Alternate Healthy Eating Index Score Research Articles

Environmental sustainability and nutritional quality of different diets considering nutritional adequacy

This study examines how four diets change nutritionally and environmentally when the diets are nutritionally adjusted. Data on individual Belgian diets of omnivores (n = 131), pescovegetarians (n = 159), vegetarians (n = 494), and vegans (n = 78) were obtained, called non-adjusted diets. We assessed if diets met energy and nutrient intake requirements and calculated the Alternative Healthy Eating Index (AHEI)-2010. The environmental impact was evaluated by a cradle-to-grave life cycle assessment considering all midpoint indicators of the Environmental Footprint 3.0 and expressing the impact per “daily food and supplement intake by one Belgian adult”. The individual dietary intakes were adjusted nutritionally to meet the recommended energy and nutrition intakes using a quadratic programming algorithm. All diets had a significantly improved AHEI score but also a significantly increased water use (WU) when adjusting. The omnivore's diet demonstrated a significantly decreased carbon footprint (CF) while it significantly (except for vegans) raised for the restrictive diets due to adjustment. The omnivorous diet had the greatest improvements in AHEI (15.4), while WU increased the most among all diets (3.7 m3), primarily due to elevated fruit intake. The CF was reduced with 1.2 kg CO2 due to decreased red meat consumption. The AHEI of the vegan diet improved the second most of all diets (13.2) due to the intake of omega-3 supplements, while its WU rose the least of all diets (2.4 m3), and its CF barely increased (0.1 kg CO2-eq). The AHEI improvements of the vegetarian diet were similar to those of the vegan diet (12.5), while the one of the pescovegetarian diet was limited (3.5). The (pesco)vegetarian diet had an increase in WU (2.5 and 2.7 m3) and the highest increase in the CF (0.3 kg CO2-eq). Since nutritionally adjusted diets do not lead to similar nutritional and environmental improvements, this research highlights the need to assess both metrics.

Effectiveness of Health Action Interventions in Enhancing Diet Quality and Glycemic Control Among Individuals With Type 2 Diabetes Mellitus: A Systematic Review of Randomized Clinical Trials.

Diet quality is directly related to glycemic control in individuals with type 2 diabetes mellitus (T2DM). The use of dietary indices can provide a comprehensive understanding of the relationship between diet quality and clinical outcomes. The aim was to evaluate the relationship between diet quality, measured using dietary indices, and its impact on improving glycemic control in individuals with T2DM through health interventions. This study was conducted using 6 databases, including Web of Science, MEDLINE (via PubMed), Embase, Bireme, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as the gray literature (Google Academic). Randomized clinical trials that evaluated the effectiveness of health interventions in adult and older adult individuals with T2DM and presented data on diet quality evaluated using dietary indices and the percentage of glycated hemoglobin (%HbA1c) were included. A total of 3735 articles were retrieved, 4 of which were included in the study selection stages. The quality indices assessed in the studies were the Alternate Healthy Eating Index (AHEI), Healthy Eating Index-2010 (HEI-2010), Diet Quality Index-International (DQI-I), and Diet Quality Index-Revised (DQI-R). A reduction in %HbA1c was observed in 2 studies, which correlated with the AHEI and DQI-I scores in the intervention groups. The approach of using food labels to improve diet quality reduced %HbA1c by 0.08% in the intervention group compared with the control group. Only 1 study found no significant association between the DQI-R index and %HbA1c. Additionally, negative correlations were observed between body weight and the AHEI and DQI-I scores. Health interventions improved diet quality, glycemic control, and weight loss in individuals with T2DM. PROSPERO no. CRD42023430036.

Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study

ObjectiveTo examine the association of ultra-processed food consumption with all cause mortality and cause specific mortality.DesignPopulation based cohort study.SettingFemale registered nurses from 11 US states in the Nurses’ Health Study...

