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. 2020 Feb 1;150(2):312-321.
doi: 10.1093/jn/nxz218.

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

Emily A Hu  1   2 , Lyn M Steffen  3 , Josef Coresh  1   2 , Lawrence J Appel  1   2 , Casey M Rebholz  1   2
Affiliations

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

Emily A Hu et al. J Nutr. .

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.

Keywords: ARIC; cardiovascular disease; dietary pattern; dietary score; mortality.

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Figures

FIGURE 1
FIGURE 1
HRs (on logarithmic scale) of CVD, CVD mortality, and all-cause mortality per 1 SD increase of each dietary score among ARIC participants, stratified by race. (A) HEI-2015; (B) AHEI-2010; (C) aMed; and (D) DASH. SD for HEI-2015 = 8.3; AHEI-2010 = 11.8; aMed = 1.8; and DASH = 4.9. Cox proportional hazards models to estimate HRs and 95% CIs were adjusted for age, sex, race center (interaction term), total energy intake, education level, income level, physical activity, and smoking status. HEI-2015 and DASH scores were additionally adjusted for alcohol status. AHEI, Alternative Healthy Eating Index; aMed, alternate Mediterranean diet; ARIC, Atherosclerosis Risk in Communities; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension Trial; HEI, Healthy Eating Index.
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References

    1. US Department of Health and Human Services, US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. [Internet]. Available from: http://health.gov/dietaryguidelines/2015/guidelines/.
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