- Title
- Diet quality and non-communicable diseases in Australian women at different stages of life
- Creator
- Hlaing Hlaing Hlaing
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Occurrence of non-communicable diseases (NCDs) and multimorbidity (the presence of two or more chronic conditions) is increasing as a consequence of population ageing and growth, globalisation and urbanisation. An emerging body of evidence has shown that these conditions are not limited to older people, and there is an increasing NCD and multimorbidity trend amongst younger Australian women of reproductive age. Multifactorial causation, interplay of non-modifiable and modifiable risk factors, is one of the determinants of NCDs. Evidence indicates that dietary factor, one of the modifiable risk factors, has significant effect on mortality and morbidity of common NCDs. However, existing evidence on risk factors of multimorbidity is still evolving. There is limited data on dietary factors and NCD multimorbidity in longitudinal settings. This thesis explores the association of overall diet and common NCDs, including multimorbidity, and all-cause mortality among women from a national population-based study. This thesis comprises four studies: one systematic review and critical appraisal summarising diet quality indices (DQIs) used in Australian and New Zealand adults; and three empirical studies (two cross-sectional and one longitudinal) investigating whether diet quality (DQ) had effect on subsequent occurrence of common NCDs in women at different life stages. Three empirical studies used data from the Australian Longitudinal Study on Women’s Health (ALSWH), 1946-51 cohort (n=13,714 at survey 1 in 1996) and 1973-78 cohort (n=14,247 at survey 1 in 1996). The systematic review and critical appraisal of DQIs used in Australian and New Zealand adults (n=25 DQIs from 76 reviewed articles) found that there were DQIs with preferable features such as the inclusion of adequacy, moderation and balance in dimension; nested structure; both food groups and nutrients in indicator selection; both healthy and unhealthy components; metric scaling procedure; normative cut-off points; weighted aggregation technique; and evaluation of DQIs. These DQIs were those built on the Australian Dietary Guidelines (the Dietary Guideline Index, Dietary Guideline Index-2013, Total Diet Score, Healthy Eating Index for Australian Adults-2013 and Aussie-Diet Quality Index) and specific dietary patterns (the Mediterranean Diet Score and Alternative Healthy Eating Index-2010). Three DQIs with preferable features based on different theoretical backgrounds were identified for use in empirical studies; (1) the HEIFA-2013 based on the Australian Dietary Guidelines-2013; (2) the MDS based on a specific dietary pattern prevalent in Mediterranean region; and (3) the AHEI-2010 based on food and nutrients beneficial for NCD prevention. In the first empirical study conducted in the 1946-51 cohort (50-55 years old at baseline), the selected DQIs were used in examining the preventive potential of DQ on NCDs across five consecutive surveys (survey 4 to survey 8, 15-year follow-up). The results showed that DQ is a potential determinant of some NCDs (hypertension, asthma, diabetes mellitus, depression and/or anxiety), and multimorbidity in later surveys (S6 to S8). Of the three selected DQIs, the AHEI-2010 was associated with more NCDs in women from the 1946-51 cohort. Thus, it was used in exploring the relationship between DQ and NCDs in the ALSWH 1973-78 cohort (25-30 years at baseline). In the second empirical study, the association between the AHEI-2010 at baseline (S3), and incident NCDs in young Australian women (25-30 years old at baseline) was explored by performing cross-sectional analysis across five consecutive surveys (survey 4 to survey 8, 15-year follow-up). It was observed that there was no relationship between DQ at baseline and NCD outcomes in women aged 25-45 years, except reducing odds of asthma at 3 years after the measure of diet. In the third empirical study, the impact of time-varying covariates on longitudinal association between diet and NCDs were explored among women from the ALSWH 1973-78 cohort. The results from this study support the temporal relationship between DQ and some NCDs such as hypertension, asthma, and multimorbidity in Australian women aged 25-45 years. Overall, this thesis concluded that overall diet supported the association between DQ and subsequent diagnosis of NCD across 15 years of follow-up in women from the 1946-51 cohort who were aged 50-55 years at baseline. Amongst young women from the 1973-78 cohort aged 25-30 years at baseline, associations between DQ and incidence of some NCDs were demonstrated in longitudinal modelling.
- Subject
- diet quality; non-communicable diseases; women; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1508702
- Identifier
- uon:56147
- Rights
- Copyright 2022 Hlaing Hlaing Hlaing
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 160 KB | Adobe Acrobat PDF | View Details Download |