AHEI Score Research Articles

Diet-quality scores and the risk of symptomatic gallstone disease: a prospective cohort study of male US health professionals.

To investigate the association between three diet-quality scores corresponding to adherence to healthy dietary patterns [alternate Mediterranean (aMed), Alternate Healthy Eating Index (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH)] and the risk of symptomatic gallstone disease. The study comprised 43 635 men of the Health Professionals Follow-up Study-an ongoing prospective cohort study of US health professionals. Participants were free of symptomatic gallstone disease and diabetes and provided dietary information every 4 years from 1986 (baseline) until 2012. The aMed, AHEI-2010 and DASH scores were generated and associated with the risk of symptomatic gallstone disease using Cox proportional hazards regression. During 716 904 person-years of follow-up, 2382 incident cases of symptomatic gallstone disease were identified. All three scores were inversely associated with risk of symptomatic gallstone disease after adjustment for potential confounders including age, smoking, physical activity, energy and coffee intake [hazard ratios (HRs) and 95% confidence intervals (CIs)] comparing the highest with the lowest quintiles: aMed: 0.66 (0.57-0.77), AHEI-2010: 0.64 (0.56-0.74) and DASH: 0.66 (0.58-0.76)]. Findings were similar after additional adjustment for body mass index and after inclusion of asymptomatic cases. Associations were stronger when analysis was restricted to cases who had undergone cholecystectomy. In this prospective cohort of male US health professionals, higher adherence to the aMed, AHEI-2010 and DASH diets was associated with lower risk of symptomatic gallstone disease. Dietary recommendations focusing on high-quality diets targeting symptomatic gallstone disease may lower the incidence of this prevalent disease.

Dietary Patterns and Cognitive Function among Older Community-Dwelling Adults.

Diet may be an important modifiable risk factor for maintenance of cognitive health in later life. This study aimed at examining associations between common dietary indices and dietary patterns defined by factor analysis and cognitive function in older community-dwelling adults. Dietary information for 1499 participants from the Rancho Bernardo Study was collected in 1988–1992 and used to calculate the alternate Mediterranean diet score, Alternate Healthy Eating Index (AHEI)-2010 score and factor scores derived from factor analysis of nutrients. Global cognitive function, executive function, verbal fluency and episodic memory were assessed at approximate four-year intervals from 1988–2016. Linear mixed models were used to examine associations between dietary patterns and cognitive trajectories. Estimates for the highest vs. lowest tertile in models adjusting for age, sex, education, energy intake, lifestyle variables and retest effect showed greater adherence to the Mediterranean score was associated with better baseline global cognitive function (β (95% CI) = 0.33 (0.11, 0.55)). The AHEI-2010 score was not significantly associated with cognitive performance. Higher loading on a plant polyunsaturated fatty acid (PUFA)/vitamin E factor was associated with better baseline global cognitive function and executive function (β = 0.22 (0.02, 0.42) and β = −7.85 (−13.20, −2.47)). A sugar/low protein factor was associated with poorer baseline cognitive function across multiple domains. Dietary patterns were not associated with cognitive decline over time. Adherence to a healthy diet with foods high in PUFA and vitamin E and a low sugar to protein ratio, as typified by a Mediterranean diet, may be beneficial for cognitive health in late life.

Improved adherence to Mediterranean Diet in adults with type 1 diabetes mellitus

PurposeWe aimed to assess food intake and adherence to the Mediterranean Diet in patients with T1D compared with nondiabetic individuals.MethodsThis was an observational, multicenter study in 262 T1D subjects and 254 age- and sex-matched nondiabetic subjects. A validated food-frequency questionnaire was administered. The alternate Mediterranean Diet Score (aMED) and alternate Healthy Eating Index (aHEI) were assessed. The clinical variables were also collected. The analysis of data included comparisons between groups and multivariate models.ResultsCompared to the controls, the patients with T1D had a higher intake of dairy products (p < 0.001), processed meat (p = 0.001), fatty fish (p = 0.009), fruits and vegetables (p < 0.001), nuts (p = 0.011), legumes (p < 0.001), potatoes (p = 0.045), and bread (p = 0.045), and a lower intake of seafood (p = 0.011), sweets (p < 0.001), and alcohol drinks (p = 0.025). This intake pattern resulted in a higher consumption of complex carbohydrates (p = 0.049), fiber (p < 0.001), protein (p < 0.001), polyunsaturated fatty acids (PUFA) (p = 0.007), antioxidants (p < 0.001), vitamins (p < 0.001), and minerals (p < 0.001). The frequency of patients with T1D and low aMED score (23.2%) was lower than that of the controls (35.4%; p = 0.019). The overall multivariate analysis showed that, among other factors, being a T1D subject was associated with improved aMED and aHEI scores (p = 0.006 and p < 0.001). In patients with T1D, residing in a nonurban area was associated with improved aMED and aHEI scores (p = 0.001 and p < 0.001).ConclusionsAdult patients with T1D showed healthier dietary habits and a higher adherence to the Mediterranean Diet than nondiabetic subjects. Residing in a nonurban area is associated with an improved dietary pattern.