OVERWEIGHT AND OBESITY AND ITS ASSOCIATION WITH HYPERTENSION IN COLOMBIA: PURE COHORT

Objective: To assess the association between overweight and obesity with blood pressure levels and incident hypertension in a prospective cohort with 12 years of follow-up. Design and method: Individuals aged 35 to 70 years from the Prospective Urban Rural Epidemiology Colombia cohort study were included. Participants with a history of hypertension and diabetes at baseline were excluded. Overweight and obesity was defined as a body mass index (BMI) greater or equal to 25 kg/m2. Blood pressure (BP) was measured at baseline and every 3-year follow-up. Hypertension was defined as a self-reported history of hypertension, baseline systolic BP greater or equal to 140 mmHg, diastolic BP greater or equal to 90 mmHg, or use of BP-lowering medications. Overweight and obese participants were propensity score matched using a 1:1 ratio with non-overweight participants. We used conditional logistic regression to evaluate the association between overweight, obesity, and hypertension, calculating the odds ratio and a 95% CI. Systolic BP and diastolic BP were analyzed in a linear mixed model as response variables, with matching pairs as random effects. The regression models were adjusted by sex, age, physical activity, tobacco use, alcohol use, education, waist-hip ratio, the alternative healthy eating index score, grip strength adjusted by weight, triglyceride-glucose index, and systolic BP at baseline. We established a p-value of <0.05 as significant. Results: Of 7500 participants, 1146 were matched, obtaining 573 pairs. The mean BMI was 25.2 kg/m2 (SD 4.02). The frequency of women was higher in the overweight group (68.1% vs. 60.9). The baseline SBP in overweight participants was 116.92 (SD 12.62) and 118.30 (SD 11.74) in non-overweight. 37.2% of overweight participants developed hypertension, but only 29.7% in non-overweight at follow-up. There was a 32% higher risk of hypertension in overweight participants (OR 1.32 95% CI:1.08-1.61). Being overweight and obese was associated with a higher increase in SBP of 2.53 mmHg (CI: 0.74-4.31) and DBP levels of 2.80 mmHg (CI: 1.68-3.93) at follow-up. Conclusions: Overweight and obesity, independently of other risk factors were associated with increased hypertension incidence and with higher SBP and DBP levels at 12 years of follow-up.

Longitudinal associations of the alternative healthy eating index with coronary artery calcification and pericardial adiposity in US adults with and without type 1 diabetes

Background and aimLong-term associations between the alternative healthy eating index (AHEI) score and two predictive indicators for CVD, pericardial adipose tissue (PAT) and coronary artery calcification (CAC) volume, are lacking. Our study aims to investigate the longitudinal associations of the AHEI score with measures of CAC and PAT in adults with and without type 1 diabetes (T1D). Methods and resultsThe prospective Coronary Artery Calcification in T1D (CACTI) study included 652 people with T1D and 764 people without diabetes (non-DM) (19–56 years old) and was conducted in 2000–2002, 2003–2004, and 2006–2007. At each visit, food frequency questionnaires were collected and PAT and CAC were measured using electron beam computed tomography. Two variables were used for CAC analyses: a continuous variable for the square-root tranformed volume (SRV) for each visit and a second variable identified CAC progression from baseline to visit 3. Mixed effect models and a logistic regression model were used to conduct statistical analyses. A one-point increase in the AHEI score was significantly associated with a −0.12 cm3 (95% CI: −0.17, −0.08; p-value<0.0001) decrease in PAT volume in combined analyses, a −0.16 cm3 (95% CI: −0.22, −0.09; p-value<0.0001) decrease in the non-DM group, a marginally significant −0.07 cm3 (95% CI: −0.14, 0.002; p-value = 0.0571) decrease in the T1D group, and was not associated with either CAC outcome. ConclusionThe AHEI score is inversely associated with PAT; the association revealed greater magnitude of PAT reduction in the non-DM group. The AHEI score did not associate with CAC progression.

