Healthy dietary patterns and the risk of individual chronic diseases in community-dwelling adults

Abstract

It is unclear regarding associations of dietary patterns with a wide range of chronic diseases and which dietary score is more predictive of major chronic diseases. Using the UK Biobank, we examine associations of four individual healthy dietary scores with the risk of 48 individual chronic diseases. Higher Alternate Mediterranean Diet score is associated with a lower risk of 32 (all 8 cardiometabolic disorders, 3 out of 10 types of cancers, 7 out of 10 psychological/neurological disorders, 5 out of 6 digestive disorders, and 9 out of 14 other chronic diseases). Alternate Healthy Eating Index-2010 and Healthful Plant-based Diet Index are inversely associated with the risk of 29 and 23 individual chronic diseases, respectively. A higher Anti-Empirical Dietary Inflammatory Index is associated with a lower risk of 14 individual chronic diseases and a higher incidence of two diseases. Our findings support dietary guidelines for the prevention of most chronic diseases.

Fig. 1. The association between dietary scores and the risk of cardiometabolic disorders.

AEDII, Anti-Empirical Dietary Inflammatory Index; AHEI-2010, Alternate Healthy Eating Index-2010; AMED, Alternate Mediterranean Diet score; CI, confidence interval; HPDI, Healthful Plant-based Diet Index. The incidence refers to the number of event cases per 1000 person-years. Cardiovascular disease includes coronary heart disease, heart failure, atrial fibrillation, other cardiac disease, stroke, and peripheral vascular disease. Cox proportional hazard regression models were used to examine associations of each of the four dietary scores with the risk of individual cardiometabolic disorders adjusted for potential confounding variables. Model 1 was adjusted for age, sex, and total energy intake; Model 2 was adjusted for Model 1 plus ethnicity, education, income, BMI, smoking, sleep, physical activity, and GRS for longevity. Dietary scores were analyzed as continuous variables (each quintile increment). The vertical dash lines represent the hazard ratio of 1. Squares represent the hazard ratios (black color for AMED, orange color for AEDII, blue color for AHEI-2010, and green color for HPDI). Horizontal lines indicate the range of the 95% confidence interval. *Indicates a significant association through two-sided statistical tests while controlling for FDR.

Fig. 2. The association between dietary scores and the risk of all cancers and types of cancers.

AEDII, Anti-Empirical Dietary Inflammatory Index; AHEI-2010, Alternate Healthy Eating Index-2010; AMED, Alternate Mediterranean Diet score; CI, confidence interval; HPDI, Healthful Plant-based Diet Index. The incidence refers to the number of event cases per 1000 person-years. All cancers encompass any type of cancer except for non-melanoma skin cancer. Cox proportional hazard regression models were used to examine associations of each of the four dietary scores with the risk of individual cancers. Model 1 was adjusted for age, sex, and total energy intake; Model 2 was adjusted for Model 1 plus ethnicity, education, income, BMI, smoking, sleep, physical activity, and GRS for longevity (pack-years, age stopping smoking, and number of cigarettes currently smoked daily were further adjusted for lung cancer). Dietary scores were analyzed as continuous variables (each quintile increment). The analysis for ovarian cancer and breast cancer was conducted among women only while the analysis for prostate cancer was conducted among men only. The vertical dash lines represent the hazard ratio of 1. Squares represent the hazard ratios (black color for AMED, orange color for AEDII, blue color for AHEI-2010, and green color for HPDI). Horizontal lines indicate the range of the 95% confidence interval. *Indicates a significant association through two-sided statistical tests while controlling for FDR.

Fig. 3. The association between dietary scores and the risk of neurological and psychological disorders.

