Diet Quality as Assessed by the Healthy Eating Index,Alternate Healthy Eating Index,Dietary Approaches to Stop Hypertension Score,and Health Outcomes: A Second Update of a Systematic Review and Meta-Analysis of Cohort Studies

BackgroundSuboptimal diet quality has a large impact on noncommunicable disease burden.ObjectiveThis study aimed to update the body of evidence on the associations between diet quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and the Dietary Approaches to Stop Hypertension score, and health status. Moreover, results of the previous systematic reviews and meta-analyses were extended by evaluating the credibility of the evidence.MethodsPubMed, Embase, and Scopus databases were searched to identify eligible studies published between May 15, 2017 and March 14, 2020. Pooled relative risk (RR) with 95% CI for highest vs lowest category of diet quality were estimated using a random-effects model. Heterogeneity was explored using Cochran's Q test and I² statistic with 95% CI. Presence of publication bias was detected by using funnel plots and Egger's regression test. The NutriGrade tool was used to assess the credibility of evidence.ResultsThe current update identified 47 new reports, resulting in a total of 113 reports including data from 3,277,684 participants. Diets of the highest quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores, were inversely associated with risk of all-cause mortality (RR 0.80, 95% CI 0.79 to 0.82, I² = 68%, n= 23), cardiovascular disease incidence or mortality (RR 0.80, 95% CI 0.78 to 0.82, I² = 59%, n= 45), cancer incidence or mortality (RR 0.86, 95% CI 0.84 to 0.89, I² = 73%, n= 45), incidence of type 2 diabetes (RR 0.81, 95% CI 0.78 to 0.85, I² = 76%, n= 16), and incidence of neurodegenerative diseases (RR 0.82, 95% CI 0.75 to 0.89, I² = 71%, n= 12). In cancer survivors, the highest diet quality was linked with lower risk of all-cause (RR 0.83, 95% CI 0.77 to 0.88, I² = 45%, n= 12) and cancer mortality (RR 0.82, 95% CI 0.75 to 0.89, I² = 44%, n= 12). The credibility of evidence for identified associations between overall healthy dietary patterns and included health outcomes was moderate.ConclusionThis updated systematic review and meta-analysis suggests that high diet quality (assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension) is inversely associated with risk of all-cause mortality, cardiovascular disease incidence or mortality, cancer incidence or mortality, type 2 diabetes, and neurodegenerative disease, as well as all-cause mortality and cancer mortality among cancer survivors. Moderate credibility of evidence for identified associations complements the recent 2020 Dietary Guidelines Advisory Committee report recommending healthy dietary patterns for disease prevention.     

Associations between Adherence to Four A Priori Dietary Indexes and Cardiometabolic Risk Factors among Hyperlipidemic Patients

Little is known about which currently available a priori dietary indexes provide best guidance for reducing cardiometabolic risk factors (CMRF) among hyperlipidemic patients. This study was designed to compare the associations between four a priori dietary indexes, including Diet Balance Index (DBI-16), Chinese Healthy Eating Index (CHEI), Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) and CMRF among hyperlipidemic patients. A total of 269 participants were enrolled into the cross-sectional study. DBI-16, CHEI, MDS, and DASH scores were calculated using established methods. CMRF was measured using standard methods. DBI-total scores (DBI-TS) were inversely associated with triglyceride concentrations and TC:HDL-C ratio, and positively associated with HDL-C and ApoA1 concentrations (all p < 0.05), while the results for DBI-low bound scores (DBI-LBS) were opposite. DBI-high bound scores (DBI-HBS) and DASH scores were positively and inversely associated with glucose concentrations, respectively (both p < 0.05). Higher diet quality distance (DQD) was positively associated with higher TC, LDL-C and ApoB concentrations, and TC:HDL-C and LDL-C:HDL-C ratios, and lower HDL-C and ApoA1 concentrations and ApoA1:ApoB ratio (all p < 0.05). CHEI scores were inversely associated with triglyceride concentrations (p = 0.036). None of the dietary indexes was associated with blood pressures. DBI-16 provided most comprehensive evaluations of the overall diet quality and balance for optimizing cardiometabolic health among hyperlipidemic individuals.     