Association of the short-chain fatty acid levels and dietary quality with type 2 diabetes: a case-control study based on Henan Rural Cohort.

Evidence of the relationship between fecal short-chain fatty acids (SCFA) levels, dietary quality and type 2 diabetes mellitus (T2DM) in rural populations is limited. Here, we aimed to investigate the association between fecal SCFA levels and T2DM and the combined effects of dietar quality on T2DM in rural China. In total, 100 adults were included in the case-control study. Dietary quality was assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), and SCFA levels were analysed using the GC-MS system. Generalised linear regression was conducted to calculate the OR and 95 % CI to evaluate the effect of SCFA level and dietary quality on the risk of T2DM. Finally, an interaction was used to study the combined effect of SCFA levels and AHEI-2010 scores on T2DM. T2DM participants had lower levels of acetic and butyric acid. Generalised linear regression analysis revealed that the OR (95 % CI) of the highest acetic and butyric acid levels were 0·099 (0·022, 0·441) and 0·210 (0·057, 0·774), respectively, compared with the subjects with the lowest tertile of level. We also observed a significantly lower risk of T2DM with acetic acid levels > 1330·106 μg/g or butyric acid levels > 585·031 μg/g. Moreover, the risks of higher acetic and butyric acid levels of T2DM were 0·007 (95 % CI: 0·001, 0·148), 0·005 (95 % CI: 0·001, 0·120) compared with participants with lower AHEI-2010 scores (all P < 0·05). Acetate and butyrate levels may be important modifiable beneficial factors affecting T2DM in rural China. Improving dietary quality for body metabolism balance should be encouraged to promote good health.

Exploring Biases of the Healthy Eating Index and Alternative Healthy Eating Index When Scoring Low-Carbohydrate and Low-Fat Diets

BackgroundThe Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010) are commonly used to measure dietary quality in research settings. Neither index is designed specifically to compare diet quality between low-carbohydrate (LC) and low-fat (LF) diets. It is unknown whether biases exist in making these comparisons. ObjectiveThe aim was to determine whether HEI-2010 and AHEI-2010 contain biases when scoring LC and LF diets. DesignSecondary analyses of the Diet Intervention Examining the Factors Interacting With Treatment Success (DIETFITS) weight loss trial were conducted. The trial was conducted in the San Francisco Bay Area of California between January 2013 and May 2016. Three approaches were used to investigate whether biases existed for HEI-2010 and AHEI-2010 when scoring LC and LF diets. Participants/settingDIETFITS participants were assigned to follow healthy LC or healthy LF diets for 12 months (n = 609). Main outcomes measuresMean diet quality index scores for each diet were measured. Statistical analysisApproach 1 examined both diet quality indices’ scoring criteria. Approach 2 compared scores garnered by exemplary quality LC and LF menus created by registered dietitian nutritionists. Approach 3 used 2-sided t tests to compare the HEI-2010 and AHEI-2010 scores calculated from 24-hour dietary recalls of DIETFITS trial participants (n = 608). ResultsScoring criteria for both HEI-2010 (100 possible points) and AHEI-2010 (110 possible points) were estimated to favor an LF diet by 10 points. Mean scores for exemplary quality LF menus were higher than for LC menus using both HEI-2010 (91.8 vs 76.8) and AHEI-2010 (71.7 vs 64.4, adjusted to 100 possible points). DIETFITS participants assigned to a healthy LF diet scored significantly higher on HEI and AHEI than those assigned to a healthy LC diet at 3, 6, and 12 months (all, P < .001). Mean baseline scores were lower than mean scores at all follow-up time points regardless of diet assignment or diet quality index used. ConclusionsCommonly used diet quality indices, HEI-2010 and AHEI-2010, showed biases toward LF vs LC diets. However, both indices detected expected changes in diet quality within each diet, with HEI-2010 yielding greater variation in scores. Findings support the use of these indices in measuring diet quality differences within, but not between, LC and LF diets.

