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Meta-Analysis
. 2024 Mar;15(3):100166.
doi: 10.1016/j.advnut.2023.100166. Epub 2024 Feb 23.

The Healthy Eating Index-2015 and All-Cause/Cause-Specific Mortality: A Systematic Review and Dose-Response Meta-Analysis

Xuanyu Hao  1 , Dongyang Li  2
Affiliations
Meta-Analysis

The Healthy Eating Index-2015 and All-Cause/Cause-Specific Mortality: A Systematic Review and Dose-Response Meta-Analysis

Xuanyu Hao et al. Adv Nutr. 2024 Mar.

Abstract

This meta-analysis was undertaken to determine the predictive value of Healthy Eating Index (HEI)-2015 in all-cause, cancer-cause, and cardiovascular disease (CVD)-cause mortality. This review was registered with PROSPERO as CRD42023421585. PubMed and Web of Science were searched for articles published by September 15, 2023. The hazard ratio (HR) was calculated with exact confidence intervals (CIs) of 95%. Statistical heterogeneity among studies was measured by Cochran's Q test (χ2) and the I2 statistic. Eighteen published studies were finally identified in this meta-analysis. The results showed that the HEI-2015 was associated with all-cause mortality either as a categorical variable (HR: 0.80; 95% CI: 0.79, 0.82) or continuous variable (HR: 0.90; 95% CI: 0.88, 0.92). The HEI-2015 was also associated with cancer-cause mortality as categorical variable (HR: 0.81; 95% CI: 0.78, 0.83) or continuous variable (HR: 0.90; 95% CI: 0.81, 0.99). The categorical HEI-2015 was also independently correlated with decreasing CVD-cause mortality (HR: 0.81; 95% CI: 0.75, 0.87). A nonlinear dose-response relation between the HEI-2015 and all-cause mortality was found. In the linear dose-response analysis, the risk of mortality from cancer decreased by 0.42% per 1 score increment of the HEI-2015 and the risk of CVD-cause mortality decreased by 0.51% with the increment of the HEI-2015 per 1 score. Our analysis indicated a significant relationship between the HEI-2015 and all-cause, cancer-cause, and CVD-cause mortality.

Keywords: CVD-cause mortality; Healthy Eating Index-2015; all-cause mortality; cancer-cause mortality; dose–response; meta-analysis.

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Figures

FIGURE 1
FIGURE 1
Flowchart of literature search and study selection.
FIGURE 2
FIGURE 2
Forest plots of pooled HRs with 95% CI for HEI-2015 (the highest category compared with the lowest category) and all-cause mortality (A), cancer-cause mortality (B), and CVD-cause mortality (C). CI, confidence interval; CVD, cardiovascular disease; HEI, Healthy Eating Index; HR, hazard ratio.
FIGURE 3
FIGURE 3
Forest plots of pooled HRs with 95% CI for HEI-2015 (continuous) and all-cause mortality (A), and cancer-cause mortality (B). CI, confidence interval; HEI, Healthy Eating Index; HR, hazard ratio.
FIGURE 4
FIGURE 4
Dose–response analysis plots of HEI-2015 and (A) all-cause mortality, (B) cancer-cause mortality, and (C) CVD-cause mortality. CVD, cardiovascular disease; HEI, Healthy Eating Index.
FIGURE 5
FIGURE 5
Sensitivity analysis of included studies for the highest HEI-2015 vs. the lowest category HEI-2015. (A) All-cause mortality. (B) Cancer-cause mortality. (C) CVD-cause mortality. CVD, cardiovascular disease; HEI, Healthy Eating Index.
FIGURE 6
FIGURE 6
Sensitivity analysis of included studies for the continuous HEI-2015. (A) All-cause mortality. (B) Cancer-cause mortality. HEI, Healthy Eating Index.
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