Public Health Nutrition


Scoring models of a diet quality index and the predictive capability of mortality in a population-based cohort of Swedish men and women

Isabel Drakea1a2 c1 p1, Bo Gullberga1, Emily Sonestedta1, Peter Wallströma1, Margaretha Perssona1a2, Joanna Hlebowicza1a2, Jan Nilssona1a2, Bo Hedblada1a2 and Elisabet Wirfälta1

a1 Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden

a2 Center for Emergency, Skåne University Hospital, Malmö, Sweden


Objective To examine how different scoring models for a diet quality index influence associations with mortality outcomes.

Design A study within the Malmö Diet and Cancer cohort. Food and nutrient intakes were estimated using a diet history method. The index included six components: SFA, PUFA, fish and shellfish, fibre, fruit and vegetables, and sucrose. Component scores were assigned using predefined (based on dietary recommendations) and population-based cut-offs (based on median or quintile intakes). Multivariate Cox regression was used to model associations between index scores (low, medium, high) and all-cause and cause-specific mortality by sex.

Setting Malmö, the third largest city in Sweden.

Subjects Men (n 6940) and women (n 10 186) aged 44–73 years. During a mean follow-up of 14·2 years, 2450 deaths occurred, 1221 from cancer and 709 from CVD.

Results The predictive capability of the index for mortality outcomes varied with type of scoring model and by sex. Stronger associations were seen among men using predefined cut-offs. In contrast, the quintile-based scoring model showed greater predictability for mortality outcomes among women. The scoring model using median-based cut-offs showed low predictability for mortality among both men and women.

Conclusions The scoring model used for dietary indices may have a significant impact on observed associations with disease outcomes. The rationale for selection of scoring model should be included in studies investigating the association between dietary indices and disease. Adherence to the current dietary recommendations was in the present study associated with decreased risk of all-cause and cause-specific mortality, particularly among men.

(Received November 04 2011)

(Revised March 01 2012)

(Accepted April 24 2012)

(Online publication May 29 2012)


  • Diet;
  • Index;
  • Mortality;
  • Scoring


c1 Corresponding author: Email

p1 Correspondence address: Research Group in Nutrition Epidemiology, Department of Clinical Sciences in Malmö, Skåne University Hospital Malmö, Entrance 72, House 60, Level 13, SE-205 02 Malmö, Sweden.