Author(s): Aksnes, Brooke; Fardet, Anthony; Bhurtyal, Ashok; Castillo, Cecilia; Schuftan, Claudio... more Author(s): Aksnes, Brooke; Fardet, Anthony; Bhurtyal, Ashok; Castillo, Cecilia; Schuftan, Claudio; Parra, Diana; Cannon, Geoffrey; Kent, George; Sattamini, Isabella; Vivero Pol, Jose Louis; Alvim, Maria; Wahlqvist, Mark; Yambi, Olivia; Zazueta, Pilar; Patel, Raj; Garduno-Diaz, Sara; Khambadkone, Seva; Vandevijvere, Stefanie; de Sa, Thiago Herick | Abstract: Brooke Aksnes, Visions convenor, writes: Here are selected extracts of the testimonies - commitments, beliefs, and aspirations - of our 19 Visions writers. They are all WN editorial team members or regular contributors. We have a balance of younger and older visionaries, women and men, and team members and regular contributors, from all continents. Rational and sustainable plans will emphasise shared meals, strengthen social coherence, valorise established cultures, multiply local agriculture and food systems, protect rural and urban livelihoods, increase all forms of diversity, cleanse land, air and water, and reduce the burden ...
Brooke Aksnes, Visions convenor, writes: Here are selected extracts of the testimonies - commitme... more Brooke Aksnes, Visions convenor, writes: Here are selected extracts of the testimonies - commitments, beliefs, and aspirations - of our 19 Visions writers. They are all WN editorial team members or regular contributors. We have a balance of younger and older visionaries, women and men, and team members and regular contributors, from all continents. Rational and sustainable plans will emphasise shared meals, strengthen social coherence, valorise established cultures, multiply local agriculture and food systems, protect rural and urban livelihoods, increase all forms of diversity, cleanse land, air and water, and reduce the burden the human species imposes on the physical world and the biosphere.
In this our ‘Visions’ series, for three months – last month, here, and next month – we ask five m... more In this our ‘Visions’ series, for three months – last month, here, and next month – we ask five members of the WN editorial family to address the same 10 questions and requests. Next month, the third and final in the series, we will collate all the responses and see what common themes emerge. This month, our five family member contributors are as follows. Olivia Yambi from Tanzania is a former UNICEF regional advisor for Eastern and Southern Africa and head of the UNICEF office in Laos and Kenya. Anthony Fardet is a senior nutrition and food scientist at the French National Institute for Agricultural Research. SaraGarduño-Diaz, who is Mexican, is an assistant professor at the American University of the Middle East in Kuwait. Author of Stuffed and Starved and the Value of Nothing, the UK and now US citizen Raj Patel is a film-maker and a research professor at the Lyndon B Johnson School of Public Affairs, Austin, Texas. Mark Wahlqvist, Professor of Nutrition at Monash University, Aus...
There is no gold standard in the assessment of individual dietary intake methodology. The choice ... more There is no gold standard in the assessment of individual dietary intake methodology. The choice of dietary method to estimate individual intake depends upon the study objectives for the assessment of individual intake. We adopted a food frequency questionnaire and modified it for use in a study of food habits and cardiovascular health status in adult Chinese living in Melbourne. Australia. This is a semi-quantitative questionnaire (MCHS-FFQ) and is designed to estimate past food intake. It consists of 220 foods and beverages. A reference portion is given to obtain a quantitative estimate of the usual intake portion. Various internal validation tests were performed. The MCHS-FFQ, being a food frequency dietary method, does not provide a good estimate of nutrients in foods which are not served in standard portions. such as sodium. The MCHS-FFQ offered a good estimate for potassium and protein intake when compared to estimates derived from a single 24-h urine collection. Finally, the MCHS-FFQ was predictive of plasma cholesterol levels. We conclude that the MCHS-FFQ is adequate for the assessment of individual usual food and nutrient intakes in a representative sample of adult Melbourne Chinese. For foods that are not served in a standard portion or quantifiable addition, an alternative more reliable method would be required for quantitative purposes. The method is. however, likely to be useful for the appraisal of overall food patterns in Chinese populations.