Adherence to the healthy eating index-2010 and alternative healthy eating index-2010 in relation to metabolic syndrome among African Americans in the Jackson heart study.

The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome. This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score. Hinds, Madison and Rankin counties, Mississippi, USA. African American adults, ages 21-94 years, 60·9 % female. Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P-trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03). These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.

The Relationship between Healthy Eating Index and Lipid Profile in Healthy Individuals: A Systematic Review.

The Healthy Eating Index (HEI) and Alternate Healthy Eating Index (AHEI) are instruments developed by competing American research teams, aiming to assess the level of adherence to a dietary pattern, claimed to prevent chronic illness conditions such as dyslipidemia. This systematic review evaluated cross-sectional studies examining the association between HEI/AHEI score and the lipid profile in healthy participants. The systematic review was Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant, and a search process was conducted through Scopus, Web of Knowledge, Google Scholar, Cochrane, PubMed, and ScienceDirect up to November 2022. Studies assessing the relationship between HEI/AHEI and lipid profile (low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)) were eligible for inclusion. The statistical differences in outcomes, anthropometric indices, and demographic data were extracted from the selected studies. Also, the quality assessment of studies was performed using the Newcastle-Ottawa scale. The systematic search presented 17 cross-sectional studies. Most of the studies revealed a significant correlation between HEI score and lipid profile (LDL-C, HDL-C, TG, and TC) (P < 0.05), while a few of them indicated a significant relationship between AHEI score and these factors. Overall, the elevation of HEI/AHEI score was associated with the improvement in lipid profile (P < 0.05), though this association was more obvious for HEI compared with AHEI. Overall, the results of the study indicated that an improved lipid profile in healthy individuals is associated with a higher score in either HEI or AHEI. Further research in the future is required to confirm the claim.

Diet Quality, Sedentary Time, and Blood Pressure in the POUCHmoms Study

BackgroundElevated blood pressure (BP) is a major contributor to cardiovascular disease in womens; diet and sedentary time (ST) are modifiable lifestyle factors thought to influence BP. ObjectivesThe aim of this study was to examine 2 diet-quality measures and ST in relation to BP among parous womens. MethodsThis cross-sectional analysis uses data from 677 womens (age 25–55 y) enrolled in the Pregnancy Outcomes and Community Health (POUCH) Study and followed up in the POUCHmoms study 7–15 y after delivery (2011 and 2014). Follow-up measures included a food-frequency questionnaire (FFQ), self-report of ST (occupational and leisure), and systolic and diastolic blood pressure (SBP and DBP, respectively). The FFQ was used to calculate 2 diet-quality measures, Alternative Healthy Eating Index-2010 (AHEI) and Dietary Approaches to Stop Hypertension (DASH). Total ST h/wk was dichotomized at the median and labeled “low” or “high.” In weighted unadjusted and adjusted regression models, BP was assessed in relation to diet scores (linear and threshold associations) and combinations of dichotomized diet-quality scores (“poor” = lowest quartile compared with “not poor” = upper 3 quartiles) and ST. ResultsHigher mean SBP and DBP occurred mainly in women with a ‘“poor” diet-quality score (AHEI and DASH). Among womens with a “poor”-quality diet (on the basis of the AHEI score) and “high” ST, (N = 93) adjusted mean SBP and DBP were 4.5 mmHg and 4.4 mmHg higher, respectively, than that of the counterparts who did not have a poor-quality diet and had “low” ST (N = 275). Results were similar in analyses using the DASH diet score. ConclusionsWomen with poor-quality diets and more ST may need closer BP monitoring. Even modest improvements in womens’ diet quality and reductions in ST might help lower their BP, but this observation needs testing in prospective studies..

