Adherence to the Healthy Eating Index-2015 and Other Dietary Patterns May Reduce Risk of Cardiovascular Disease, Cardiovascular Mortality, and All-Cause Mortality

Overview

Journal J Nutr

Publisher Elsevier

Specialty Nutritional Sciences

Date 2019 Sep 19

PMID 31529069

Citations 94

Authors

Emily A Hu

Lyn M Steffen

Josef Coresh

Lawrence J Appel

Casey M Rebholz

Affiliations

Soon will be listed here.

Abstract

Background: The Healthy Eating Index-2015 (HEI-2015) score measures adherence to recommendations from the 2015-2020 Dietary Guidelines for Americans. The HEI-2015 was altered from the HEI-2010 by reclassifying sources of dietary protein and replacing the empty calories component with 2 new components: saturated fats and added sugars.

Objectives: Our aim was to assess whether the HEI-2015 score, along with 3 other previously defined indices, were associated with incident cardiovascular disease (CVD), CVD mortality, and all-cause mortality.

Methods: We conducted a prospective analysis of 12,413 participants aged 45-64 y (56% women) from the Atherosclerosis Risk in Communities (ARIC) Study. The HEI-2015, Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean (aMed) diet, and Dietary Approaches to Stop Hypertension Trial (DASH) scores were computed using the average dietary intakes of Visits 1 (1987-1989) and 3 (1993-1995). Incident CVD, CVD mortality, and all-cause mortality data were ascertained from baseline through 31 December, 2017. We used Cox proportional hazards models to estimate HRs and 95% CIs.

Results: There were 4509 cases of incident CVD, 1722 cases of CVD mortality, and 5747 cases of all-cause mortality over a median of 24-25 y of follow-up. Compared with participants in the lowest quintile of HEI-2015, participants in the highest quintile had a 16% lower risk of incident CVD (HR: 0.84; 95% CI: 0.76-0.93; P-trend < 0.001), 32% lower risk of CVD mortality (HR: 0.68; 95% CI: 0.58-0.80; P-trend < 0.001), and 18% lower risk of all-cause mortality (HR: 0.82; 95% CI: 0.75-0.89; P-trend < 0.001) after adjusting for demographic and lifestyle covariates. There were similar protective associations for AHEI-2010, aMed, and DASH scores, and no significant interactions by race.

Conclusions: Higher adherence to the 2015-2020 Dietary Guidelines for Americans was associated with lower risks of incident CVD, CVD mortality, and all-cause mortality among US adults.

Citing Articles

Evaluating the impact of a full-service mobile food market on food security, diet quality and food purchases: a cluster randomised trial protocol and design paper.

Horning M, Gorman K, Wagner S, Fulkerson J, Wolfson J, Laska M BMJ Open. 2025; 15(3):e099414.

PMID: 40050056 PMC: 11887311. DOI: 10.1136/bmjopen-2025-099414.

Dietary patterns in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study: comparisons across methodologies.

Beasley J, Hussain B, Gadgil M, Talegawkar S, Parekh N, Bhupathiraju S BMJ Nutr Prev Health. 2025; 7(2):e000853.

PMID: 39882305 PMC: 11773655. DOI: 10.1136/bmjnph-2023-000853.

The inverse relationship between Life's Essential 8 and risk of metabolic syndrome: evidence from NHANES 2005-2018.

Liu Y, Tang J, Gao S Front Endocrinol (Lausanne). 2024; 15:1449930.

PMID: 39530117 PMC: 11551013. DOI: 10.3389/fendo.2024.1449930.

Omega-3 Supplementation in Coronary Artery Bypass Graft Patients: Impact on ICU Stay and Hospital Stay-A Systematic Review and Meta-Analysis.

Ouagueni A, Shi Z, Shraim M, Al-Zoubi R, Zarour A, Al-Ansari A Nutrients. 2024; 16(19).

PMID: 39408265 PMC: 11478518. DOI: 10.3390/nu16193298.

Capillary Blood Docosahexaenoic Acid Levels Predict Electrocardiographic Markers in a Sample Population of Premenopausal Women.

Casagrande B, Sherrard G, Fowler M, Estadella D, Bueno A J Clin Med. 2024; 13(19).

PMID: 39408016 PMC: 11478101. DOI: 10.3390/jcm13195957.