Association between Diet Quality Scores and Risk of Hip Fracture in Postmenopausal Women and Men Aged 50 Years and Older

Background

Although a number of studies showed a lower risk of hip fractures with high-quality diets, few of them were conducted in the United States.

Diet Quality Indices in the SUN Cohort: Observed Changes and Predictors of Changes in Scores Over a 10-Year Period

BackgroundDietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood.ObjectiveTo evaluate within-participant longitudinal changes in scores for nine a priori–defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the “Seguimiento Universidad de Navarra” (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up.DesignIn this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ).Participants/settingSpanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7).Main outcome measuresMain outcome measures were within-participant longitudinal changes for FQI, CQI, PVG, MEDAS, MDS, DASH, MIND, PDQS, and AHEI-2010.Statistical analyses performedAdjusted logistic regression models were used to evaluate within-participant longitudinal changes and to identify baseline predictors of improvements ≥10% in MEDAS and AHEI-2010 scores after 10 years of follow-up.ResultsThe comparison of the nine scores of DQI calculated at baseline and after 10 years of follow-up showed an improvement in all DQI scores except for PDQS. The greatest changes in DQIs were found for MEDAS (from 6.2 to 7.2, +22.9%) and MDS (from 4.3 to 4.4, +15.4%). The strongest predictors at baseline for ≥10% improvements in MEDAS or AHEI-2010 scores varied across indices. Being female, ≥35 years old, and more physically active at baseline were associated with improvement, whereas snacking between meals was associated with <10% improvements in both indices.ConclusionsIn this cohort, the changes in nine a priori-defined DQI scores suggested modest improvements in diet quality, in which MEDAS and MDS scores showed the largest improvements. Additional longitudinal studies, especially intervention trials with long follow-up, are warranted to establish the most appropriate DQIs to assess long-term changes in diet quality in adult populations.     

The Role of Dietary Patterns in the Contribution of Cardiorespiratory Fitness in Community-Dwelling Older Chinese Adults in Hong Kong

ObjectiveWe examined the influence of various dietary patterns on cardiorespiratory fitness (CRF) expressed as peak oxygen uptake (VO₂peak), taking into account demographics and lifestyle risk factors.DesignProspective cohort study.Participants and methodsWe conducted multivariate linear regression analyses using available data from a cohort of community-dwelling older Chinese adults (752 men, 483 women) in Hong Kong. Baseline interviewer-administered questionnaires covered dietary intake estimation and dietary pattern generation from the food frequency questionnaire, demographic and lifestyle factors, self-reported medical history, as well as frailty status. VO₂peak at the 7-year follow-up was measured using symptom-limited maximal exercise testing on an electrically braked bicycle ergometer.ResultsIn men, baseline Diet Quality Index–International (DQI-I) score (β = 0.044, P = .013) and Okinawan diet score (β = 0.265, P = .014) was independently associated with age-adjusted VO₂peak at the 7-year follow-up. The significant association was only retained for the Okinawan diet score in the multivariate adjusted model (β = 0.227, P = .039). Dietary pattern scores including the Dietary Approaches to Stop Hypertension (DASH) score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet score, Mediterranean Diet Score, and 3 other pattern scores derived by factor analysis were not associated with VO₂peak. In women, none of the dietary pattern scores at baseline was associated with VO₂peak in both the age-adjusted and multivariate-adjusted models.Conclusions/ImplicationsA higher Okinawan diet score was associated with a higher 7-year CRF in community-dwelling Chinese older men. Further studies are warranted to examine the underlying mechanisms on how the Okinawan diet influences CRF.     

Association Between Dietary Patterns in Midlife and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study