Abstract 5265: Association of dietary patterns with serum testosterone levels in men

Abstract Background: Testosterone (T) plays an important role in men's health and its deficiency has been linked with prostate cancer (PCa).1-3 In the U.S., there are approximately 2.4 million men (40-69 years old) with T deficiency4-7 and this number is projected to increase to 6.5 million men by 2025.8 Although this may be due, in part, to the increasing elderly population and body size, dietary factors may also play a role in T levels.9,16 Dietary patterns have been linked with PCa, and it has been hypothesized that T levels may be involved in the biological pathway.10-15 Therefore, we investigated the associations of prudent, western and alternative healthy eating index (AHEI) dietary pattern scores with serum T levels and whether these associations varied by obesity status (body mass index ≥ 30 kg/m2). Methods: We performed a cross-sectional analysis for the associations of the dietary pattern scores with T levels in 1,376 male participants of the Health Professionals Follow-up Study (HPFS). Total testosterone was measured by chemiluminescent immunoassay in blood samples collected in three assay batches: blood-draw to 1996, 1996-1998, 1998-2000. T deficiency was defined as total testosterone ≤ 350 ng/dL.17 We assessed diet every 4 years using a validated food frequency questionnaire.18 Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. AHEI-2010 score is a modified version of the Healthy Eating Index 2005. Multivariable linear and logistic regression analyses were conducted to investigate these associations.Results: After adjusting for risk factors of T levels, we did not identify significant associations between quintiles (lowest to highest) of prudent, western, and AHEI dietary pattern scores with T levels, Ptrend ≥ 0.05 for all. However, there seemed to be a weak association with AHEI, Ptrend ≥ 0.07. Furthermore, a potential nonlinear relationship with the prudent diet was observed (Pnonlinearity = 0.0005). The associations of the three dietary patterns with T deficiency did not reach statistical significance, Ptrend ≥ 0.48 for all. In stratified analysis, we identified a weak linear relationship between prudent diet and T levels in obese men (Ptrend = 0.05).Conclusion: With the exception of a weak association with AHEI, we did not find a significant linear relationship between prudent and western dietary patterns and T levels, but this doesn't exclude potential nonlinear associations. Although we only identified a weak relationship between prudent diet and T levels in obese men, it seemed that obesity overwhelmed any impact of the three dietary patterns on T levels because in general the T levels across the quintiles of the three dietary patterns scores were lower among obese than non-obese men irrespective of the diet. Citation Format: David S. Lopez, Lydia Liu, Stephanie A. Smith-Warner, Eric B. Rimm, Konstantinos K. Tsilidis, Steven Canfield, Edward Giovannucci. Association of dietary patterns with serum testosterone levels in men [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5265.

Abstract P213: Change in Diet Quality and Risk of Incident Diabetes: The Atherosclerosis Risk in Communities Study

