Abstract
PURPOSE: Evaluation of the added value of Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diet scores on the prediction model of the World Health Organization (WHO) to predict 10-year cardiovascular disease (CVD) mortality using the Golestan Cohort Study data. METHODS: A total of 44,648 participants (25,268 women and 18,531 men) were included in the final analysis. To assess the external validity of the non-laboratory risk model of WHO, the Area Under the Curve (AUC) and calibration plot methods were used. The multivariate Cox proportional hazards regression analysis was used to evaluate the association of 10-year CVD mortality risk with DASH and Mediterranean scores and their components. The added value of each significant variables was evaluated by the concordance C-statistic and integrated discrimination improvement (IDI). Statistical significance was defined as p-value < 0.05. RESULTS: DASH and Mediterranean diet scores were not significant predictors of 10-year CVD mortality in both genders (p > 0.05). However, sodium and total vegetable in both genders and added sugar in women were significant predictors for 10-year stroke mortality (p < 0.05). Sodium intake in women and monounsaturated fatty acid (MUFA) to saturated fatty acid (SFA) ratio in men had significant associations with 10-year mortality of myocardial infarction/coronary heart disease (MI/CHD). Calculation of IDI showed that none of the evaluated nutritional indices/variables could significantly improve the WHO model performance and predictive ability. CONCLUSION: Inclusion of DASH and Mediterranean diet scores and their components did not improve WHO risk prediction model performance and predictive ability to predict 10-year CVD mortality. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-024-01463-x.