ObjectiveTo examine the associations between dietary patterns in midlife and likelihood of future healthy ageing in Chinese older adults.DesignProspective population-based study.Setting and ParticipantsWe included 14,159 participants aged 45-74 years who were free from cancer, cardiovascular disease, or diabetes at baseline (1993-1998) from the Singapore Chinese Health Study.MethodsDietary intakes in midlife were assessed by a validated food frequency questionnaire at baseline. Diet quality was scored according to the alternate Mediterranean diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) diet, the alternative Healthy Eating Index (AHEI)–2010, overall plant-based diet index (PDI), and healthful plant-based diet index (hPDI). Healthy ageing was assessed at the third follow-up visit (2014-2016), which occurred about 20 years after the baseline visit, and was defined as the absence of 10 chronic diseases, no impairment of cognitive function, no limitations in instrumental activities of daily living, no clinical depression at screening, good overall self-perceived health, good physical functioning, and no function-limiting pain among participants who had survival to at least 65 years of age. Multivariable-adjusted logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between each dietary pattern score and healthy ageing.ResultsAbout 20.0% of participants met the healthy ageing criteria. The OR (95% CI) for healthy ageing comparing the highest with the lowest quartile of diet quality scores was 1.52 (1.31-1.77) for aMED, 1.53 (1.35-1.73) for DASH, 1.39 (1.23-1.57) for AHEI-2010, 1.34 (1.18-1.53) for PDI, and 1.45 (1.27-1.65) for hPDI (all P-trend < .001). Each standard deviation increment in different diet quality scores was associated with 12% to 18% higher likelihood of healthy ageing.Conclusions and ImplicationsIn this Chinese population, adherence to various healthy dietary patterns at midlife is associated with higher likelihood of healthy ageing at later life.     

Abstracts of Articles on Nutrition and Cancer

Background: Overall diet quality measurements have been suggested as a useful tool to assess diet-disease relationships. Oxidative stress has been related to the development of obesity and other chronic diseases. Furthermore, antioxidant intake is being considered as protective against cell oxidative damage and related metabolic complications.

Objective: To evaluate potential associations between the dietary total antioxidant capacity of foods (TAC), the energy density of the diet, and other relevant nutritional quality indexes in healthy young adults.

Methods: Several anthropometric variables from 153 healthy participants (20.8 ± 2.7 years) included in this study were measured. Dietary intake was assessed by a validated food-frequency questionnaire, which was also used to calculate the dietary TAC and for daily energy intake adjustment.

Results: Positive significant associations were found between dietary TAC and Mediterranean energy density hypothesis–oriented dietary scores (Mediterranean Diet Score, Alternate Mediterranean Diet Score, Modified Mediterranean Diet Score), non-Mediterranean hypothesis–oriented dietary scores (Healthy Eating Index, Alternate Healthy Eating Index, Diet Quality Index-International, Diet Quality Index-Revised), and diversity of food intake indicators (Recommended Food Score, Quantitative Index for Dietary Diversity in terms of total energy intake). The Mediterranean Diet Quality Index and Diet Quality Index scores (a Mediterranean and a non–Mediterranean hypothesis–oriented dietary score, respectively), whose lower values refer to a higher diet quality, decreased with higher values of dietary TAC. Energy density was also inversely associated with dietary TAC.

Conclusion: These data suggest that dietary TAC, as a measure of antioxidant intake, may also be a potential marker of diet quality in healthy subjects, providing a novel approach to assess the role of antioxidant intake on health promotion and diet-based therapies.     

Consumption of Foods Away from Home Is Associated with Lower Diet Quality Among Adults Living in Puerto Rico

BackgroundConsuming foods away from home (FAFH) is ubiquitous, yet, it is unclear how it influences diet in diverse populations.ObjectiveThe study aimed to evaluate the association between frequency and type of consumption of FAFH and diet quality.DesignThe study had a cross-sectional design. Participants self-reported the frequency of consuming FAFH as “rarely” (≤1 time per week) vs “frequently” (≥2 times per week) at various commercial establishments or noncommercial FAFH (ie, friends’ or relatives’ homes).Participants/settingParticipants were adults (aged 30 through 75 years) from the PRADLAD (Puerto Rico Assessment of Diet, Lifestyle, and Diseases) study conducted in San Juan, Puerto Rico metro area (n = 239) in 2015.Main outcome measuresA validated food frequency questionnaire captured dietary intake. The Alternate Healthy Eating Index-2010 defined diet quality. Secondary outcomes included whether participants met 2015-2020 Dietary Guidelines for Americans recommendations for sodium, added sugars, saturated fat, dietary fiber, total energy, and alcohol.Statistical analyses performedLinear or logistic regression models adjusted for age, sex, employment, income, education, and food insufficiency tested differences in mean Alternate Healthy Eating Index-2010 scores or odds of meeting (vs not meeting) intake recommendations by FAFH type and frequency.ResultsOverall, 54.4% and 37.2% of participants reported consuming commercial FAFH and noncommercial FAFH “frequently,” respectively. Consuming FAFH “frequently” (vs “rarely”) was associated with lower mean Alternate Healthy Eating Index-2010 scores for both commercial FAFH (57.92 vs 63.58; P = .001) and noncommercial FAFH (56.22 vs 62.32; P < .001). Consuming commercial FAFH “frequently” (vs “rarely”) at any type of food establishment was associated with lower odds of meeting the dietary fiber Dietary Reference Intakes (odds ratio 0.43; 95% CI 0.23 to 0.81). Consuming noncommercial FAFH “frequently” was associated with lower odds of meeting recommendations for sodium (odds ratio 0.30; 95% CI 0.11 to 0.79) and added sugars (odds ratio 0.41; 95% CI 0.18 to 0.93).ConclusionsFrequent consumption of FAFH is associated with lower diet quality and lower adherence to dietary recommendations in Puerto Rico. Future studies should explore whether diet quality can be improved by prioritizing healthy at-home meals and reformulating the quality of commercial FAFH.     