Association of alternative healthy eating index and severity of pemphigus vulgaris: A cross-sectional study

Background Evidence on the association between following healthy eating and the severity of pemphigus vulgaris (PV) is scarce. Therefore, the aim of this cross-sectional study aimed to investigate the relationship between adherence to the alternative healthy eating index (AHEI) and the severity of Pemphigus vulgaris disease in adults. Methods In this hospital-based cross-sectional study, a total of 138 pemphigus vulgaris cases were studied, of which 108 had pemphigus disease area index (PDAI) ≤15, and 30 had PDAI&gt;15. Dietary intakes were assessed using a valid 168-item food frequency questionnaire (FFQ). To calculate the AHEI, the data received from the diet were used. The subjects of this index received a score of 1–10. The final AHEI was calculated by summing the component scores. Results After adjusting for age and sex, we found that individuals with the highest AHEI score were 72% less likely to have increased PV severity compared with those with the lowest score (OR: 0.28; 95% CI: 0.08–0.92, P trend = 0.020). Further control for another potential confounder, intake energy, made the association stronger (OR: 0.24; 95% CI: 0.06–0.88, P trend = 0.017). Also, after controlling the body mass index (BMI) confounding factor, it maintained its strong relationship (OR: 0.24; 95% CI: 0.06–0.88, P trend = 0.016). Conclusion The evidence of our study shows that following the healthy eating index is associated with a reduction in the severity of pemphigus vulgaris. Prospective cohort studies are needed to confirm these findings.

Dietary intakes of hypertensive patients in rural India: Secondary outcomes of a randomised, double-blind, controlled trial.

Hypertension is highly prevalent in India; however, little is known about the dietary intakes of those living with hypertension, particularly in rural areas. The primary aim was to assess the dietary intakes of individuals living in rural India with self-reported history of hypertension. As secondary analyses, we explored the dietary impact of a salt substitute in this population group. This study used data from a large randomised controlled trial conducted in seven villages across rural India. Participants received either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride) to replace all home salt use. Dietary intake at baseline and end-of-trial was assessed using 24-h dietary recalls. A range of dietary outcomes were assessed including energy intake, macronutrient intake and overall diet quality according to the Alternate Healthy Eating Index (AHEI). A total of 454 participants were included in the analysis. At baseline, mean (SE) energy intakes in regular salt group and salt substitute group were similar at 5240 (110) kJ/day and 5120 (106) kJ/day, respectively. This was largely attributable to intakes of carbohydrates (74.4% of total energy intakes for regular salt group vs 75.4% for the salt substitute group) followed by total fat (15.8% vs 15.4%) and protein (10.4% vs 10.3%). Both groups also had similar AHEI scores at baseline, with mean (SE) total scores equating to 33.0 (0.4) (out of a total 90) for the regular salt group and 32.7 (0.4) for the salt substitute group. Both groups received lowest AHEI scores across the following components: vegetables, fruit and wholegrains. At baseline, the mean (SE) intakes of sodium across the regular salt and salt substitute groups were similar at 2349 (67) mg/day and 2396 (64) mg/day, respectively. In the salt substitute group, there was a significant reduction in total sodium intakes over time (-264 mg/day, 95% CI, -442 to -85), driven by the use of the salt substitute. This study found individuals with hypertension living in rural India had poor dietary intakes, including low intakes of fruits, vegetables and wholegrains, and high intakes of sodium. Salt substitutes may be an effective strategy for reducing sodium intake in this population group.