Introduction: Despite the well-established association between diet and chronic disease risk, there is limited evidence on the association between diet change and long-term risk of diabetes in a community-based setting. Hypothesis: Decline in diet quality is associated with an increased risk for incidence of diabetes in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: We included 8285 ARIC participants who had complete dietary intake assessments by food frequency questionnaire (FFQ) at both visits 1 (1987-1989) and 3 (1993-1995) and had no prevalent diabetes, cardiovascular disease, or cancer prior to visit 3. Change in diet quality was assessed using the Healthy Eating Index (HEI)-2015 and the Alternative HEI (AHEI)-2010 scores calculated at the two study visits. Change in scores was classified into five categories from moderate/large decrease to moderate/large increase. We used adjusted Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between HEI-2015/AHEI-2010 score changes and incidence of diabetes, which is defined using doctor diagnosis, medication use, or elevated glucose. Results: There were 2,136 cases of incident diabetes during a median of 18.05 years of follow-up (124,639 person-years). For HEI-2015, there were no statistically significant association between dietary score change and diabetes risk, comparing the five categories of changes (adjusted HRs and 95% CIs for the five categories from decrease to increase were 1.06 [0.90-1.25],1.04 [0.90-1.21],1.00 (ref.), 0.91 [0.79-1.05], 1.04 [0.91-1.20]). Similar trends were found in AHEI-2010 scores changes, but for the moderate to large decrease group, the decrease in dietary scores was associated with a higher diabetes risk (HR 1.23, 95%CI 1.03 to 1.46), compared to the stable group. Conclusion: The results suggest that deterioration of diet quality is associated with a higher risk of diabetes.

Abstract MP37: Diet Quality and Lifetime Risk of Total Cardiovascular Disease in US Adults

Introduction: Suboptimal diet is a leading risk factor for cardiovascular disease (CVD). Yet, the relationship between diet quality and lifetime CVD risk, and whether it differs by age, are unclear. Methods: Diet data from 10 US prospective cohorts were harmonized according to a standard protocol. Three diet quality indices were calculated within each cohort: Dietary Approaches to Stop Hypertension (DASH) diet, alternate Healthy Eating Index 2010 (aHEI-2010), and alternate Mediterranean (aMED) diet. CVD included coronary heart disease, stroke and heart failure. Study sample was divided into younger (&lt;40 years old), middle-aged (40-60) and older (&gt;60) groups based on age at the first dietary assessment. Cumulative CVD risk according to 5-year interval was estimated using modified Kaplan-Meier analysis, adjusting for competing risk of death. Multivariable proportional hazards regression was applied to determine the association between the three diet quality indices and CVD by sex and age. Results: A total of 129,892 participants with 1,603,199 person years of follow-up were analyzed. The adjusted cumulative CVD risk was lower in younger and middle-aged men and all women who had higher DASH score (Figure 1). Age modified the diet-CVD association in both men and women (P &lt;0.0005). Compared to the lowest DASH score quintile (poorest diet), the adjusted hazard ratio (HR) for CVD decreased with increasing quintile of diet quality. The HR for the highest quintile was 0.41 (95% CI: 0.20-0.87) in younger men, 0.97 (0.82-1.16) in middle-aged men, 1.03 (0.89-1.19) in older men, 0.47 (0.21-1.05) in younger women, 0.73 (0.63-0.84) in middle-aged women, and 0.82 (0.76-0.88) in older women. Results were similar for aMED and aHEI-2010 score. Conclusions: Better diet quality is associated with lower lifetime CVD risk in all women and men except older men. Stronger inverse diet quality-CVD association in younger than middle-aged and older adults suggests that relative benefits of a healthy diet for CVD risk reduction may be greater at younger ages.

Dietary Quality and Ovarian Cancer Risk in African-American Women.

This study evaluated 3 index-based dietary patterns-Healthy Eating Index (HEI)-2005, HEI-2010, and Alternate Healthy Eating Index (AHEI)-2010-in relation to ovarian cancer risk in African-American women. The study was conducted among 415 ovarian cancer cases and 629 age- and site-matched controls of African-American descent recruited from the population-based African American Cancer Epidemiology Study. Multivariable unconditional logistic regression models were used to estimate odds ratios and 95% confidence intervals between quartiles of dietary quality indices and ovarian cancer risk, adjusting for potential confounders. We found that higher AHEI-2010 scores, but not HEI-2005 or HEI-2010 scores, were associated with lower risk of ovarian cancer (comparing the highest quartile (4th) vs. lowest (1st), odds ratio (OR)=0.66, 95% confidence interval (CI): 0.45, 0.98; P for trend=0.05). When stratified by menopausal status, no noteworthy associations were observed among premenopausal women. However, among postmenopausal women, greater adherence to HEI-2010 (quartile 4 vs. quartile 1, OR=0.57, 95% CI: 0.36, 0.92; P for trend=0.03) and AHEI-2010 (quartile 4 vs. quartile 1, OR=0.49, 95% CI: 0.31, 0.78; P for trend=0.01) were inversely associated with ovarian cancer. Our findings indicate that adherence to an overall healthy dietary pattern may reduce ovarian cancer risk in African-American women, and particularly among postmenopausal African-American women.