Gender Expression and Sexual Orientation Differences in Diet Quality and Eating Habits from Adolescence to Young Adulthood

BackgroundDiet and eating habits during youth have implications on diet and eating habits during adulthood, however, little longitudinal research has examined sexual orientation and gender expression differences in diet.ObjectiveOur aim was to examine sexual orientation and gender expression differences in diet quality and eating habits from adolescence to young adulthood.DesignData across multiple time points from the longitudinal Growing Up Today Study cohorts (1997 to 2011) were used.Participants/settingParticipants (n=12,880; aged 10 to 23 years) were the children of women from the Nurses’ Health Study II cohort.Main outcome measuresDiet quality scores were assessed using the Alternative Healthy Eating Index-2010. In addition, breakfast consumption (≥5 days/wk) and family dinners (≥5 days/wk) were assessed.Statistical analyses performedMultivariable generalized estimating equation regression models were fit to estimate sexual orientation and gender expression differences in diet quality scores, breakfast consumption, and family dinners, stratified by sex assigned at birth over available repeated measures.Results“Gender-nonconforming” males had significantly higher diet quality scores than “very gender-conforming” males (P<0.05). Diet quality scores did not differ by gender expression among females. “Mostly heterosexual” females and gay males had higher diet quality scores than their same-sex completely heterosexual counterparts (P<0.05). Adjustment for mother’s diet quality scores attenuated effects, except for gay males (P<0.05). “Gender-nonconforming” females were less likely to consume breakfast than “very gender-conforming” females (P<0.05). Similar results were found for “mostly heterosexual” and bisexual compared to completely heterosexual females. There were no gender expression or sexual orientation differences in family dinners among males and females.ConclusionsSexual orientation and gender expression have independent effects on diet quality scores and eating habits for both males and females. Very gender-conforming and completely heterosexual males had the lowest diet quality scores compared to other gender expression and sexual orientation groups. Additional research to explore the effects of sexual orientation and gender expression on diet-related health is needed to build upon these findings.     

Changes in Energy Intake and Diet Quality during an 18-Month Weight-Management Randomized Controlled Trial in Adults with Intellectual and Developmental Disabilities

Background

Previous research indicates that individuals with intellectual and developmental disabilities (IDDs) are at risk for poor diet quality.

Association of Dietary Patterns with Cognitive Function and Cognitive Decline in Sydney Memory and Ageing Study: A Longitudinal Analysis

BackgroundThe relationship of dietary patterns to cognitive health in older adults has attracted much research attention. However, results from existing studies are inconclusive.ObjectiveThe aim of this study was to investigate the association between dietary patterns and overall cognitive performance and cognitive change over time.DesignThis analysis was conducted as part of the longitudinal Sydney Memory and Ageing study with 6 years’ follow-up. Mediterranean diet and Dietary Approaches to Stop Hypertension diet scores were generated based on dietary intake for each individual, assessed by the Dietary Questionnaire for Epidemiological Studies Version 2.Participants/settingThis longitudinal study comprised 1037 community dwelling nondemented participants aged 70 to 90 years at baseline (September 2005 to December 2007), recruited from Sydney, Australia.Main outcome measuresNeuropsychological tests assessed global cognition and 6 cognitive domains on 4 occasions, at baseline and 2, 4, and 6 years later.Statistical analyses performedLinear mixed-model analyses were conducted to examine the relationship between dietary scores, food components, and overall cognitive function and cognitive change over 6 years.ResultsNo associations of Mediterranean or Dietary Approaches to Stop Hypertension dietary scores with overall cognition and cognitive decline over 6 years were found. Higher intake of legumes and nuts was related to better overall performance in global cognition (β = .091; 95% CI: 0.035-0.146; P = .001) and to multiple cognitive domains and to less decline in global cognition (β = ?.016; 95% CI: ?0.032 to ?0.001; P = .032).ConclusionStudy findings suggest that greater consumption of legumes and nuts may be important to slow cognitive decline with age.     