Abstract 15791: Higher Diet Quality Associates With Lower Inflammation in Black Adults With Heart Failure

Introduction: Heart failure (HF) is associated with a chronic inflammatory state. Diet-derived metabolites, such as trimethylamine-N-oxide (TMAO), may be associated with chronic inflammation. Most Americans consume a pro-inflammatory diet with high intakes of sugar and processed foods, but adherence to high quality diet patterns may be beneficial in HF-associated inflammation. The Healthy Eating Index (HEI) and the Alternative Healthy Eating Index (AHEI) measure adherence to the Dietary Guidelines for Americans with greater adherence associated with lower inflammation and better HF outcomes but is understudied in Black adults. Hypothesis: Higher adherences to the HEI or the AHEI is inversely associated with TMAO and inflammation measured by TNF-α. Methods: Participants included Black adults living with HF (N=36, mean age 57 years, 64% women); HEI and AHEI diet scores were derived from a food frequency questionnaire (FFQ). TMAO and TNF-α were analyzed with dried blood spots and immunoassays. A lifestyle factor (LIS) score consisting of alcohol intake, body mass index, physical activity, and smoking was measured. Analyses included correlational and regression analyses. Results: Regression models explained the variance of TMAO and TNF-α levels. HEI and related covariates (AHEI, LIS) explained 15.9% change in TMAO levels: F(3,30)=3.09, p&lt;.042. Standardized beta coefficients were at least 0.3 and higher. HEI scores and related covariates explained 17.2% change in TNF-α levels: F(4,29)=2.71, p&lt;.050. There was an inverse correlation between AHEI scores and TNF-α: r=-.36, p=.031. Conclusions: Higher diet quality, as measured by the HEI/AHEI, was associated with lower levels of TNF-α. The anti-inflammatory benefits of adherence to healthy eating patterns are important in the self-management of HF, yet these foods may include precursors for TMAO levels. Thus, healthy eating should be balanced with an overall dietary plan that attends to the quantity and nature of foods consumed by those with HF. Interventions which promote adherence to high quality diet patterns are needed in adults with HF, particularly in Black adults who bear an excess burden of disease. More research to understand which specific diet components decrease inflammation in HF are warranted.

Association of dietary total antioxidant capacity, alternative healthy eating index, and dietary inflammatory index with semen quality in men seeking infertility treatment.

Since the association between dietary quality scores and semen quality remains unclear, we carried out a hospital-based cross-sectional study to investigate the association of Dietary Total Antioxidant Capacity (dTAC), Dietary Inflammatory Index (DII), and Alternative Healthy Eating Index (AHEI) scores with semen quality in men seeking infertility treatment. This study enrolled 210 men with unexplained or idiopathic infertility. Semen samples were collected and analyzed according to the WHO 2010 criteria. Dietary data was collected using a 168-item semi-quantitative food frequency questionnaire (FFQ) developed for Tehran Lipid and Glucose Study. Multivariable logistic regression models were used to estimate the relationship between dTAC, AHEI, and DII scores with abnormal semen in crude and adjusted models. There were no significant differences across quartile categories of the dTAC, AHEI, and DII scores regarding semen parameters. There was a trend toward a significant direct association between DII and abnormal semen risk (p = 0.01). Infertile men in the highest quartile of DII had a 2.84 times higher risk of abnormal semen in the crude model (OR: 3.84; 95% CI: 1.64-8.95); such that remained after adjusting for several potential confounders. There was no significant association between dTAC or AHEI and the risk of abnormal semen in infertile men, either before or after adjusting for potential confounders. Total energy (p = 0.05), fat (p = 0.02), saturated fat (p = 0.02), mono-saturated fat (p = 0.009), Thiamine (Vitamin B1) (p = 0.02), Niacin (Vitamin B3) (p = 0.03), Calcium (p = 0.01), and Selenium (p = 0.01) were inversely associated with semen normality. The study suggests that certain dietary factors may affect semen quality, and the mechanisms underlying the observed associations are likely multifactorial, involving complex interactions between diet, oxidative stress, inflammation, and hormone levels. Further research is required to confirm the results, fully elucidate the mechanisms underlying the associations, and identify specific dietary interventions that may improve male fertility outcomes.