Abstract P095: Diet Quality and Genetic Association With Body Mass Index

Background: Whether dietary quality modifies genetic association with body mass index (BMI) is unknown. Methods: We examined the interactions prospectively of a genetic risk score (GRS) based on 97 BMI-associated variants with three diet quality scores (alternative healthy eating index 2010 (AHEI-2010), Alternative Mediterranean Diet score (AMED) and Dietary Approach to Stop Hypertension (DASH) diet score) on BMI in 30,904 participants from three large US cohorts. According to the enrichment of genes near the BMI-associated loci in the central nervous system (CNS), we further created two subsets of GRSs: CNS GRS based on 54 variants and non-CNS GRS based on 43 variants. Findings: We found significant interactions between total GRS and all three diet scores on BMI assessed after 2 to 3 years, with an attenuated genetic effect observed in individuals with healthier diets (AHEI: P for interaction = 0.003; AMED: P = 0.001; DASH: P = 0.004). For example, the difference in BMI per 10 unit increment of the GRS was smaller among participants in the highest tertile of AHEI score compared to those in the lowest tertile (0.84 [95% CI: 0.72, 0.96] vs. 1.14 [0.99, 1.29] kg/m 2 ). Results were consistent across the three cohorts with no significant heterogeneity. The interactions with diet scores on BMI appeared more significant for CNS GRS (AHEI: P = 0.009; AMED and DASH: P &lt; 0.001) than for non-CNS GRS (AHEI: P = 0.10; AMED: P = 0.50; DASH: P = 0.68). Among individual components of diet scores, higher consumption of red/processed meat, sugar-sweetened beverages, and trans fat accentuated genetic associations with BMI (P &lt;0.01), while higher consumption of fruit and moderate alcohol attenuated genetic associations with BMI (P &lt; 0.01). Interpretation: A higher diet quality may mitigate genetic predisposition to obesity. These findings provide insights into complex interplays between diet and genetic influences and underscore the importance of adopting a healthful diet for the prevention of obesity, particularly those individuals with a strong genetic predisposition to obesity.

The Alternative Healthy Eating Index Is Associated with a Lower Risk of Fatal and Nonfatal Acute Myocardial Infarction in a Chinese Adult Population

Background: Indexes to quantify adherence to recommended dietary patterns have been developed for Western populations, but it is unclear whether these indexes can predict acute myocardial infarction (AMI) in Asian populations.Objectives: We aimed to investigate the association between the Alternative Healthy Eating Index (AHEI)–2010 and risk of AMI and to evaluate potential mediation by traditional cardiovascular risk factors in a Chinese population.Methods: A nested case-control study in 751 incident cases of AMI (564 nonfatal and 288 fatal) and 1443 matched controls was conducted within the prospective Singapore Chinese Health Study, a cohort of ethnic Chinese men and women aged 45–75 y. At baseline, habitual diet was assessed by using a validated, semiquantitative food-frequency questionnaire. AMI cases were ascertained via linkage with nationwide hospital databases (confirmed through medical record review) and the Singapore Birth and Death Registry. We evaluated the association between the AHEI-2010 and cardiovascular risk factors, including glycated hemoglobin, high-sensitivity C-reactive protein, creatinine, plasma lipids (LDL and HDL cholesterol, triglycerides), and blood pressure. ORs and 95% CIs were computed by using multivariable-adjusted conditional logistic regression models.Results: Higher AHEI-2010 scores were associated with a lower risk of AMI (OR for the highest quartile compared with the lowest quartile: 0.62; 95% CI: 0.47, 0.81; P-trend < 0.001), with similar associations for fatal (OR: 0.60; 95% CI: 0.39, 0.94; P-trend = 0.009) and nonfatal (OR: 0.59; 95% CI: 0.43, 0.81; P-trend = 0.002) AMI. This association was only slightly attenuated after adjustment for potential biological intermediates (OR: 0.64; 95% CI: 0.48, 0.86; P-trend = 0.003).Conclusions: Adherence to dietary recommendations as reflected in the AHEI-2010 was associated with a substantially lower risk of fatal and nonfatal AMI in an Asian population, and this association was largely independent of traditional cardiovascular risk factors.