Diet Quality Scores and Cardiometabolic Risk Factors in Mexican Children and Adolescents: A Longitudinal Analysis

There is limited evidence for the effects of diet on cardiometabolic profiles during the pubertal transition. We collected repeated measures of diet quality and cardiometabolic risk factors among Mexican youth. This analysis included 574 offspring of the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort followed up to three time points. Dietary Approaches to Stop Hypertension (DASH), alternate Mediterranean Diet (aMedDiet), and Children’s Dietary Inflammatory Index (C-DII^TM) scores were computed from food frequency questionnaires. Higher DASH and aMedDiet scores reflect a higher diet quality, and lower C-DII scores reflect an anti-inflammatory diet. Cardiometabolic risk factors were lipid profile, glucose homeostasis, blood pressure, and waist circumference. Linear mixed models were used between quartiles of each diet score and outcomes. Compared to the first quartile, the fourth DASH quartile was inversely associated with log serum insulin (μIU/mL) [β = −0.19, p = 0.0034] and log-Homeostatic Model Assessment of Insulin Resistance [β = −0.25, p = 0.0008]. Additionally, log serum triglycerides (mg/dL) was linearly associated with aMedDiet score [β = −0.03, p = 0.0022]. Boys in the highest aMedDiet quartile had higher serum high-density lipoprotein cholesterol (mg/dL) [β = 4.13, p = 0.0034] compared to the reference quartile. Higher diet quality was associated with a better cardiometabolic profile among Mexican youth.     

Associations Among Food Security,Diet Quality,and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina

BackgroundLow food security during pregnancy can negatively affect women’s physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood.ObjectiveThis study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina.DesignThis was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy.Participants and settingThis study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016.Main outcome measureDiet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well.Statistical analysis performedMultiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake.ResultsIn this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = –.43; P = 0.03).ConclusionsVery low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.     

Determining the risk of diabulimia and its relationship with diet quality and nutritional status of adolescents with type 1 diabetes

IntroductionDiabulimia is known as an eating disorder specific to individuals with diabetes.ObjectivesIn this study, it was aimed to determine the diabulimia risk and to evaluate the possible relationships between diabulimia risk and diet quality, anthropometric measurements, and biochemical parameters of adolescents with type 1 diabetes.Material and methodsIn total, 110 adolescents (male: 51.8%, female: 48.2%) with type 1 diabetes between 10–19 years were included in the study. Sociodemographic characteristics and information about diabetes of adolescents were collected using a questionnaire prepared by the researchers through face-to-face interview technique. Anthropometric measurements and 3-day food consumption records were obtained to evaluate their nutritional status, and their biochemical parameters were obtained from hospital files to evaluate their metabolic status. The diet quality was evaluated using the Healthy Eating Index-2015. Diabetes Eating Problem Survey was administered to individuals and it was accepted that diabetics with a total score of ≥ 20 were at risk of diabetes-related eating disorders.Results/ConclusionAmong the 110 adolescents included in this study, 31.8% were found to be at risk of diabulimia. There was a significant relationship between the groups with and without diabulimia risk in terms of diet quality scores (P < 0.05). All individuals with a risk of diabulimia as well as 86.8% of individuals without a risk of diabulimia had high HbA1c levels (P < 0.05). Diet quality, some anthropometric measurements and biochemical parameters of adolescents at risk of diabulimia should be improved. It is important to periodically evaluate the risk of diabulimia, the diet quality, and the nutritional status of adolescents with type 1 diabetes to reduce the occurrence of short and long-term complications.     