Behavioral Lifestyle Intervention Program Using Mobile Application Improves Diet Quality in Adults With Prediabetes (D’LITE Study): A Randomized Controlled Trial

BackgroundMobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. ObjectiveThe objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. DesignA secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) was conducted, with participants recruited from October 2017 to September 2019. Participants/settingCommunity-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. InterventionParticipants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. Main outcome measuresDietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. Statistical AnalysesBetween-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. ResultsThere was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8–8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, −0.8, −0.2; P < 0.001) and sodium by 726 mg/day (95% CI, −983, −468; P < .001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. ConclusionFor adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss.

Diet Quality and Subsequent Incidence of Upper Gastrointestinal Cancers: Results from the Golestan Cohort Study.

Recent evidence suggests overall diet quality, as assessed by dietary scores, may play a role in the development of upper gastrointestinal (UGI) cancers. However, the existing dietary scores are derived from high-income countries with different dietary habits than regions with the highest burden of UGI cancers, where limited data is available. This study aimed to investigate the association between overall diet quality and risk of esophageal and stomach cancers in a high-risk region for UGI cancers. We recruited 50045 individuals aged 40-75 between 2004-2008 from northeastern Iran and followed them annually through July 2020. Data on demographics, diet, and various exposures were collected using validated questionnaires. Diet quality was assessed by calculating the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), Alternative Mediterranean Diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and World Cancer Research Fund-American Institute for Cancer Research (WCRF-AICR) scores. During an average 12 years of follow-up, 359 participants developed esophageal cancer and 358 developed stomach cancer. After adjustments, each standard deviation increase in baseline dietary scores was associated with up to 12% reduction in esophageal cancer risk and up to 17% reduction in stomach cancer risk. Esophageal cancer showed stronger inverse associations with adherence to AMED (HRQ4-vs-Q1=0.69 (0.49-0.98), P-trend=0.038). Stomach cancer showed stronger inverse correlation with WCRF-AICR (HRQ4-vs-Q1=0.58 (0.41-0.83), P-trend=0.004), and DASH (HRC4-vs-C1=0.72 (0.54-0.96), P-trend=0.041). These associations were comparable across different population subgroups. We did not observe significant associations between HEI and AHEI scores and UGI cancers in this population. Despite the differences in consuming individual food groups, adherence to the available dietary recommendations (derived from high-income countries) was associated with lower risk for subsequent esophageal and gastric cancers in this high-risk population. Educating the public to have a healthy eating pattern might be an effective strategy towards prevention of UGI cancers in high-risk regions.

Self-reported engagement in healthy eating behaviors is associated with favorable dietary intake among adults in Puerto Rico

A diet high in quality is essential for prevention of chronic diseases. Specific healthy eating behaviors may modulate dietary intake. However, these behaviors have been seldomly studied, particularly in Puerto Rico (PR), a population with documented poor dietary quality and high burden of chronic diseases. This study aimed to document self-reported engagement in eating behaviors and examine their associations with intake of nutrients and diet quality. We hypothesized that greater engagement in healthy eating behavior would be associated with greater diet quality. This cross-sectional analysis used data from the PRADLAD study (adults aged 30-75 years residing in the San Juan, PR, area [n = 234]). Frequency (never, sometimes, often, always) of habitual eating behaviors was measured. Dietary intake was assessed with a food frequency questionnaire. Diet quality was measured with the Alternate Healthy Eating Index-2010. Statistical analyses included adjusted linear models. The most common behavior was “controlling intake of salt” (51.7%). Engaging “always” (vs. less frequently) in making healthier meals, reading nutrition facts labels, searching media for healthy eating information, counting calories, buying organic foods, eating a vegetarian diet, and controlling intake of salt, fat, carbohydrates/sugar, and portions were associated with higher Alternate Healthy Eating Index-2010 scores (P < .05). Controlling intakes of fats, carbohydrates/sugars, and portions “always” was associated with lower intakes of trans fats, added sugars, and total food (g), respectively (P < .05). Engagement in eating a vegetarian diet “always” was associated with higher intake of plant-based protein (P < .05). In conclusion, adults following several habitual eating behaviors had greater diet quality and a lower amount of unfavorable nutrients. Encouraging adherence to these behaviors may contribute to healthier dietary intake.

