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Health issues and nutrition in the elderly

Diet quality in an ethnically diverse population of older men in Australia

European Journal of Clinical Nutrition volume 75, pages 1792–1800 (2021)Cite this article

Subjects

Abstract

Background/objectives

To compare the Australian Dietary Guideline Index (DGI-2013) and the Pyramid-based Mediterranean Diet Score (pyrMDS) as measures of diet quality in an ethnically diverse group of older men.

Subjects/methods

Seven hundred and ninety-four older men aged ≥75 participated in wave 3 (2012–2013) of the Concord Health and Ageing in Men Project. Dietary intake was assessed using a validated diet history questionnaire. Ethnicity was based on self-reported country of birth and categorised as Australian-born (418 men), Italian or Greek migrants (188), and other migrants (188). Incident cardiovascular outcomes until March 2018 were measured using the composite of major adverse cardiovascular events (MACE), which comprises all-cause mortality, acute myocardial infarction, congestive cardiac failure, coronary revascularisation and/or ischaemic stroke. Ability to predict incident cardiovascular outcomes and all-cause mortality were compared between standardised DGI-2013 pyrMDS scores by comparison of hazard ratios, discrimination (Harrell’s C-statistic) and calibration (calibration plots).

Results

Italian and Greek migrant men had significantly lower DGI-2013 scores (91.7 vs. 93.9; p = 0.01) but significantly higher pyrMDS scores (8.8 vs. 8.2; p < 0.0001) than Australian-born men. In the whole sample (794 men), the pyrMDS was a better predictor of both MACE (age-adjusted HR = 0.84; 95% CI = 0.75–0.94 vs. HR = 0.92; 95% CI = 0.82–1.03 for DGI-2013) and all-cause mortality (age-adjusted HR = 0.69; 95% CI = 0.60–0.80 vs. HR = 0.86; 95% CI = 0.74–0.99). The pyrMDS also demonstrated superior discrimination for predicting all-cause mortality and superior calibration for MACE and all-cause mortality.

Conclusions

The DGI-2013 appears to underestimate diet quality in older Italian and Greek migrant men. The pyrMDS appears superior to the DGI-2013 for prediction of incident cardiovascular disease and mortality regardless of ethnic background.

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Fig. 1: Mean diet quality scores based on pyrMDS and DGI-2013 by country of birth (n = 794).
Fig. 2: Hazard ratios for MACE and all-cause mortality per SD increase in pyrMDS and DGI-2013 (n = 745).
Fig. 3: Comparison of discrimination in prediction of MACE and death between the pyrMDS and DGI-2013 (n = 745).
Fig. 4: Hazard ratios for MACE and all-cause mortality per SD increase in pyrMDS and DGI-2013 in sensitivity analysis excluding those reporting being on a special diet for their health (n = 601).

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Funding

The CHAMP study is funded by the National Health and Medical Research Council of Australia (Project Grant No. 301916) and the Ageing and Alzheimer’s Institute and the Sydney Medical School Foundation. This work was supported by the Australian Research Council Centre of Excellence in Population Aging Research (Project number CE170100005). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Author notes

  1. These authors contributed equally: Fiona F. Stanaway, Rosilene V. Ribeiro

Authors and Affiliations

  1. Faculty of Medicine and Health, University of Sydney School of Public Health, Sydney, NSW, Australia

    Fiona F. Stanaway, Saman Khalatbari-Soltani, Erin Cvejic, Fiona M. Blyth & Robert G. Cumming

  2. ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, NSW, Australia

    Fiona F. Stanaway, Saman Khalatbari-Soltani, Fiona M. Blyth & Robert G. Cumming

  3. School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia

    Rosilene V. Ribeiro, Stephen J. Simpson & Vasant Hirani

  4. Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, NSW, Australia

    Vasi Naganathan & Louise M. Waite

  5. Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Vasi Naganathan, David G. Le Couteur, Louise M. Waite, Robert G. Cumming & Vasant Hirani

  6. Ageing and Alzheimer’s Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, NSW, Australia

    Vasi Naganathan, David G. Le Couteur & Louise M. Waite

  7. ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia

    David J. Handelsman & David G. Le Couteur

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Contributions

FFS and RVR conceived the study in discussion with RGC and VH. All authors played an important role in interpreting the results. FFS and RVR drafted the manuscript and all other authors played a critical role in revising the manuscript. All authors approved the final version. All authors are accountable for the work.

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Correspondence to Fiona F. Stanaway.

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Stanaway, F.F., Ribeiro, R.V., Khalatbari-Soltani, S. et al. Diet quality in an ethnically diverse population of older men in Australia. Eur J Clin Nutr 75, 1792–1800 (2021). https://doi.org/10.1038/s41430-021-00893-7

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