Food Insecurity Is Inversely Associated with Diet Quality of Lower-Income Adults

Food insecurity acts as a chronic stressor independent of poverty. Food-insecure adults may consume more highly palatable foods as a coping mechanism, leading to poorer diet quality and increased risks of chronic disease over time. Using data from the 1999-2008 National Health and Nutrition Examination Surveys, this study aimed to examine the cross-sectional differences in dietary intake and diet quality by household food security among 8,129 lower-income adults (≤300% of the federal poverty level). Food insecurity was assessed using the 18-item US Household Food Security Survey Module. Dietary intake was assessed from 24-hour recalls and diet quality was measured using the Healthy Eating Index-2005 and the Alternate Healthy Eating Index-2010. Relative mean differences in dietary outcomes by household food security were estimated using linear regression models, adjusting for sociodemographic characteristics. Lower-income food-insecure adults reported higher consumption of some highly palatable foods, including high-fat dairy products (P trend<0.0001) and salty snacks (P trend=0.01) compared with lower-income food-secure adults. Food insecurity was also associated with more sugar-sweetened beverages (P trend=0.003); more red/processed meat (P trend=0.005); more nuts, seeds, and legumes (P trend=0.0006); fewer vegetables (P trend<0.0001); and fewer sweets and bakery desserts (P trend=0.0002). No differences were observed for intakes of total energy and macronutrients. Food insecurity was significantly associated with lower Healthy Eating Index-2005 (P trend<0.0001) and Alternate Healthy Eating Index-2010 scores (P trend<0.0001). Despite no macronutrient differences, food insecurity was associated with characteristics of poor diet quality known to increase chronic disease risk.     

Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension: Findings from the 2011-2018 National Health and Nutrition Examination Survey

BackgroundLittle is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension.ObjectiveThe aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness.DesignAnalysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population.Participants/settingA total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included.Main outcome measuresDiet quality was assessed by Healthy Eating Index 2015 (HEI-2015).Statistical analysis performedWeighted χ² tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates.ResultsAmong the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status.ConclusionsThere were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.     

Low-carbohydrate diets, dietary approaches to stop hypertension-style diets, and the risk of postmenopausal breast cancer

The authors prospectively examined the association between the Dietary Approaches to Stop Hypertension diet score, overall, animal-based, and vegetable-based low-carbohydrate-diet scores, and major plant food groups and the risk of postmenopausal breast cancer in 86,621 women in the Nurses' Health Study. Diet scores were calculated by using data from up to 7 food frequency questionnaires, with follow-up from 1980 to 2006. The authors ascertained 5,522 incident cases of breast cancer, including 3,314 estrogen receptor-positive (ER+) cancers and 826 estrogen receptor-negative (ER-) cancers. After adjustment for potential confounders, the Dietary Approaches to Stop Hypertension diet score was associated with a lower risk of ER- cancer (relative risk comparing extreme quintiles = 0.80, 95% confidence interval: 0.64, 1.01; P trend = 0.02). However, this was largely explained by higher intakes of fruits and vegetables. The authors also observed an inverse association between risk of ER- cancer and the vegetable-based, low-carbohydrate-diet score (corresponding relative risk = 0.81, 95% confidence interval: 0.65, 1.01; P trend = 0.03). High total fruit and low-protein vegetable intakes were associated with a lower risk of ER- cancer (relative risk comparing extreme quintiles = 0.71, 95% confidence interval: 0.55, 0.90; P trend = 0.005). No association was found between ER+ tumors and fruit and vegetable intakes. A diet high in fruits and vegetables, such as one represented by the Dietary Approaches to Stop Hypertension diet score, was associated with a lower risk of ER- breast cancer. In addition, a diet high in plant protein and fat and moderate in carbohydrate content was associated with a lower risk of ER- cancer.     