This study investigated the food consumption patterns of 430 Beijing Chinese adults and assessed ... more This study investigated the food consumption patterns of 430 Beijing Chinese adults and assessed the impact on these patterns of the following socio-demographic characteristics: gender, age, educational achievement, and gross household income. Food intake by category, food variety and meal patterns were assessed using a 156-item food frequency questionnaire. It was found that gender and age were the most important factors to influence food consumption patterns. Men consumed more wheat products, red meat and tea, whereas women consumed more vegetables, fruit, nuts, fish, eggs and milk. Women also tended to consume a wider variety of food than did men. Furthermore, it was found that younger and more educated people tended to consume a wider variety of food. Age also had an important influence on the food intake. Younger and generally more educated adults tended to consume foods associated with affluence: meats, soft drinks and beer, while the older population tended to consume more ve...
The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-... more The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Australia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to develop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nutrient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting f...
Child undernutrition is a major health problem in Malawi. We assessed the association between mat... more Child undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15–49 years)—child (27.6 ± 16.7 months, range 0–59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score < – 2). Logistic regression assessed associations between maternal autonomy and stunting, and dominance analysis evaluated the relative importance of the associated factors. From the two surveys combined, 39.2% were stunted. Stunting decreased from 45.0% in 2010 to 34.6% in 2015/16; concurrently, maternal autonomy improved and was evidently associated with stunting (aOR = 0.81, 95% CI = 0.71, 0.93...
A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about bas... more A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about basic commodities was designed for the Elderly Nutrient and Health Survey in Taiwan (NAHSIT) to collect participants' usual intake of the previous month. We have examined the validity this SFFQ as assessed by multiple 24-hour dietary recall (n=81) and biomarkers (n=1473). All questionnaires were completed by face-to-face interview and fasting blood taken. Thirty seven males and 44 females were randomly selected from NAHSIT participants. Of these, 31 and 50 subjects completed 2 or 3 24-hour dietary recalls within one month, respectively. Mean daily intake frequencies for each food group were calculated from the SFFQ and 24-hr recalls, respectively. Spearman rank correlation coefficients between frequencies of food intake from the FFQ and dietary recalls ranged from 0.132 to 0.678 for men; 0.052 to 0.759 for women. For food weight, the trends were similar to frequency findings. For biomar...
annotation/report summary Barriers identified by authors Stated aims/goals of the program Outcome... more annotation/report summary Barriers identified by authors Stated aims/goals of the program Outcomes Year conducted Unexpected outcomes Methods Was an evaluation carried out? If yes, what type? Study design and setting Contact address Description of population group Table 1: Details examined in programs assessed. If a detail was not identified, it was recorded as ‘not stated’. In order to eliminate bias and judgement, the programs were assessed using the author’s identification of strengths, weaknesses, outcomes, key findings, and barriers. It is understood that project officers may have a biased view of the success of their program, especially if the only evaluation carried out was by anecdotal evidence or observation. External evaluators are less likely to be biased; however in many cases, programs conducted in schools do not have the available funding to employ an external evaluator. Due to a lack of Victorian based nutrition interventions; programs from other Australian states wer...
The Southeast Asian journal of tropical medicine and public health, 1997
International comparison of food intake and health studies amongst the aged is providing new insi... more International comparison of food intake and health studies amongst the aged is providing new insight into the importance of food culture in social context for healthy aging. At same time the possible variance in eating behavior compatible with good health requires consideration. The IUNS (International Union of Nutritional Sciences) FHILL (Food Habits in Later Life) Project, comprises (1) a morbidity study on about 2,000 elderly in 13 communities (now available on CD Rom) and (2) a mortality follow-up study. In the morbidity study, a total health assessment score or Later Life Status Score (LLSS) has been considered in relation to non-nutritional and nutritional factors. The elderly Greek cohorts aged 70+ in Melbourne. Australia (M = 94, F = 95) and Spata, Greece (M = 51, F = 53) have been used as a model for multivariate analyses to determine separately the importance of non-nutritional (well-being, memory, general health, medication-use, activities of daily living, exercise, socia...