References

Shivappa N, Hebert J, Kivimaki M, Akbaraly T . Alternative Healthy Eating Index 2010, Dietary Inflammatory Index and risk of mortality: results from the Whitehall II cohort study and meta-analysis of previous Dietary Inflammatory Index and mortality studies. Br J Nutr. 2017; 118(3):210-221. DOI: 10.1017/S0007114517001908. View

Fung T, Chiuve S, McCullough M, Rexrode K, Logroscino G, Hu F . Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008; 168(7):713-20. DOI: 10.1001/archinte.168.7.713. View

Sofi F, Abbate R, Gensini G, Casini A . Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010; 92(5):1189-96. DOI: 10.3945/ajcn.2010.29673. View

Rodriguez-Monforte M, Flores-Mateo G, Sanchez E . Dietary patterns and CVD: a systematic review and meta-analysis of observational studies. Br J Nutr. 2015; 114(9):1341-59. DOI: 10.1017/S0007114515003177. View

Krebs-Smith S, Pannucci T, Subar A, Kirkpatrick S, Lerman J, Tooze J . Update of the Healthy Eating Index: HEI-2015. J Acad Nutr Diet. 2018; 118(9):1591-1602. PMC: 6719291. DOI: 10.1016/j.jand.2018.05.021. View

Fung T, McCullough M, Newby P, Manson J, Meigs J, Rifai N . Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005; 82(1):163-73. DOI: 10.1093/ajcn.82.1.163. View

Tobias D, Hu F, Chavarro J, Rosner B, Mozaffarian D, Zhang C . Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med. 2012; 172(20):1566-72. PMC: 3774782. DOI: 10.1001/archinternmed.2012.3747. View

Sacks F, Svetkey L, Vollmer W, Appel L, Bray G, Harsha D . Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001; 344(1):3-10. DOI: 10.1056/NEJM200101043440101. View

Willett W, Sampson L, Stampfer M, Rosner B, Bain C, Witschi J . Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985; 122(1):51-65. DOI: 10.1093/oxfordjournals.aje.a114086. View

10.

Panizza C, Shvetsov Y, Harmon B, Wilkens L, Le Marchand L, Haiman C . Testing the Predictive Validity of the Healthy Eating Index-2015 in the Multiethnic Cohort: Is the Score Associated with a Reduced Risk of All-Cause and Cause-Specific Mortality?. Nutrients. 2018; 10(4). PMC: 5946237. DOI: 10.3390/nu10040452. View

11.

Martinez-Gonzalez M, Bes-Rastrollo M . Dietary patterns, Mediterranean diet, and cardiovascular disease. Curr Opin Lipidol. 2013; 25(1):20-6. DOI: 10.1097/MOL.0000000000000044. View

12.

Baecke J, BUREMA J, Frijters J . A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982; 36(5):936-42. DOI: 10.1093/ajcn/36.5.936. View

13.

Folsom A, Arnett D, Hutchinson R, Liao F, Clegg L, Cooper L . Physical activity and incidence of coronary heart disease in middle-aged women and men. Med Sci Sports Exerc. 1997; 29(7):901-9. DOI: 10.1097/00005768-199707000-00009. View

14.

Liese A, Krebs-Smith S, Subar A, George S, Harmon B, Neuhouser M . The Dietary Patterns Methods Project: synthesis of findings across cohorts and relevance to dietary guidance. J Nutr. 2015; 145(3):393-402. PMC: 4336525. DOI: 10.3945/jn.114.205336. View

15.

Shimakawa T, Sorlie P, Carpenter M, Dennis B, Tell G, Watson R . Dietary intake patterns and sociodemographic factors in the atherosclerosis risk in communities study. ARIC Study Investigators. Prev Med. 1994; 23(6):769-80. DOI: 10.1006/pmed.1994.1133. View

16.

. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol. 1989; 129(4):687-702. View

17.

Schwingshackl L, Hoffmann G . Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies. J Acad Nutr Diet. 2015; 115(5):780-800.e5. DOI: 10.1016/j.jand.2014.12.009. View

18.

Chiuve S, Fung T, Rimm E, Hu F, McCullough M, Wang M . Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012; 142(6):1009-18. PMC: 3738221. DOI: 10.3945/jn.111.157222. View

19.

Jannasch F, Kroger J, Schulze M . Dietary Patterns and Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Prospective Studies. J Nutr. 2017; 147(6):1174-1182. DOI: 10.3945/jn.116.242552. View

20.

Hu F, Stampfer M, Rimm E, Ascherio A, Rosner B, Spiegelman D . Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol. 1999; 149(6):531-40. DOI: 10.1093/oxfordjournals.aje.a009849. View