A moderate-sodium DASH-type diet improves mood in postmenopausal women

ObjectiveWe compared the effect on mood of a moderate sodium Dietary Approaches to Stop Hypertension-type diet, which included lean red meat (vitality diet [VD]), with a healthy diet (HD; decreased fat and increased wholegrain breads and cereal).MethodsIn a randomized, parallel intervention study, postmenopausal women were assigned to the VD or HD for 14 wk. Mood was measured every 2 wk by the Profile of Mood States. Dietary adherence was assessed using 24-h urine collections. Data were analyzed using one-way between-groups multivariate analysis of variance and correlations.ResultsForty-six subjects completed the VD and 49 completed the HD. The two groups showed an improvement in anger, confusion, depression, fatigue, tension, vigor, and the Profile of Mood States global score over the length of the intervention (P < 0.01 for time), but there was a significant diet group by time effect for anger (P < 0.05), such that anger improved more in the VD compared with the HD group. For the two groups combined, urinary sodium excretion was associated with the Profile of Mood States global score, such that a low sodium intake was associated with a better mood (r = 0.267, P < 0.05). In addition, red meat consumption (a component of the VD) was associated with a decrease in depression (r = ?0.21, P < 0.05) and an increase in fruit consumption was associated with a decrease in confusion (r = ?0.26, P < 0.05).ConclusionIn addition to the health benefits of a moderate-sodium Dietary Approaches to Stop Hypertension diet on blood pressure and bone health, this diet had a positive effect on improving mood in postmenopausal women.     

Associations between long-term adherence to healthy diet and recurrent depressive symptoms in Whitehall II Study

We examined whether long-term adherence to three diet quality scores—the Alternative Healthy Eating Index-2010 (AHEI-2010), Dietary Approach to Stop Hypertension (DASH) and  transformed-Mediterranean Diet Score (tMDS), Alternative Healthy Eating Index-2010 (AHEI-2010) and Dietary Approach to Stop Hypertension (DASH) is associated with the risk of recurrent depressive symptoms. Analyses were conducted on a sample of 4949 men and women from the Whitehall II study. Diet scores were calculated using data collected from food frequency questionnaires repeated over 11 years of exposure (1991/1993–2002/2004). Recurrence of depressive symptoms was defined when participants reported at least two episodes of depressive symptoms (assessed by Center for Epidemiologic Studies Depression Scale and use of antidepressants) over the four phases of follow-up (2002/04–2015/16). After adjustment for potential cofounders, higher scores on AHEI-2010, DASH and tMDS at the end of the exposure period were associated with lower risk of recurrent depressive symptoms over the 13-year follow-up. Repeat measures of dietary history showed that participants who maintained a high AHEI-2010 score over the 11-year exposure period had a 19% (OR 0.81, 95% CI 0.65–1.00) lower odds of recurrent depressive symptoms compared to those who maintained a low AHEI score. Participants whose AHEI-2010 score decreased over time had a 1.34-fold increased odds (95% CI 1.02–1.75) of developing recurrent depressive symptoms compared to those maintaining a high AHEI-2010. No robust associations were observed for long-term tMDS and DASH. Our findings suggest that long-term adherence to healthy diet defined by Alternative Healthy Eating Index-2010 confers protection against recurrent depressive symptoms.     

Dietary indices,cardiovascular risk factors and mortality in middle-aged adults: findings from the Aerobics Center Longitudinal Study

PurposeWe examined the association between three predefined dietary indices and both cardiovascular disease (CVD) risk factors and long-term mortality in adult Aerobics Center Longitudinal Study’s participants.MethodsBetween 1987 and 1999, 12,449 (77% male) participants aged 20–84 years completed a clinical examination, which included dietary assessment by 3-day diet records. Three dietary indices were calculated: the Ideal Diet Index, the Diet Quality Index, and the Mediterranean Diet Score. CVD risk factors measurements included body mass index, total cholesterol, fasting glucose, blood pressure, and cardiorespiratory fitness. We calculated hazard ratios from Cox regression analyses, adjusting for potential confounders including physical fitness.ResultsHigher Ideal Diet Index, Diet Quality Index, and Mediterranean Diet Score scores were consistently associated with lower body mass index, cholesterol and glucose levels, and diastolic blood pressure, and higher cardiorespiratory fitness (all P < .05). However, after adjusting for age, sex, energy intake, and baseline examination year, the indices were not significantly related to all-cause, CVD, or cancer mortality. No association was observed in fully adjusted models, which controlled for fitness.ConclusionsAlthough these dietary indices based on 3-day diet records are strongly associated cross-sectionally to CVD risk profile of middle-aged men and women, they do not add to ability to predict long-term mortality in follow-up.