AEDII, Anti-Empirical Dietary Inflammatory Index; AHEI-2010, Alternate Healthy Eating Index-2010; AMED, Alternate Mediterranean Diet score; CI, confidence interval; HPDI, Healthful Plant-based Diet Index. The incidence refers to the number of event cases per 1000 person-years. Cox proportional hazard regression models were used to examine associations of each of the four dietary scores with the risk of individual neurological/psychological disorders. Model 1 was adjusted for age, sex, and total energy intake; Model 2 was adjusted for Model 1 plus ethnicity, education, income, BMI, smoking, sleep, physical activity, and GRS for longevity. Dietary scores were analyzed as continuous variables (each quintile increment). The vertical dash lines represent the hazard ratio of 1. Squares represent the hazard ratios (black color for AMED, orange color for AEDII, blue color for AHEI-2010, and green color for HPDI). Horizontal lines indicate the range of the 95% confidence interval. *Indicates a significant association through two-sided statistical tests while controlling for FDR.

Fig. 4. The association between dietary scores and the risk of digestive disorders.

AEDII, Anti-Empirical Dietary Inflammatory Index; AHEI-2010, Alternate Healthy Eating Index-2010; AMED, Alternate Mediterranean Diet score; CI, confidence interval; HPDI, Healthful Plant-based Diet Index. The incidence refers to the number of event cases per 1000 person-years. Cox proportional hazard regression models were used to examine associations of each of the four dietary scores with the risk of individual digestive disorders. Model 1 was adjusted for age, sex, and total energy intake; Model 2 was adjusted for Model 1 plus ethnicity, education, income, BMI, smoking, sleep, physical activity, and GRS for longevity. Dietary scores were analyzed as continuous variables (each quintile increment). The vertical dash lines represent the hazard ratio of 1. Squares represent the hazard ratios (black color for AMED, orange color for AEDII, blue color for AHEI-2010, and green color for HPDI). Horizontal lines indicate the range of the 95% confidence interval. *Indicates a significant association through two-sided statistical tests while controlling for FDR.

Fig. 5. The association between dietary scores and the risk of other chronic diseases.

AEDII, Anti-Empirical Dietary Inflammatory Index; AHEI-2010, Alternate Healthy Eating Index-2010; AMED, Alternate Mediterranean Diet score; AMD, age related macular degeneration; CI, confidence interval; COPD, chronic obstructive pulmonary disease; HPDI, Healthful Plant-based Diet Index. The incidence refers to the number of event cases per 1000 person-years. Cox proportional hazard regression models were used to examine associations of each of the four dietary scores with the risk of individual other chronic diseases. Model 1 was adjusted for age, sex, and total energy intake; Model 2 was adjusted for Model 1 plus ethnicity, education, income, BMI, smoking, sleep, physical activity, and GRS for longevity. Dietary scores were analyzed as continuous variables (each quintile increment). The analysis for prostate disorders was conducted among men only. The vertical dash lines represent the hazard ratio of 1. Squares represent the hazard ratios (black color for AMED, orange color for AEDII, blue color for AHEI-2010, and green color for HPDI). Horizontal lines indicate the range of the 95% confidence interval. *Indicates a significant association through two-sided statistical tests while controlling for FDR.

Fig. 6. The association between individual components of the Alternate Mediterranean Diet Index and the risk of individual chronic diseases.

AMD, age related macular degeneration; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease. Data are hazard ratios (95% confidence intervals). All cancers encompass any type of cancer except for non-melanoma skin cancer. Cardiovascular disease includes coronary heart disease, heart failure, atrial fibrillation, other cardiac disease, stroke, and peripheral vascular disease. All cancers encompass any type of cancer except for non-melanoma skin cancer. Cox proportional hazard regression models were used to examine associations of individual components of the Alternate Mediterranean Diet Index with the risk of individual chronic diseases. The analysis was adjusted for age, sex, ethnicity, education, income, smoking, alcohol consumption, sleep, physical activity, GRS for longevity, and total energy intake. The hazard ratio refers to the risk for the disease associated with the component (recommended level versus non-recommended level). The analysis for ovarian cancer and breast cancer was conducted among women only while the analysis for prostate cancer and prostate disorders was conducted among men only. Green color refers to inverse associations and red color refers to positive associations. We conducted two-sided statistical tests, and significant associations were adjusted for FDR.