British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Adherence to dietary guidelines and 15-year risk of all-cause mortality

Joanna Russella1, Victoria Flooda1 c1, Elena Rochtchinaa2, Bamini Gopinatha2, Margaret Allman-Farinellia3, Adrian Baumana4 and Paul Mitchella2

a1 School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, NSW 2522, Australia

a2 Centre for Vision Research (Westmead Millennium Institute), University of Sydney, NSW 2006, Australia

a3 School of Molecular Bioscience, University of Sydney, NSW 2006, Australia

a4 School of Public Health, University of Sydney, NSW 2006, Australia


Past investigation of diet in relation to disease or mortality has tended to focus on individual nutrients. However, there has been a recent shift to now focus on overall patterns of food intake. The present study aims to investigate the relationship between diet quality reflecting adherence to dietary guidelines and mortality in a sample of older Australians, and to report on the relationship between core food groups and diet quality. This was a population-based cohort study of persons aged 49 years or older at baseline, living in two postcode areas west of Sydney, Australia. Baseline dietary data were collected during 1992–4, from 2897 people using a 145-item Willett-derived FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine diet quality scores. The Australian National Death Index provided 15-year mortality data using multiple data linkage steps. Hazard risk (HR) ratios and 95 % CI for mortality were assessed for diet quality. Subjects in quintile 5 (highest) of the Total Diet Score had a 21 % reduced risk of all-cause mortality (HR 0·79, 95 % CI 0·63, 0·98, P trend= 0·04) compared with those in quintile 1 (lowest) after multivariate adjustment. The present study provides longitudinal support for a reduced risk of all-cause mortality in an older population who have greater compliance with published dietary guidelines.

(Received May 25 2011)

(Revised March 08 2012)

(Accepted March 17 2012)

(Online publication May 09 2012)

Key Words:

  • Total Diet Score;
  • Mortality;
  • Older adults


c1 Corresponding author: Dr V. Flood, fax +61 2 4221 3486, E-mail:


  Abbreviations: AGHE, Australian Guide to Healthy Eating; BMES, Blue Mountains Eye Study; DGAA, Dietary Guidelines for Australian Adults; HR, hazard risk; MET.min, metabolic equivalents.min; TDS, Total Diet Score