Background: Knowledge of traditional African foods and food habits has been, and continues to be,... more Background: Knowledge of traditional African foods and food habits has been, and continues to be, systematically extirpated. With the primary intent of collating data for our online collection documenting traditional African foods and food habits (available at: www.healthyeatingclub.com/Africa/), we reviewed the Oltersdorf Collection, 75 observational investigations conducted throughout East Africa (i.e. Tanzania, Kenya, and Uganda) between the 1930s and 1960s as compiled by the Max Planck Nutrition Research Unit, formerly located in Bumbuli, Tanzania. Methods: Data were categorized as follows: (1) food availability, (2) chemical composition, (3) staple foods (i.e. native crops, cereals, legumes, roots and tubers, vegetables, fruits, spices, oils and fats, beverages, and animal foods), (4) food preparation and culture, and (5) nutrient intake and health status indicators. Results: Many of the traditional foods identified, including millet, sorghum, various legumes, root and tubers, green leafy vegetables, plant oils and wild meats have known health benefits. Food preparatory practices during this period, including boiling and occasional roasting are superior to current practices which favor frying and deep-frying. Overall, our review and data extraction provide reason to believe that a diversified diet was possible for the people of East Africa during this period (1930s-1960s). Conclusions: There is a wealth of knowledge pertaining to traditional East African foods and food habits within the Oltersdorf Collection. These data are currently available via our online collection. Future efforts should contribute to collating and honing knowledge of traditional foods and food habits within this region, and indeed throughout the rest of Africa. Preserving and disseminating this knowledge may be crucial for abating projected trends for non-communicable diseases and malnutrition in Africa and abroad.
In 1987, the International Union of Nutritional Sciences (IUNS) subcommittee on Nutrition and Age... more In 1987, the International Union of Nutritional Sciences (IUNS) subcommittee on Nutrition and Ageing, in conjunction with the World Health Organization (WHO) global program for the elderly, embarked on the 'Food Habits in Later Life' (FHILL): a cross-cultural study to determine to what extent health, social and lifestyle variables, especially food intake, collectively predict survival amongst long-lived cultures. A total of 818 participants aged 70 years and over were recruited from five IUNS centres. Mortality data were collected after five to seven years. The cohorts included Swedes in Sweden (SWD), Greeks in Greece (GRS) and in Melbourne, Australia (GRM), Anglo-Celts in Australia (ACS) and Japanese in Japan (JPN). Information was obtained on health, lifestyle and diet at baseline. A Cox Proportional Hazard model containing ten potential predictors of survival, adjusted to age at enrollment and ethnicity/locality, was developed to analyse the survival data. Based on up to seven years survival data, it was found that being an elderly Greek in Australia conferred the lowest mortality risk and being an elderly Greek in Greece conferred the highest mortality risk. When the ten potential predictors of survival were entered into the Cox model, the memory score, the Mediterranean diet score, Activities of Daily Living (ADL) and general health status scores showed the greatest effects in significantly reducing mortality hazard ratios by 22%, 13%, 4% and 4%, respectively. For diet score, a one-unit change predicted a significant 13% difference in survival. Of the lifestyle (modifiable) variables entered in the multivariate model, exercise and social activity were not significant predictors of survival suggesting that diet is a more important predictor of survival than these variables. Another lifestyle variable, smoking, significantly increased mortality hazard ratios by 67%, making it a more important predictor of survival than diet. Being male (non-modifiable) also increased risk of death by 63%. Diet, particularly the Mediterranean Diet, operates irrespective and together with other factors as an appreciable contributor to survival, with a strength comparable to or greater than all other measured variables. The independence and strength of the predictiveness of food pattern for survival, and for this to be cross-cultural from Europe to Asia is a novel and important observation for food and health policy.
