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.
Bibliographical noteFunding Information:
The Atherosclerosis Risk in Communities (ARIC) Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, NIH, and the Department of Health and Human Services (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I). Author disclosures: LMS, JC, and LJA, no conflicts of interest. EAH is supported by a grant from the NIH/National Heart, Lung, and Blood Institute (training grant T32 HL007024). CMR is supported by a mentored research scientist development award from the National Institute of Diabetes and Digestive and Kidney Diseases (K01 DK107782) and a grant from the National Heart, Lung, and Blood Institute (R21 HL143089). Supplemental Tables 1–8 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn. Address correspondence to CMR (e-mail: email@example.com). Abbreviations used: AHEI, Alternative Healthy Eating Index; aMed, alternate Mediterranean diet; ARIC, Atherosclerosis Risk in Communities; CAD, coronary artery disease; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension Trial; HEI, Healthy Eating Index; ICD, International Classification of Diseases.
Copyright © American Society for Nutrition 2019. All rights reserved.
- Cardiovascular disease
- Dietary pattern
- Dietary score
- Prospective Studies
- Cardiovascular Diseases/epidemiology
- Middle Aged
- Diet, Healthy
- Cause of Death
- Guideline Adherence
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural