Abstract
Diet-quality scores (DQS), which are developed across the globe, are used to define adherence to specific eating patterns and have been associated with risk of coronary heart disease and type-II diabetes. We explored the association between five diet-quality scores (Healthy Eating Index, HEI; Alternate Healthy Eating Index, AHEI; MedDietScore, MDS; PREDIMED Mediterranean Diet Score, P-MDS; Dutch Healthy Diet-Index, DHDI) and markers of metabolic health (anthropometry, objective physical activity levels (PAL), and dried blood spot total cholesterol (TC), total carotenoids, and omega-3 index) in the Food4Me cohort, using regression analysis. Dietary intake was assessed using a validated Food Frequency Questionnaire. Participants (n = 1480) were adults recruited from seven European Union (EU) countries. Overall, women had higher HEI and AHEI than men (p < 0.05), and scores varied significantly between countries. For all DQS, higher scores were associated with lower body mass index, lower waist-to-height ratio and waist circumference, and higher total carotenoids and omega-3-index (p trends < 0.05). Higher HEI, AHEI, DHDI, and P-MDS scores were associated with increased daily PAL, moderate and vigorous activity, and reduced sedentary behaviour (p trend < 0.05). We observed no association between DQS and TC. To conclude, higher DQS, which reflect better dietary patterns, were associated with markers of better nutritional status and metabolic health.
Highlights
Healthy diets, which are characterised by high intakes of fruits, vegetables, whole grains, legumes, poultry, and seafood omega-3 fats and low intakes of refined grains and red and processed meats, are associated with a lower risk of cardiovascular diseases (CVD), such as coronary heart disease [1,2]. dietary recommendations aimed at preventing chronic disease mostly relate to individual nutrients or foods, it is increasingly recognised that whole dietary patterns are a more important predictor of non-communicable disease risk, including mortality from all causes and CVD [3,4].Recently, indices have been developed to assess the overall quality of dietary intakes
This study aims to (1) explore the association between five Diet-quality scores (DQS) (HEI, alternate healthy eating index (AHEI), MDS, PREDIMED Mediterranean Diet Score (P-MDS), and Dutch Healthy Diet Index (DHDI)) and markers of cardiometabolic health (physical activity (PA), anthropometry, and dietary and metabolic markers); and, (2) compare DQS between seven Food4Me research centres in Europe
physical activity level (PAL), sedentary behaviours (SB), and LPA did not differ between sexes, men engaged in higher amounts of moderate and vigorous PA (p < 0.001)
Summary
Indices have been developed to assess the overall quality (healthfulness) of dietary intakes These indices assess intakes of 10 to 14 nutrient/dietary components, including foods such as fruits, vegetables, and oily fish, where higher intakes are healthier and foods or nutrients, for which lower intakes are healthier (e.g., processed meats, trans fatty acids and sodium). A systematic review and meta-analysis of associations between the HEI, alternate healthy eating index (AHEI) (based on food and nutrients predictive of chronic disease [8]), and Dietary Approaches to Stop Hypertension (DASH) score and disease mortality in individuals with the highest versus lowest quintile of diet quality score (DQS), revealed a significant 22% lower risk for all-cause mortality CVD and type-2 diabetes, and a 15% lower risk for cancer [9]. The AHEI has been found to be a strong predictor of major chronic disease and CVD risk [10]
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