Author(s): Aksnes, Brooke; Fardet, Anthony; Bhurtyal, Ashok; Castillo, Cecilia; Schuftan, Claudio... more Author(s): Aksnes, Brooke; Fardet, Anthony; Bhurtyal, Ashok; Castillo, Cecilia; Schuftan, Claudio; Parra, Diana; Cannon, Geoffrey; Kent, George; Sattamini, Isabella; Vivero Pol, Jose Louis; Alvim, Maria; Wahlqvist, Mark; Yambi, Olivia; Zazueta, Pilar; Patel, Raj; Garduno-Diaz, Sara; Khambadkone, Seva; Vandevijvere, Stefanie; de Sa, Thiago Herick | Abstract: Brooke Aksnes, Visions convenor, writes: Here are selected extracts of the testimonies - commitments, beliefs, and aspirations - of our 19 Visions writers. They are all WN editorial team members or regular contributors. We have a balance of younger and older visionaries, women and men, and team members and regular contributors, from all continents. Rational and sustainable plans will emphasise shared meals, strengthen social coherence, valorise established cultures, multiply local agriculture and food systems, protect rural and urban livelihoods, increase all forms of diversity, cleanse land, air and water, and reduce the burden ...
Brooke Aksnes, Visions convenor, writes: Here are selected extracts of the testimonies - commitme... more Brooke Aksnes, Visions convenor, writes: Here are selected extracts of the testimonies - commitments, beliefs, and aspirations - of our 19 Visions writers. They are all WN editorial team members or regular contributors. We have a balance of younger and older visionaries, women and men, and team members and regular contributors, from all continents. Rational and sustainable plans will emphasise shared meals, strengthen social coherence, valorise established cultures, multiply local agriculture and food systems, protect rural and urban livelihoods, increase all forms of diversity, cleanse land, air and water, and reduce the burden the human species imposes on the physical world and the biosphere.
In this our ‘Visions’ series, for three months – last month, here, and next month – we ask five m... more In this our ‘Visions’ series, for three months – last month, here, and next month – we ask five members of the WN editorial family to address the same 10 questions and requests. Next month, the third and final in the series, we will collate all the responses and see what common themes emerge. This month, our five family member contributors are as follows. Olivia Yambi from Tanzania is a former UNICEF regional advisor for Eastern and Southern Africa and head of the UNICEF office in Laos and Kenya. Anthony Fardet is a senior nutrition and food scientist at the French National Institute for Agricultural Research. SaraGarduño-Diaz, who is Mexican, is an assistant professor at the American University of the Middle East in Kuwait. Author of Stuffed and Starved and the Value of Nothing, the UK and now US citizen Raj Patel is a film-maker and a research professor at the Lyndon B Johnson School of Public Affairs, Austin, Texas. Mark Wahlqvist, Professor of Nutrition at Monash University, Aus...
There is no gold standard in the assessment of individual dietary intake methodology. The choice ... more There is no gold standard in the assessment of individual dietary intake methodology. The choice of dietary method to estimate individual intake depends upon the study objectives for the assessment of individual intake. We adopted a food frequency questionnaire and modified it for use in a study of food habits and cardiovascular health status in adult Chinese living in Melbourne. Australia. This is a semi-quantitative questionnaire (MCHS-FFQ) and is designed to estimate past food intake. It consists of 220 foods and beverages. A reference portion is given to obtain a quantitative estimate of the usual intake portion. Various internal validation tests were performed. The MCHS-FFQ, being a food frequency dietary method, does not provide a good estimate of nutrients in foods which are not served in standard portions. such as sodium. The MCHS-FFQ offered a good estimate for potassium and protein intake when compared to estimates derived from a single 24-h urine collection. Finally, the MCHS-FFQ was predictive of plasma cholesterol levels. We conclude that the MCHS-FFQ is adequate for the assessment of individual usual food and nutrient intakes in a representative sample of adult Melbourne Chinese. For foods that are not served in a standard portion or quantifiable addition, an alternative more reliable method would be required for quantitative purposes. The method is. however, likely to be useful for the appraisal of overall food patterns in Chinese populations.
