Association of the Healthy Dietary Index 2020 and Its Components with Chronic Respiratory Disease Among U.S. Adults

Overview

Journal Front Nutr

Specialty Nutritional Sciences

Date 2024 Jul 18

PMID 39021605

Authors

Liu Zhiyi

Zhou Shuhan

Zhang Libing

Li Jiaqi

Ding Xin

Qin Lingxi

Shi Yuan-Mei

Zhang Hong

Nie Jiaqi

Li Hui

Fang Sanyou

Affiliations

Soon will be listed here.

Abstract

Background: Chronic respiratory disease is an important public health problem in the United States and globally. Diet, an important part of a healthy lifestyle, is also relevant to chronic respiratory health. We aimed to explore the relationship between overall dietary quality and the risk of chronic respiratory disease (CRD), include chronic bronchitis (CB), emphysema and asthma.

Method: A total of 4,499 United States adults were extracted from the National Health and Nutrition Examination Survey (NHANES) in 2017-2018. Diet quality was assessed using 2 day, 24 h dietary recall data and quantified as the Healthy Diet Index (HEI)-2020 score. Binary logistic regression models, restricted cubic splines (RCS) and generalized additive modeling (GAM), the weighted quartile sum (WQS) and qgcom models were used to assess the relationship between HEI-2020 scores and risk of CB, emphysema and asthma.

Results: High HEI-2020 scores are associated with low risk of chronic respiratory disease (CB: 0.98, 0.97-0.99; emphysema: 0.98, 0.97-0.99; asthma: 0.98, 0.97-0.99) and consistent results across different dietary variable categorization (Tertile: CB: 0.58, 0.42-0.81; asthma: 0.51, 0.35-0.74; Quartile: CB: 0.57, 0.34-0.97; asthma: 0.56, 0.36-0.86) and different weighting models. Negative dose-response relationship between dietary quality and risk of chronic respiratory disease also shown in RCS and GAM models. The WQS and qgcom models also showed a healthy mixing effect of dietary components on respiratory disease, with high-quality proteins, vegetables, and fruits making the heaviest contributions.

Conclusion: Higher HEI-2020 scores were associated with lower risk of CB, emphysema, and asthma. Following Dietary Guidelines for Americans 2020-2025 could support enhanced respiratory health.

Citing Articles

Association of lung health and cardiovascular health (Life's Essential 8).

Zhang W, Zou M, Liang J, Zhang D, Zhou M, Feng H Front Med (Lausanne). 2025; 12:1481213.

PMID: 39991052 PMC: 11844003. DOI: 10.3389/fmed.2025.1481213.

Adherence to combined healthy lifestyle and odds of metabolic syndrome in Iranian adults: the PERSIAN Dena cohort study.

Jowshan M, Pourjavid A, Amirkhizi F, Hosseini M, Zolghadrpour M, Hamedi-Shahraki S Sci Rep. 2025; 15(1):5164.

PMID: 39939646 PMC: 11822003. DOI: 10.1038/s41598-025-89028-7.

Association between the healthy eating index 2020 and heart failure among the U.S. middle-aged and older adults from NHANES 2005-2020: a cross-sectional study.

Gu F, Yu W, Shu T, Zhu Y Front Nutr. 2025; 11():1496379.

PMID: 39834452 PMC: 11743723. DOI: 10.3389/fnut.2024.1496379.

References

Rahman H, Niemann D, Munson-McGee S . Association between asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, and lung cancer in the US population. Environ Sci Pollut Res Int. 2022; 30(8):20147-20158. DOI: 10.1007/s11356-022-23631-3. View

Scholes S, Bann D . Education-related disparities in reported physical activity during leisure-time, active transportation, and work among US adults: repeated cross-sectional analysis from the National Health and Nutrition Examination Surveys, 2007 to 2016. BMC Public Health. 2018; 18(1):926. PMC: 6064072. DOI: 10.1186/s12889-018-5857-z. View

Phillips J . Dietary Guidelines for Americans, 2020-2025. Workplace Health Saf. 2021; 69(8):395. DOI: 10.1177/21650799211026980. View

Wan H, Jiang Y, Yang J, Ma Q, Liu L, Peng L . Sex-specific associations of the urinary fourteen-metal mixture with NAFLD and liver fibrosis among US adults: A nationally representative study. Ecotoxicol Environ Saf. 2022; 248:114306. DOI: 10.1016/j.ecoenv.2022.114306. View