An Increase in Dietary Quality Is Associated with Favorable Plasma Biomarkers of the Brain-Adipose Axis in Apparently Healthy US Women1

Background: The associations between long-term dietary quality and biomarkers of the brain-adipose axis have not been examined.Objective: We evaluated both cross-sectional and longitudinal associations between dietary quality and several biomarkers involved in the brain-adipose axis.Methods: In the Nurses’ Health Study II, 831 women [baseline mean age: 45 y; body mass index (BMI; in kg/m2): 24.6] were randomly selected from women who provided 2 fasting blood samples in 1996–1999 and 2010–2011 to measure plasma concentrations of leptin, soluble leptin receptor (sOB-R), adiponectin, insulin, retinol binding protein-4 (RBP-4), interleukin-6 (IL-6), and C-reactive protein (CRP). Dietary quality was assessed by the Alternative Healthy Eating Index (AHEI-2010) with the use of semiquantitative food-frequency questionnaires administered in 1995 and 2011. We used linear mixed models to evaluate the cross-sectional associations between dietary quality and biomarker concentrations. We also examined change in dietary quality in relation to change in biomarker concentrations.Results: In cross-sectional analyses that compared the highest with the lowest quintile of AHEI-2010, we observed significantly lower leptin (P-trend < 0.0001), insulin (P-trend < 0.0001), and CRP (P-trend = 0.02) and significantly higher sOB-R (P-trend < 0.0001) and adiponectin (P-trend = 0.0003). These associations, except for CRP, remained significant after adjustment for BMI. In longitudinal analyses, women in the highest quintile of AHEI-2010 score change (most improvement) had a 13% increase in leptin, compared with a 42% increase (P-trend < 0.0001) in the lowest quintile (least improvement). The corresponding multivariable-adjusted percentage changes for other biomarkers were 4% compared with −1% for sOB-R (P-trend = 0.04), 14% compared with 6% for adiponectin (P-trend = 0.02), and −11% compared with 16% for CRP (P-trend = 0.02). Adjustment for interim weight change attenuated these associations. No associations were observed for RBP-4 or IL-6.Conclusion: Improvement in dietary quality was associated with favorable profiles of several biomarkers of the brain-adipose axis in women.

Abstract P080: Associations of Bowel Movement Frequency with Risk of Coronary Heart Disease and Mortality Among Us Women

Background: Bowel movement frequency has been related to a variety of cardiovascular risk factors such as inflammation and metabolism of gut microbiota. However, few studies have examined the relations of bowel movement frequency with risk of coronary heart disease (CHD) and mortality in prospective cohorts. Objectives: To investigate the prospective associations between bowel movement frequency, incident CHD, and mortality in a large cohort of US women, the Nurses’ Health Study. Methods: Bowel movement frequency was self-reported at baseline in 1982 by 85,976 women who were free from cardiovascular disease and cancer. Incident CHD including symptomatic nonfatal myocardial infarction or fatal CHD was subsequently identified. Deaths were reported by the next of kin or the postal authorities or identified by searching the National Death Index. Multivariable Cox proportional hazards models were used to assess the associations of bowel movement frequency with risk of CHD, total mortality, and mortality due to cardiovascular disease. Results: During follow-up, we documented a total of 5,805 incident CHD cases (1982-2010) and 20,972 deaths (1982-2012). After adjustment for potential confounders and CHD risk factors at baseline (age, ethnicity, multivitamin use, aspirin use, family history of heart disease, hypertension, hypercholesterolemia, or diabetes at baseline, menopausal status and postmenopausal hormone therapy use, smoking status, alcohol consumption, physical activity, BMI, dietary fiber intake, and AHEI score), having a bowel movement more than once daily was significantly associated with increased risk of CHD, total mortality, and cardiovascular mortality. As compared with women with bowel movement frequency of once daily (reference), the hazard ratios (HRs) for those with more than once daily were 1.09 (95% confidence interval [CI]: 1.01-1.18) for incident CHD; 1.08 (95% CI: 0.99-1.18) for cardiovascular mortality; and 1.13 (95% CI: 1.08-1.18) for total mortality. Less frequent bowel movements were not significantly related to risk of CHD or mortality. Similar findings were observed in sensitivity analyses that excluded participants who had ulcerative colitis history or excluded those who used laxatives. Conclusions: Compared to those with daily bowel movements, women with more frequent bowel movements had a modestly increased risk of CHD incidence and total mortality. These associations should be examined in other populations.