This study investigated the food consumption patterns of 430 Beijing Chinese adults and assessed ... more This study investigated the food consumption patterns of 430 Beijing Chinese adults and assessed the impact on these patterns of the following socio-demographic characteristics: gender, age, educational achievement, and gross household income. Food intake by category, food variety and meal patterns were assessed using a 156-item food frequency questionnaire. It was found that gender and age were the most important factors to influence food consumption patterns. Men consumed more wheat products, red meat and tea, whereas women consumed more vegetables, fruit, nuts, fish, eggs and milk. Women also tended to consume a wider variety of food than did men. Furthermore, it was found that younger and more educated people tended to consume a wider variety of food. Age also had an important influence on the food intake. Younger and generally more educated adults tended to consume foods associated with affluence: meats, soft drinks and beer, while the older population tended to consume more ve...
The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-... more The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Australia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to develop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nutrient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting f...
Child undernutrition is a major health problem in Malawi. We assessed the association between mat... more Child undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15–49 years)—child (27.6 ± 16.7 months, range 0–59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score < – 2). Logistic regression assessed associations between maternal autonomy and stunting, and dominance analysis evaluated the relative importance of the associated factors. From the two surveys combined, 39.2% were stunted. Stunting decreased from 45.0% in 2010 to 34.6% in 2015/16; concurrently, maternal autonomy improved and was evidently associated with stunting (aOR = 0.81, 95% CI = 0.71, 0.93...
A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about bas... more A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about basic commodities was designed for the Elderly Nutrient and Health Survey in Taiwan (NAHSIT) to collect participants' usual intake of the previous month. We have examined the validity this SFFQ as assessed by multiple 24-hour dietary recall (n=81) and biomarkers (n=1473). All questionnaires were completed by face-to-face interview and fasting blood taken. Thirty seven males and 44 females were randomly selected from NAHSIT participants. Of these, 31 and 50 subjects completed 2 or 3 24-hour dietary recalls within one month, respectively. Mean daily intake frequencies for each food group were calculated from the SFFQ and 24-hr recalls, respectively. Spearman rank correlation coefficients between frequencies of food intake from the FFQ and dietary recalls ranged from 0.132 to 0.678 for men; 0.052 to 0.759 for women. For food weight, the trends were similar to frequency findings. For biomar...
annotation/report summary Barriers identified by authors Stated aims/goals of the program Outcome... more annotation/report summary Barriers identified by authors Stated aims/goals of the program Outcomes Year conducted Unexpected outcomes Methods Was an evaluation carried out? If yes, what type? Study design and setting Contact address Description of population group Table 1: Details examined in programs assessed. If a detail was not identified, it was recorded as ‘not stated’. In order to eliminate bias and judgement, the programs were assessed using the author’s identification of strengths, weaknesses, outcomes, key findings, and barriers. It is understood that project officers may have a biased view of the success of their program, especially if the only evaluation carried out was by anecdotal evidence or observation. External evaluators are less likely to be biased; however in many cases, programs conducted in schools do not have the available funding to employ an external evaluator. Due to a lack of Victorian based nutrition interventions; programs from other Australian states wer...
The Southeast Asian journal of tropical medicine and public health, 1997
International comparison of food intake and health studies amongst the aged is providing new insi... more International comparison of food intake and health studies amongst the aged is providing new insight into the importance of food culture in social context for healthy aging. At same time the possible variance in eating behavior compatible with good health requires consideration. The IUNS (International Union of Nutritional Sciences) FHILL (Food Habits in Later Life) Project, comprises (1) a morbidity study on about 2,000 elderly in 13 communities (now available on CD Rom) and (2) a mortality follow-up study. In the morbidity study, a total health assessment score or Later Life Status Score (LLSS) has been considered in relation to non-nutritional and nutritional factors. The elderly Greek cohorts aged 70+ in Melbourne. Australia (M = 94, F = 95) and Spata, Greece (M = 51, F = 53) have been used as a model for multivariate analyses to determine separately the importance of non-nutritional (well-being, memory, general health, medication-use, activities of daily living, exercise, socia...
