Traditional Eastern European diet and mortality: prospective evidence from the HAPIEE study

Denes Stefler, Daniel Brett, Eszter Sarkadi-Nagy, Ewa Kopczynska, Stefan Detchev, Aniko Bati, Mircea Scrob, Diane Koenker, Bojan Aleksov, Elodie Douarin, Galina Simonova, Sofia Malyutina, Ruzena Kubinova, Andrzej Pajak, Milagros Ruiz, Anne Peasey, Hynek Pikhart, Martin Bobak

Research output: Contribution to journalArticlepeer-review


Purpose: Cardiovascular disease (CVD) and cancer mortality rates in Eastern Europe are among the highest in the world. Although diet is an important risk factor, traditional eating habits in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European cohorts. Methods: Data from the Health, Alcohol and Psychosocial factors in Eastern Europe prospective cohort were used, including participants from Russia, Poland and the Czech Republic. Based on food frequency questionnaire data, we constructed an Eastern European diet score (EEDS) from nine food groups which can be considered as traditional in this region. The relationship between categorical (low, moderate, high) and continuous (range 0–18) EEDS and mortality was estimated with Cox-regression. Results: From 18,852 eligible participants, 2234 died during follow-up. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.23; 95% CI 1.08–1.42) and CVD (1.34; 1.08–1.66) deaths compared to those with low adherence. The association with cancer mortality was only significant in Poland (high vs. low EEDS: 1.41; 1.00–1.98). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while preserved fruit and vegetable consumption showed consistent inverse associations. Conclusion: Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential.

Original languageEnglish (US)
Pages (from-to)1091-1100
Number of pages10
JournalEuropean Journal of Nutrition
Issue number2
StatePublished - Mar 2021


  • Cancer
  • Cardiovascular disease
  • Dietary pattern
  • Eastern Europe
  • Mortality

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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