# The Prime Diet Quality Score (PDQS), chronic disease and cause-specific mortality in UK Biobank: a prospective study

## TL;DR

A study found that better diet quality, measured by the PDQS, is linked to lower risks of chronic diseases and death in UK adults.

## Contribution

The study introduces the PDQS as a practical tool for assessing diet quality and demonstrates its association with reduced mortality and chronic disease risks.

## Key findings

- Higher PDQS scores were associated with lower total mortality (HR 0.80) and cancer mortality (HR 0.87).
- PDQS was linked to reduced risks of respiratory diseases (HR 0.56) and neurodegenerative diseases (HR 0.61).
- Better diet quality correlated with lower risks of T2D (HR 0.73) and NAFLD (HR 0.66).

## Abstract

The Prime Diet Quality Score (PDQS) is a global food-based metric for assessing diet quality. We evaluated PDQS-measured diet quality in relation to mortality and major chronic disease outcomes in the UK Biobank.

This population-based cohort study included UK adults (40–69 years) recruited in 2006–2010 and followed until 2021. PDQS was derived from ≥ 2 dietary recalls. Multivariable Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for total and cause-specific mortality, cardio-metabolic diseases (type 2 diabetes [T2D], cardiovascular disease [CVD], myocardial infarction [MI], stroke), respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma), cancers (total, lung, colorectal, oesophageal, postmenopausal breast, prostate), neurodegenerative diseases (dementia, Parkinson’s, anxiety, depression), non-alcoholic fatty liver disease (NAFLD), chronic kidney disease (CKD), eczema, psoriasis, fracture, and osteoporosis.

Among 124,851 participants (mean age 59 ± 8 years), those in the highest PDQS quartile had lower mortality risks: total (HR 0.80, 95% CI 0.73–0.88), cancer (0.87, 0.77–0.98), respiratory (0.56, 0.37–0.87), and neurodegenerative (0.61, 0.39–0.96). Chronic morbidity risks were lower for T2D (0.73, 0.66–0.81), MI (0.80, 0.71–0.90), ischemic stroke (0.86, 0.74–1.00), COPD (0.80, 0.69–0.94), total cancer (0.94, 0.88–0.99), lung cancer (0.75, 0.58–0.97), anxiety (0.85, 0.78–0.92), NAFLD (0.66, 0.56–0.77), and CKD (0.74, 0.69–0.80).

Higher PDQS scores are linked to reduced mortality and chronic disease risk. PDQS is a practical tool for assessing diet quality in epidemiological research.

The online version contains supplementary material available at 10.1007/s00394-025-03877-6.