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study

BackgroundEarly life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking. MethodsA cross-sectional sample of 151 males and females (age: 45.6±3.5years, BMI: 30.0±7.1kg/m2) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA–PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics. ResultsIndividuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above lifestyle parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants. ConclusionFewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index.

Eating behavior by sleep duration in the Hispanic Community Health Study/Study of Latinos

Sleep is an important pillar of health and a modifiable risk factor for diabetes, stroke and obesity. Little is known of diet and sleep patterns of Hispanics/Latinos in the US. Here we examine eating behavior as a function of sleep duration in a sub-sample of 11,888 participants from the Hispanic Community Health Study/Study of Latinos, a community-based cohort study of Hispanics aged 18–74 years in four US cities. Using a cross-sectional probability sample with self-report data on habitual sleep duration and up to two 24-h dietary recalls, we quantified the Alternative Healthy Eating Index (AHEI-2010) score, a measure of diet quality, and intake of selected nutrients related to cardiovascular health. Linear regression models were fit to estimate least-square means of usual nutrient intake of saturated fats, potassium density, fiber, calcium, caffeine and the AHEI-2010 score by sleep duration adjusting for age, sex, Hispanic/Latino background, income, employment status, education, depressive symptomology, and years lived in the US. Distribution of calories over the day and association with sleep duration and BMI were also examined.Short sleepers (≤6 h) had significantly lower intake of potassium, fiber and calcium and long sleepers (≥9 h) had significantly lower intake of caffeine compared to others sleepers after adjusting for covariates. However no difference in the AHEI-2010 score was seen by sleep duration. Significantly more long sleepers, compared to intermediate and short sleepers, reported having ≥30% total daily calories before bedtime. Not consuming a snack or meal within 3 h before bedtime was associated with higher AHEI-2010 scores. These findings identify novel differences in dietary patterns by sleep duration in a Hispanic/Latino cohort in the U.S. ClinicalTrials.gov IdentifierNCT02060344

Alternative health eating index and the Dietary Guidelines from American Diabetes Association both may reduce the risk of cardiovascular disease in type 2 diabetes patients.

In the general population, a higher Alternate Healthy Eating Index (AHEI)-2010 score is related to decreased cardiovascular disease (CVD) risk. Few studies have described the dietary patterns that reduce the risk of CVD or coronary heart disease (CHD) in type 2 diabetes mellitus (T2DM) patients. In the present study, the association between the American Diabetes Association (ADA)-recommended dietary pattern, AHEI-2010 , and CVD risk factors and the CVD incidence over 52 months in T2DM patients was evaluated. The ADA score was developed from the ADA dietary recommendations. In this prospective study, the 24-h dietary recall of 124 adult T2DM patients without nephropathy or chronic kidney disease was collected. The CVD risk factors were collected at baseline and at 6-month follow-up. Compared with lower ADA and AHEI-2010 score participants, the higher score participants exhibited a significantly lower waist circumference, serum low-density lipoprotein cholesterol level and 10-year risk of CHD. Participants with higher ADA dietary scores had a significantly reduced risk of central obesity and systolic blood pressure >140 mmHg. Higher AHEI-2010 scores were significantly related to a reduced risk of serum low-density lipoprotein cholesterol > 100 mg dL(-1) . Seven participants had their first-ever CVD during the follow-up period, although neither ADA score, nor AHEI-2010 score could predict CVD incidence. The ADA-recommended dietary pattern and a higher AHEI-2010 score might both exhibit reduced risk factors of CVD in T2DM patients.

Abstract P163: Healthful Dietary Patterns and the Risk of Hypertension Among Women With a History of Gestational Diabetes

Background: Women who developed gestational diabetes (GDM) are at an increased risk for hypertension, compared with parous women without GDM. The role of diet in the progression to hypertension among this highly susceptible population is unknown. Methods: We conducted a prospective cohort study among 3,818 women with a history of GDM in the Nurses’ Health Study II, as a part of the ongoing Diabetes &amp; Women’s Health Study. These women were followed from 1991 until 2011. Incident hypertension was identified by self-report with a previously validated questionnaire. Adherence scores for the 2010 Alternative Health Eating Index (AHEI-2010), the Alternate Mediterranean Diet (aMed) and the Dietary Approaches to Stop Hypertension (DASH) were computed for each participant; higher scores indicate better diet quality. Cox proportional hazard models were used adjusting for major risk factors for hypertension, including dietary and lifestyle factors, medical history, reproductive factors and medications. Results: We documented 1,069 incident hypertension cases during a median of 18.5 years follow-up. After multivariate adjustment, the AHEI-2010, and DASH scores were significantly and inversely associated with risk of hypertension. Hazard ratio (HR) and 95% confidence interval (CI) comparing the extreme quartiles (highest vs. lowest) was 0.78 (0.63-0.96, P for linear trend=0.02) for AHEI-2010, 0.77 (0.62-0.96, P for trend=0.02) for DASH score and 0.80 (0.65-0.99, P for trend=0.06) for aMed score. Conclusion: After GDM, adherence to a healthful dietary pattern was related to a lower risk of developing hypertension.

