
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