Background: Knowledge of traditional African foods and food habits has been, and continues to be,... more Background: Knowledge of traditional African foods and food habits has been, and continues to be, systematically extirpated. With the primary intent of collating data for our online collection documenting traditional African foods and food habits (available at: www.healthyeatingclub.com/Africa/), we reviewed the Oltersdorf Collection, 75 observational investigations conducted throughout East Africa (i.e. Tanzania, Kenya, and Uganda) between the 1930s and 1960s as compiled by the Max Planck Nutrition Research Unit, formerly located in Bumbuli, Tanzania. Methods: Data were categorized as follows: (1) food availability, (2) chemical composition, (3) staple foods (i.e. native crops, cereals, legumes, roots and tubers, vegetables, fruits, spices, oils and fats, beverages, and animal foods), (4) food preparation and culture, and (5) nutrient intake and health status indicators. Results: Many of the traditional foods identified, including millet, sorghum, various legumes, root and tubers, green leafy vegetables, plant oils and wild meats have known health benefits. Food preparatory practices during this period, including boiling and occasional roasting are superior to current practices which favor frying and deep-frying. Overall, our review and data extraction provide reason to believe that a diversified diet was possible for the people of East Africa during this period (1930s-1960s). Conclusions: There is a wealth of knowledge pertaining to traditional East African foods and food habits within the Oltersdorf Collection. These data are currently available via our online collection. Future efforts should contribute to collating and honing knowledge of traditional foods and food habits within this region, and indeed throughout the rest of Africa. Preserving and disseminating this knowledge may be crucial for abating projected trends for non-communicable diseases and malnutrition in Africa and abroad.
In 1987, the International Union of Nutritional Sciences (IUNS) subcommittee on Nutrition and Age... more In 1987, the International Union of Nutritional Sciences (IUNS) subcommittee on Nutrition and Ageing, in conjunction with the World Health Organization (WHO) global program for the elderly, embarked on the 'Food Habits in Later Life' (FHILL): a cross-cultural study to determine to what extent health, social and lifestyle variables, especially food intake, collectively predict survival amongst long-lived cultures. A total of 818 participants aged 70 years and over were recruited from five IUNS centres. Mortality data were collected after five to seven years. The cohorts included Swedes in Sweden (SWD), Greeks in Greece (GRS) and in Melbourne, Australia (GRM), Anglo-Celts in Australia (ACS) and Japanese in Japan (JPN). Information was obtained on health, lifestyle and diet at baseline. A Cox Proportional Hazard model containing ten potential predictors of survival, adjusted to age at enrollment and ethnicity/locality, was developed to analyse the survival data. Based on up to seven years survival data, it was found that being an elderly Greek in Australia conferred the lowest mortality risk and being an elderly Greek in Greece conferred the highest mortality risk. When the ten potential predictors of survival were entered into the Cox model, the memory score, the Mediterranean diet score, Activities of Daily Living (ADL) and general health status scores showed the greatest effects in significantly reducing mortality hazard ratios by 22%, 13%, 4% and 4%, respectively. For diet score, a one-unit change predicted a significant 13% difference in survival. Of the lifestyle (modifiable) variables entered in the multivariate model, exercise and social activity were not significant predictors of survival suggesting that diet is a more important predictor of survival than these variables. Another lifestyle variable, smoking, significantly increased mortality hazard ratios by 67%, making it a more important predictor of survival than diet. Being male (non-modifiable) also increased risk of death by 63%. Diet, particularly the Mediterranean Diet, operates irrespective and together with other factors as an appreciable contributor to survival, with a strength comparable to or greater than all other measured variables. The independence and strength of the predictiveness of food pattern for survival, and for this to be cross-cultural from Europe to Asia is a novel and important observation for food and health policy.
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