Abstract 25: Adolescent Diet Quality and Primordial Prevention of Cardiovascular Disease in the Nurses’ Health Study II

Background: Current clinical practice focuses on primary prevention of CVD through modification of clinical risk factors, such as high cholesterol, hypertension and diabetes. The absence of established risk factors at mid-life is associated with a low long-term risk of CVD. Previously, a healthy lifestyle in young adulthood was associated with a low CVD risk profile at mid-life. Whether a high quality diet in adolescence can prevent development of CVD risk factors in adulthood is unknown. Methods: As part of the Nurses’ Health Study II, which included women aged 25-42 at recruitment in 1989, women completed a validated high school food frequency questionnaire, reflecting intake in grades 9-12, in 1998. Diet quality was defined by a modified Alternative Healthy Eating Index (AHEI-hs), where high scores reflect a diet high in fruits, vegetables, whole grains and unsaturated fats and low in red/processed meat, sugar sweetened beverages and trans fat. Physician-diagnosed clinical risk factors (hypertension, high cholesterol, diabetes) were assessed every 2 years. We assessed the relation between the AHEI-hs and time-to-first-development of any risk factor in 28,284 women who were free of diagnosed clinical risk factors in 1998 (mean age 43). We also explored the AHEI-hs in relation to risk of CVD (CHD or ischemic stroke) in 43,721 women who were free from CVD, but not necessarily risk factors, in 1998 (mean age 44). Cox proportional hazards models were adjusted for potential confounders in high school (BMI, energy, smoking, physical activity) and adulthood (smoking, physical activity, oral contraceptives, postmenopausal hormones, aspirin use, energy, alcohol, family history of disease). Results: From 1998 through 2011, 11,328 risk factors and 520 CVD events were documented. After adjustment for high school and adult confounders, higher AHEI-hs scores were associated with a lower rate of diagnosed risk factors (HR comparing quartile 4 to 1: 0.84, 95% CI 0.80,0.89, p trend &lt;0.001). Further adjustment for adult diet quality did not alter results appreciably. A higher AHEI-hs was also associated with lower risk of CVD (HR comparing quartile 4 to 1: 0.77, 95% CI 0.60, 0.99, p trend = 0.03), but not after adjustment for adult confounders and adult diet quality (HR 0.98, 95% CI 0.75, 1.27, p trend = 0.85). Compared to women in the lowest tertiles of AHEI scores in high school and adulthood, women in the highest tertiles at both time points had a lower risk of developing a CVD risk factor (HR 0.78, 95% CI 0.73, 0.84) and of CVD (HR: 0.70, 95% CI 0.50, 0.97). Conclusions: A high quality diet during adolescence was associated with lower risk of developing clinical CVD risk factors in adulthood, and maintenance of good dietary habits throughout early adulthood was most strongly associated with lower risk of CVD. For ideal cardiovascular health, healthy diet habits should begin in early life and continue through adulthood.

Abstract 17257: The Association Between Diet Quality After Diabetes Diagnosis and Major Cardiovascular Events in Women With Type 2 Diabetes Mellitus

