Non-adherence to established dietary guidelines associated with increased mortality: the Copenhagen General Population Study
Abstract
AIMS: The relevance of adherence to established dietary guidelines is repeatedly challenged. We hypothesised that non-adherence to established dietary guidelines is associated with an excess risk of cardiovascular, non-cardiovascular and all-cause mortality. METHODS: We studied 100,191 white adult Danes aged 20-100 years recruited in 2003-2015 and followed up until December 2018. During follow-up equalling 865,600 person-years, 9273 individuals died. Participants' diets were assessed at baseline by a food frequency questionnaire focusing on key foods defining a healthy diet according to Danish dietary guidelines. Individuals were divided into five categories ranging from very high to very low adherence to dietary guidelines and studied with Cox and Fine-Gray regression models. At study inclusion, we collected demographic and lifestyle characteristics by questionnaire, made a physical examination and took a blood sample. RESULTS: Cardiovascular, non-cardiovascular and all-cause mortality increased gradually with increasing non-adherence to dietary guidelines. Cardiovascular mortality was 30% higher (95% confidence interval 7-57%), non-cardiovascular mortality 54% higher (32-79%) and all-cause mortality 43% higher (29-59%) in individuals with very low adherence to dietary guidelines compared with those with very high adherence after adjustments for age, sex, education, income, smoking, leisure time physical activity and alcohol intake. Mortality risk estimates were similar in all strata of adjusted variables. CONCLUSION: Non-adherence to Danish food-based dietary guidelines is associated with up to 43% increased all-cause mortality in a dose-response manner. The mortality excess was seen for both cardiovascular and non-cardiovascular causes. The public has good reasons to have confidence in and to adhere to established dietary guidelines.
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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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- Authors
- Ewers, B., Marott, J. L., Schnohr, P., Nordestgaard, B. G., & Marckmann, P.
- Affiliations
- Steno Diabetes Center Copenhagen (DK)
- Frederiksberg Hospital (DK)
- University of Copenhagen (DK)
- Zealand University Hospital (DK)
- Corresponding author
- Marckmann, Peter
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-07-09
- Volume
- 28
- Issue
- 11
- Pages
- 1259-1268
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W3042163812
- Cited by
- 35
- References
- 32
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 10 · 2021: 5 · 2020: 2
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- 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-compliance, all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, healthy eating, dose-response relationship, Copenhagen General Population Study
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Denmark, Diet, Humans, Middle Aged, Risk Factors, Nutrition Policy, Young Adult
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