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Diet and Mortality Rates Studies

Three scientific works that explore the relations between nutrition and public health were selected for the assignment. They are Adherence to a Mediterranean Diet and Survival in a Greek Population by Trichopoulou et al., Midlife Moderation-Quantified Healthy Diet and 40-Year Mortality Risk from CHD by Dai, Krasnow, and Reed, and Mediterranean Diet Score and Total and Cardiovascular Mortality in Eastern Europe by Stefler et al. The main topic of these studies is the correlation between nutrition and diseases, which increase mortality rates in countries such as Greece, the United States, Check Republic, Poland, and Russia. Trichopoulou et al. explored the general relationship between the Mediterranean diet and longevity, and Stefler et al. reviewed its influence on mortality from cardiovascular diseases (Trichopoulou et al., 2003). In contrast, Dai, Krasnow, and Reed narrowed the topic to middle-aged death rates from CHD and the impact of healthy nutrition as prevention.

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While the Mediterranean diet-related researches are population-based, the Midlife Moderation-Quantified Healthy Diet one has the twin study type, making it more precise and evidence-based than the other two. The data source for all studies is individuals of certain countries, their lifestyle, nutritional, and health conditions. Tools such as a semiquantitative food-frequency questionnaire, food intake, and physical activity measurement were applied to retrieve and structure the data in the first study (Trichopoulou et al., 2003). Similarly, the other researchers used surveys, yet the Eastern Europe-based one included medical examination and blood sampling (Stefler et al., 2017). The most comprehensive data collection analysis was in the CHD study: in-person interviews for 514 middle-aged, white male veteran twin pares combined with checking their nutrition’s relevance to a moderation-quantified healthy diet (Dai et al., 2016). All studies included a variety of Mediterranean food consumption as the most beneficial eating pattern.

The Mediterranean diet is traditional for European countries, and its variations are considered the healthiest for the continent’s inhabitants. Indeed, the health outcomes from Trichopoulou et al. (2003) are that “greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality.” (p. 2599). The Eastern Europe population study outcomes support this statement because cardiovascular diseases are the leading causes of death (Stefler et al., 2017). Compared to these works, the twin-based research did not reveal that a specific diet can prevent CHD, yet it submitted that healthy, whole-food nutrition is a useful preventative measure (Dai et al., 2016). Consequently, the proper diet, such as the Mediterranean, is considered a protective factor in all three studies, while the absence of healthy meals is the risk factor that threatens the longevity of various populations. The results retrieved from statistical analysis and follow-ups showed that a two-point increment in the Mediterranean-diet score was associated with a 25 percent reduction in total mortality among Greeks (Trichopoulou et al., 2003). Similarly, the twin study and the Eastern Europe population researchers’ concluded that mortality rates lower as the healthy diet scores increase.

The main strength of all studies is the quantitative reference for healthy nutrition and the essential scope of results that show the dependence between individuals’ longevity and diet. Furthermore, Dai et al. (2016) research’s advantage was that the participants were twins, and “within-pair associations are controlled for age, cohort, period effects and secular trends as unmeasured (latent) environmental factors” (p. 333). The critical limitation for Greek and Eastern Europe studies is that dietary habits vary among the populations, and some products might be prevalent in certain regions while others might be in deficit (Stefler et al., 2017). Besides, all three pieces of research did not measure physical activity levels and patterns, yet they also impact the longevity and cardiovascular disease development.

The studies’ are high-quality because they include clearly specified and defined populations, sufficient timeframes, and retrieved data to discover and analyze patterns. Moreover, their validity is shown through the appropriate participants’ selection, specified content of interviews and questionnaires, and constructed measurements of the outcomes. Compared to the Mediterranean diet-based studies’ sample size, which was larger than 20,000, the CHD one sampled 910 twins, which is also a considerable population due to its rareness (Dai et al., 2016). All scientific works are reliable because the analysis tools such as Falconer’s method, SAS software statistics, and Cox proportional hazard models were applied (Stefler et al., 2017). Studies’ populations were different as Greek, Eastern European, and American inhabitants participated, yet the primary outcome of the relationship between lower mortality and a healthy diet was the same. Consequently, the analyzed researches are highly generalizable, and the results can be utilized in healthcare and nutrition institutions worldwide.

Table 1: The degree to which causal criteria are met for the relationship between the health outcome and risk factors for the selected health outcome

Criteria for a causal relationship Yes/No Why or why not
Strength of association Yes Poor nutrition is considered as a risk factor for increased mortality rates, proven in the studies;
Consistency upon repetition Yes The patterns are noticeable in all studies, and health outcomes are consistent among different populations;
Specificity No The populations were large, and the mortality rate is not specific (excluding the CHD study);
Time sequence/Temporality Yes The statement that poor nutrition threatens longevity preceded the scientific works’ and observations’ results (Archer et al., 2018);
Biologic plausibility Yes The observations of three different populations showed evidence of the benefits of Mediterranean and whole-foods diets;
Dose/response relationship No There is no clear evidence that a specific range or amount of healthy foods relates to mortality or cardiovascular diseases’ risks;
Experiment No The studies did not include specific experiments or interventions;

The results of nutritional studies must be applied to public health practice as preventative measures because of the food intake’s vitality for every individual. The conclusions made from the analysis of a disease’s development, mortality rates, and dietary patterns need to be used for updating healthcare recommendations. For instance, governments can update food programs updates in facilities like schools to help young citizens develop proper nutritional habits. Consequently, the mortality rates from diseases such as CHD will decrease due to the effective diet-based prevention supported by the analyzed studies.

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Archer, E., Lavie, C. J., & Hill, J. O. (2018). The failure to measure dietary intake engendered a fictional discourse on diet-disease relations. Frontiers in Nutrition, 5, 105.

Dai, J., Krasnow, R. E., & Reed, T. (2016). A midlife moderation-quantified healthy diet and 40-year mortality risk from CHD: the prospective National Heart, Lung, and Blood Institute Twin Study. British Journal of Nutrition, 116(2), 326-334.

Stefler, D., Malyutina, S., Kubinova, R., Pajak, A., Peasey, A., Pikhart, H.,… & Bobak, M. (2017). Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study. European Journal of Nutrition, 56(1), 421-429.

Trichopoulou, A., Costacou, T., Bamia, C., & Trichopoulos, D. (2003). Adherence to a Mediterranean diet and survival in a Greek population. New England Journal of Medicine, 348(26), 2599-2608.

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