Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study
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We aimed to evaluate the criterion validity of the 2015 food-based Dutch dietary guidelines, which were formulated based on evidence on the relation between diet and major chronic diseases. We studied 9701 participants of the Rotterdam Study, a population-based prospective cohort in individuals aged 45 years and over [median 64.1 years (95%-range 49.0-82.8)]. Dietary intake was assessed at baseline with a food-frequency questionnaire. For all participants, we examined adherence (yes/no) to fourteen items of the guidelines: vegetables (≥200 g/day), fruit (≥200 g/day), whole-grains (≥90 g/day), legumes (≥135 g/week), nuts (≥15 g/day), dairy (≥350 g/day), fish (≥100 g/week), tea (≥450 mL/day), ratio whole-grains:total grains (≥50%), ratio unsaturated fats and oils:total fats (≥50%), red and processed meat (<300 g/week), sugar-containing beverages (≤150 mL/day), alcohol (≤10 g/day) and salt (≤6 g/day). Total adherence was calculated as sum-score of the adherence to the individual items (0-14). Information on disease incidence and all-cause mortality during a median follow-up period of 13.5 years (range 0-27.0) was obtained from data collected at our research center and from medical records. Using Cox proportional-hazards models adjusted for confounders, we observed every additional component adhered to was associated with a 3% lower mortality risk (HR 0.97, 95% CI 0.95; 0.98), lower risk of stroke (HR 0.95, 95% CI 0.92; 0.99), chronic obstructive pulmonary disease (HR 0.94, 95% CI 0.91; 0.98), colorectal cancer (HR 0.90, 95% CI 0.84; 0.96), and depression (HR 0.97, 95% CI 0.95; 0.999), but not with incidence of coronary heart disease, type 2 diabetes, heart failure, lung cancer, breast cancer, or dementia. These associations were not driven by any of the individual dietary components. To conclude, adherence to the Dutch dietary guidelines was associated with a lower mortality risk and a lower risk of developing some but not all of the chronic diseases on which the guidelines were based.
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Adherence to food-based dietary guidelines is associated with better quality of life, mental health, healthy weight maintenance, lower risk of major chronic diseases, and lower all-cause mortality.
“adherence to FBDGs has been associated with desirable outcomes in multiple domains such as a better quality of life [5,6] and mental health [7], healthy weight maintenance, and lower risk of major chronic diseases [for example, CVD, type 2 diabetes (T2D), multiple cancers [2,[8], [9], [10]]] and all-cause mortality [2,9,11].”
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Seasonal variation of diet quality in a large middle-aged and elderly Dutch population-based cohort
van der Toorn, J. E., Cepeda, M., Jong, J. C. K., Franco, O. H., Voortman, T., & Schoufour, J. D. (2019) · European Journal of Nutrition · doi:10.1007/s00394-019-01918-5 · Cited by 36 · see citing works
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MIND diet lowers risk of open-angle glaucoma: the Rotterdam Study
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Self-citationChu, A. H. Y., Lin, K., Croker, H. A., Kefyalew, S., Becerra‐Tomás, N., Dossus, L., González‐Gil, E. M., Ahmadi, N., Park, Y., Krebs, J. R., et al. (2025) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.02.021 · Cited by 34 · see citing works
Meta-analysis of sugar-sweetened beverage intake and the risk of cognitive disorders
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The inflammatory potential of diet is associated with the risk of age-related eye diseases
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Self-citationAssociations between diet quality and anxiety and depressive disorders: A systematic review
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Healthy lifestyle in older adults and life expectancy with and without heart failure
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Sociodemographic, Lifestyle, Physical, and Psychosocial Determinants of Cognitive Reserve
Zijlmans, J. L., Lamballais, S., Vernooij, M. W., Ikram, M. A., & Luik, A. I. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-215122 · Cited by 24 · see citing works
Self-citationAdiposity in the older population and the risk of dementia: The Rotterdam Study
Mooldijk, S. S., de Crom, T. O. E., Ikram, M. K., Ikram, M. A., & Voortman, T. (2022) · Alzheimer s & Dementia · doi:10.1002/alz.12888 · Cited by 24 · see citing works
Self-citationMacronutrient intake and frailty: the Rotterdam Study
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Self-citationKonieczna, J., Chaplin, A. M. L., Paz‐Graniel, I., Croker, H. A., Becerra‐Tomás, N., Markozannes, G., Tsilidis, K. K., Dossus, L., González‐Gil, E. M., Park, Y., et al. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.10.003 · Cited by 23 · see citing works