Nguyen H, Collins P, Pavey T, Nguyen N, Pham T, Gallegos D . Nutritional status, dietary intake, and health-related quality of life in outpatients with COPD. Int J Chron Obstruct Pulmon Dis. 2019; 14:215-226. PMC: 6336029. DOI: 10.2147/COPD.S181322. View

Golub J, Brickman A, Ciarleglio A, Schupf N, Luchsinger J . Association of Subclinical Hearing Loss With Cognitive Performance. JAMA Otolaryngol Head Neck Surg. 2019; 146(1):57-67. PMC: 6865840. DOI: 10.1001/jamaoto.2019.3375. View

Papi A, Brightling C, Pedersen S, Reddel H . Asthma. Lancet. 2017; 391(10122):783-800. DOI: 10.1016/S0140-6736(17)33311-1. View

Christenson S, Smith B, Bafadhel M, Putcha N . Chronic obstructive pulmonary disease. Lancet. 2022; 399(10342):2227-2242. DOI: 10.1016/S0140-6736(22)00470-6. View

Varraso R, Barr R, Willett W, Speizer F, Camargo Jr C . Fish intake and risk of chronic obstructive pulmonary disease in 2 large US cohorts. Am J Clin Nutr. 2015; 101(2):354-61. PMC: 4307205. DOI: 10.3945/ajcn.114.094516. View

10.

Collins P, Stratton R, Elia M . Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Am J Clin Nutr. 2012; 95(6):1385-95. DOI: 10.3945/ajcn.111.023499. View

11.

Gaffney A, Hawks L, Bor D, White A, Woolhandler S, McCormick D . National Trends and Disparities in Health Care Access and Coverage Among Adults With Asthma and COPD: 1997-2018. Chest. 2021; 159(6):2173-2182. DOI: 10.1016/j.chest.2021.01.035. View

12.

Shan Z, Li Y, Y Baden M, Bhupathiraju S, Wang D, Sun Q . Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease. JAMA Intern Med. 2020; 180(8):1090-1100. PMC: 7296454. DOI: 10.1001/jamainternmed.2020.2176. View

13.

Smit H . Chronic obstructive pulmonary disease, asthma and protective effects of food intake: from hypothesis to evidence?. Respir Res. 2001; 2(5):261-4. PMC: 59508. DOI: 10.1186/rr65. View

14.

Chen-Xu M, Yokose C, Rai S, Pillinger M, Choi H . Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019; 71(6):991-999. PMC: 6536335. DOI: 10.1002/art.40807. View

15.

Kheradmand F, Zhang Y, Corry D . Contribution of adaptive immunity to human COPD and experimental models of emphysema. Physiol Rev. 2022; 103(2):1059-1093. PMC: 9886356. DOI: 10.1152/physrev.00036.2021. View

16.

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

17.

Shams-White M, Pannucci T, Lerman J, Herrick K, Zimmer M, Meyers Mathieu K . Healthy Eating Index-2020: Review and Update Process to Reflect the Dietary Guidelines for Americans,2020-2025. J Acad Nutr Diet. 2023; 123(9):1280-1288. PMC: 10524328. DOI: 10.1016/j.jand.2023.05.015. View

18.

Tao C, Huang Y, Huang X, Li Z, Fan Y, Zhang Y . Association between Blood Manganese Levels and Visceral Adipose Tissue in the United States: A Population-Based Study. Nutrients. 2022; 14(22). PMC: 9697925. DOI: 10.3390/nu14224770. View

19.

Alwarith J, Kahleova H, Crosby L, Brooks A, Brandon L, Levin S . The role of nutrition in asthma prevention and treatment. Nutr Rev. 2020; 78(11):928-938. PMC: 7550896. DOI: 10.1093/nutrit/nuaa005. View

20.

ALHarthi S, Natto Z, Midle J, Gyurko R, ONeill R, Steffensen B . Association between time since quitting smoking and periodontitis in former smokers in the National Health and Nutrition Examination Surveys (NHANES) 2009 to 2012. J Periodontol. 2018; 90(1):16-25. DOI: 10.1002/JPER.18-0183. View