Introduction: The role of dietary choices in the prevention of cardiovascular hard-outcome among type 2 diabetes patients has not been studied well. We examined whether there is an association between dietary quality after diagnosis of type 2 diabetes and major cardiovascular events among women using long-term prospective cohort study. Hypothesis: Healthy dietary pattern after type 2 diabetes diagnosis is associated with decreased risk for major cardiovascular events among women. Methods: The women with type 2 diabetes (n=6,895, mean age 64 years old) from the Nurses’ Health Study with no baseline cancer or cardiovascular disease were selected. Cox proportional hazard model was used to assess the multivariate association between the alternate Healthy Eating Index (aHEI) and the first episode of major cardiovascular events (coronary heart disease (CHD) or stroke). Results: During 26 years of follow-up (75, 276 person-years), a total of the 705 major cardiovascular events (432 cases of CHD, 314 cases of stroke, 41 cases of both CHD and stroke) were documented. The age-adjusted relative risks of major cardiovascular events across quintiles of aHEI score (Q1, Q2, Q3, Q4, Q5) were 1, 0.99 (95% CI, 0.80 to 1.22), 0.84 (CI, 0.67 to 1.05), 0.57 (CI, 0.44 to 0.72), and 0.66 (CI, 0.52 to 0.84) (P &lt; 0.0001 for trend). These figures did not change materially after adjustment for body mass index, physical activity, smoking and other cardiovascular risk factors (1, 1.00, 0.91, 0.63, and 0.80, respectively; P = 0.008 for trend). The multivariate relative risks for stroke and CHD across quintiles of aHEI score were 1, 0.72, 0.80, 0.46, and 0.72 (P = 0.028 for trend) and 1, 1.21, 0.96, 0.72, and 0.73 (p=0.014 for trend), respectively. Conclusions: Healthier dietary habits after the diagnosis of diabetes are associated with a reduced risk of cardiovascular events including stroke and coronary heart disease.

Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study

Aims/hypothesisFew studies have investigated the relationship between predefined dietary patterns and type 2 diabetes incidence; little is known about the generalisability of these associations. We aimed to assess the association between predefined dietary patterns and type 2 diabetes risk in European populations.MethodsFrom among a case-cohort of 12,403 incident diabetes cases and 16,154 subcohort members nested within the prospective European Prospective Investigation into Cancer and Nutrition study, we used data on 9,682 cases and 12,595 subcohort participants from seven countries. Habitual dietary intake was assessed at baseline with country-specific dietary questionnaires. Two diet-quality scores (alternative Healthy Eating Index [aHEI], Dietary Approaches to Stop Hypertension [DASH] score) and three reduced rank regression (RRR)-derived dietary-pattern scores were constructed. Country-specific HRs were calculated and combined using a random-effects meta-analysis.ResultsAfter multivariable adjustment, including body size, the aHEI and DASH scores were not significantly associated with diabetes, although for the aHEI there was a tendency towards an inverse association in countries with higher mean age. We observed inverse associations of the three RRR-derived dietary-pattern scores with diabetes: HRs (95% CIs) for a 1-SD difference were 0.91 (0.86, 0.96), 0.92 (0.84, 1.01) and 0.87 (0.82, 0.92). Random-effects meta-analyses revealed heterogeneity between countries that was explainable by differences in the age of participants or the distribution of dietary intake.Conclusions/interpretationAdherence to specific RRR-derived dietary patterns, commonly characterised by high intake of fruits or vegetables and low intake of processed meat, sugar-sweetened beverages and refined grains, may lower type 2 diabetes risk.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-013-3092-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Diet-Quality Scores and the Risk of Type 2 Diabetes in Men

OBJECTIVETo 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata.RESEARCH DESIGN AND METHODSMen from the Health Professionals Follow-Up Study, who were initially free of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for ≤20 years. The Healthy Eating Index (HEI) 2005, the alternative HEI (aHEI) the Recommended Food Score, the alternative Mediterranean Diet (aMED) Score, and the Dietary Approaches to Stop Hypertension (DASH) Score were calculated from food-frequency questionnaires. Cox proportional hazard models with time-varying covariates were used to assess risk by quintiles and continuous intervals.RESULTSThere were 2,795 incident cases of type 2 diabetes. After multivariate adjustment, the aHEI, aMED, and DASH scores were significantly associated with reduced risk. A 1-SD increase was associated with 9–13% reduced risk (P < 0.01), and the DASH score was associated with lower risk independent of other scores. These scores were associated with lower absolute risk among those who were overweight or obese compared with normal weight (P for interaction < 0.01).CONCLUSIONSSeveral diet-quality scores were associated with a lower risk of type 2 diabetes and reflect a common dietary pattern characterized by high intakes of plant-based foods such as whole grains; moderate alcohol; and low intakes of red and processed meat, sodium, sugar-sweetened beverages, and trans fat. High-quality diets may yield the greatest reduction in diabetes cases when followed by those with a high BMI.