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.

Department of Epidemiology and Population Studies Jagiellonian University Collegium Medicum Krakow Poland

Department of Epidemiology and Public Health University College London 1 19 Torrington Place London WC1E 7HB UK

Department of History South West University Blagoevgrad Bulgaria

Department of Liberal Arts and Natural Sciences University of Birmingham Birmingham UK

Department of Nutritional Epidemiology National Institute of Pharmacy and Nutrition Budapest Hungary

Institute of Ethnology MTA Research Centre for the Humanities Budapest Hungary

Institute of Sociology Jagiellonian University Krakow Poland

National Institute of Public Health Prague Czech Republic

Novosibirsk State Medical University Novosibirsk Russia

Research Institute of Internal and Preventive Medicine Branch of the Institute of Cytology and Genetics Siberian Branch of Russian Academy of Sciences Novosibirsk Russia

School of Slavonic and East European Studies University College London London UK

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