Adherence to the 2017 French dietary guidelines and adult weight gain: A cohort study
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Hofman, A., Rodríguez‐Ayllón, M., Vernooij, M. W., Croll, P. H., Luik, A. I., Neumann, A., Niessen, W. J., Ikram, M. A., Voortman, T., & Muetzel, R. L. (2022) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2022.10.002 · Cited by 22 · see citing works
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Total Dietary Antioxidant Capacity and Longitudinal Trajectories of Body Composition
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Self-citationThyroid Status and Brain Circulation: The Rotterdam Study
Fani, L., Dueñas, O. H. R., Bos, D., Vernooij, M. W., Klaver, C. C. W., Ikram, M. K., Peeters, R. P., Ikram, M. A., & Chaker, L. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab744 · Cited by 20 · see citing works
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Self-citationAssociations of Activity and Sleep With Quality of Life: A Compositional Data Analysis
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Self-citationAdherence to a food group-based dietary guideline and incidence of prediabetes and type 2 diabetes
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Slurink, I. A. L., Voortman, T., Ochoa‐Rosales, C., Ahmadizar, F., Kavousi, M., Kupper, N. H. M., Smeets, T., & Soedamah‐Muthu, S. S. (2022) · Nutrients · doi:10.3390/nu14030415 · Cited by 18 · see citing works
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Design Issues in Personalized Nutrition Advice Systems
de Hoogh, I. M., Reinders, M. J., Doets, E. L., Hoevenaars, F. P. M., & Top, J. L. (2023) · Journal of Medical Internet Research · doi:10.2196/37667 · Cited by 17 · see citing works
Diet quality indices and gastrointestinal cancer risk: results from the Lifelines study
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Cardiovascular health, genetic predisposition, and lifetime risk of type 2 diabetes
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Associations between macronutrient intake and coronary heart disease (CHD): The Rotterdam Study
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Self-citationWaqas, K., Chen, J., Lu, T., van der Eerden, B. C. J., Rivadeneira, F., Uitterlinden, A. G., Voortman, T., & Zillikens, M. C. (2022) · Bone · doi:10.1016/j.bone.2022.116564 · Cited by 13 · see citing works
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Self-citationPredictors of Gastrointestinal Transit Times in Colon Capsule Endoscopy
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Self-citationProspective Study of Diet Quality and the Risk of Dementia in the Oldest Old
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Adherence to the Danish food-based dietary guidelines and risk of colorectal cancer: a cohort study
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- Authors
- Voortman, T., Kiefte-de Jong, J. C., Ikram, M. A., Stricker, B. H., van Rooij, F. J. A., Lahousse, L., Tiemeier, H., Brusselle, G. G., Franco, O. H., & Schoufour, J. D.
- Affiliations
- Erasmus MC (NL)
- Ghent University Hospital (BE)
- Corresponding author
- Voortman, Trudy
- ORCID
- Venue
- European Journal of Epidemiology
- Published
- 2017-08-19
- Volume
- 32
- Issue
- 11
- Pages
- 993-1005
- ISSN
- 0393-2990 (ISSN-L)
- 1573-7284
- PMC
- PMC5684301
- OpenAlex
- W2749030620
- Cited by
- 153
- References
- 37
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 17 · 2023: 21 · 2022: 25 · 2021: 20 · 2020: 23 · 2019: 19 · 2018: 11 · 2017: 1
- FWCI
- 13.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Journal of Epidemiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- National University of Singapore (submittedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Funders
- European Commission
- Erasmus Universiteit Rotterdam
- Fonds Wetenschappelijk Onderzoek
- Vlaamse regering
- Nestec
- Erasmus Universitair Medisch Centrum Rotterdam
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- dietary guidelines adherence, non-communicable diseases, all-cause mortality, stroke, chronic obstructive pulmonary disease, colorectal cancer, depression, criterion validity, dietary intake, whole grains, fruit and vegetable intake, red and processed meat, sweetened beverages, alcohol consumption, salt intake, unsaturated fat, Rotterdam Study, older adults, disease incidence
- MeSH terms
- Noncommunicable Diseases, Aged, Aged, 80 and over, Cause of Death, Chronic Disease, Diet Surveys, Female, Health Status Indicators, Humans, Male, Middle Aged, Mortality, Netherlands, Population Surveillance, Prospective Studies, Risk Factors, Proportional Hazards Models, Guidelines as Topic, Nutrition Policy, Guideline Adherence
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