Index‐based Dietary Patterns and All‐cause and Cause‐specific Mortality Stratified by Body Mass Index and Race/Ethnicity: NIH‐AARP Diet and Health Study

Abstract

Objectiveto examine how four diet quality indices– the Healthy Eating Index‐2010 (HEI‐2010), Alternative Healthy Eating Index (AHEI‐2010), alternate Mediterranean Diet Score (aMED), and Dietary Approaches to Stop Hypertension (DASH) Score – are associated with all‐cause, cardiovascular disease (CVD), and cancer mortality when stratified by body mass index (BMI: normal <25 kg/m2, overweight 25‐蠄30 kg/m2, obese 蠅 30kg/m2) and race/ethnicity (white, black) in the NIH‐AARP Diet and Health Study (n=492,823). Data from a 124‐item food frequency questionnaire were used to compute scores; adjusted hazard ratios (HR) and 95% CI were estimated using Cox proportional hazards regression. We documented 86419 deaths. For all BMI categories, higher diet quality index scores were associated with an 8‐30% reduced all‐cause and cancer mortality risk. For CVD mortality, normal and overweight individuals had a 16‐40% significantly reduced risk; reduced risk was not significant for obese individuals, with the exception of AHEI for men, HR = 0.84 (95% CI:0.75,0.92). For whites and blacks, higher scores were associated with an 11‐25% reduced risk for all‐cause mortality. For whites, high adherence for each index was protective for CVD and cancer mortality. For blacks, this relationship was not consistently significant across indices and cause‐specific outcomes. Only aMED (among women) and HEI (among men) were associated with reduced CVD and cancer mortality risk. Sample size may be a factor in non‐significant associations found among blacks. These findings suggest that adherence to healthy diets may lower the risk of mortality even for overweight and obese individuals.