The Dietary Patterns Methods Project: synthesis of findings across cohorts and relevance to dietary guidance

Abstract

The Dietary Patterns Methods Project (DPMP) was initiated in 2012 to strengthen research evidence on dietary indices, dietary patterns, and health for upcoming revisions of the Dietary Guidelines for Americans, given that the lack of consistent methodology has impeded development of consistent and reliable conclusions. DPMP investigators developed research questions and a standardized approach to index-based dietary analysis. This article presents a synthesis of findings across the cohorts. Standardized analyses were conducted in the NIH-AARP Diet and Health Study, the Multiethnic Cohort, and the Women's Health Initiative Observational Study (WHI-OS). Healthy Eating Index 2010, Alternative Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean Diet, and Dietary Approaches to Stop Hypertension (DASH) scores were examined across cohorts for correlations between pairs of indices; concordant classifications into index score quintiles; associations with all-cause, cardiovascular disease (CVD), and cancer mortality with the use of Cox proportional hazards models; and dietary intake of foods and nutrients corresponding to index quintiles. Across all cohorts in women and men, there was a high degree of correlation and consistent classifications between index pairs. Higher diet quality (top quintile) was significantly and consistently associated with an 11-28% reduced risk of death due to all causes, CVD, and cancer compared with the lowest quintile, independent of known confounders. This was true for all diet index-mortality associations, with the exception of AHEI-2010 and cancer mortality in WHI-OS women. In all cohorts, survival benefit was greater with a higher-quality diet, and relatively small intake differences distinguished the index quintiles. The reductions in mortality risk started at relatively lower levels of diet quality. Higher scores on each of the indices, signifying higher diet quality, were associated with marked reductions in mortality. Thus, the DPMP findings suggest that all 4 indices capture the essential components of a healthy diet.

Keywords: cohorts; dietary guidance; dietary indices; dietary quality; epidemiology; mortality.

FIGURE 1

Median HEI-2010 (A), AHEI-2010 (B), aMED (C), and DASH (D) scores by quintile according to respective dietary quality index, cohort, and sex: the Dietary Patterns Methods Project. AARP, NIH-AARP Diet and Health Study; AHEI-2010, Alternative Healthy Eating Index 2010; aMED, alternate Mediterranean Diet; DASH, Dietary Approaches to Stop Hypertension; F, females; HEI-2010, Healthy Eating Index 2010; M, males; MEC, Multiethnic Cohort; Q, quintile; WHI-OS, Women’s Health Initiative Observational Study.

FIGURE 2

Association of dietary quality indices with all-cause (A), CVD (B), and cancer (C) mortality by cohort and sex (quintile 5 vs. quintile 1): the Dietary Patterns Methods Project. Values are HRs (95% CIs) for quintile 5 vs. quintile 1 from multivariate models adjusted for age, race/ethnicity, education, marital status, physical activity, smoking, energy intake, BMI, diabetes, and alcohol intake (HEI-2010 and DASH only) and hormone replacement therapy (women only). Refer also to data presented in references –. AARP, NIH-AARP Diet and Health Study; AHEI2010, Alternative Healthy Eating Index 2010; aMED, alternate Mediterranean Diet; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; HEI2010, Healthy Eating Index 2010; MEC, Multiethnic Cohort; WHI-OS, Women’s Health Initiative Observational Study.