Abstract MP63: Higher Alternative Healthy Eating Index Scores Including Greater EPA and DHA Consumption Are Associated With Attenuated Platelet Function in the Framingham Heart Study

Introduction: Dietary modification that reflects healthy eating is a notable strategy for CVD prevention on a population level. The cardioprotective role diet plays in hemostasis and thrombosis, particularly in respect to platelet function remains unclear. Hypothesis: Healthier Alternative Healthy Eating Index (AHEI) scores associate with attenuated platelet reactivity in a large-scale population cohort. Methods: Cross-sectional data was obtained from Framingham Heart Study participants (N=3,429). AHEI scores were derived from self-reported Harvard semi-quantitative food frequency questionnaires. Ranging from 0 to 110, higher AHEI scores reflect healthier overall diet quality. Five bioassays measured platelet reactivity traits across several agonists in whole blood and platelet-rich plasma samples. Linear mixed effects models adjusted for age, sex, aspirin use, family relatedness, daily energy intake, and BMI evaluated associations between platelet reactivity and AHEI scores and components. Results: Higher AHEI scores associated with attenuated platelet reactivity among 16 different traits (P&lt;0.01), with notable decreased platelet aggregation to collagen, TRAP6 (PAR1 agonist), ADP, and ristocetin. Of the 11 AHEI components, higher EPA &amp; DHA intake was most strongly associated to decreased platelet function with the greatest number of significant associations to platelet traits (18 traits, P&lt;0.01) and moderate negative effect sizes (Figure 1). Conclusions: We report that higher AHEI scores associate with decreased platelet reactivity. Effects appear strongest for EPA &amp; DHA intake consistent with several small randomized controlled trials. However, we found that a holistic AHEI score reflects a better interpretation of diet as a modulator of platelet function compared to individual components. Our results conclude that the impact of a healthier diet in preventing thrombosis may be partially mediated through a decline in platelet reactivity through multiple independent activation pathways.

Relationship between healthy eating index and sarcopenia in elderly people

BackgroundData on the association of Alternative Healthy Eating Index-2010 (AHEI-2010) with sarcopenia are scarce. We aimed to evaluate the association between adherence to AHEI-2010 and sarcopenia and its components including low muscle mass, low muscle strength, and low muscle performance among elderly people.MethodsIn this cross-sectional study, which was conducted on 300 older people (150 men and 150 women) aged ≥55 years. Dietary information was done using a valid 117-item food frequency questionnaire (FFQ). To construct AHEI-2010 score, earlier studies were used. Sarcopenia and its components were described based on both former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines.ResultsWe found no significant association between AHEI-2010 score and odds of EWGSOP2-sarcopenia, either before (OR for the highest vs. lowest tertiles: 0.55; 95% CI: 0.19, 1.55) or after (OR: 0.44; 95% CI: 0.14, 1.34) adjustment for confounders. In gender-stratified analyses, we found a significant protective association between adherence to the AHEI-2010 score and odds of EWGSOP2-sarcopenia among women after controlling for confounders (0.20; 95%CI: 0.04, 0.91).ConclusionsIn conclusion, healthy eating was inversely associated with odds of sarcopenia among women, but not in men. Further studies with a large sample size and prospective design are needed to examine this association.

Dietary quality indices and recurrent chronic kidney disease in Taiwanese post-renal transplant recipients.

This study investigated the association between dietary quality indices and recurrent chronic kidney disease (rCKD) in Taiwanese post-renal transplant recipients (RTRs). This prospective study recruited RTRs aged >18 years with a functioning allograft and without any acute rejection in the past 3 months from September 2016 to June 2018. Dietary quality indices included the Alternative Healthy Eating Index (AHEI) and AHEI-2010, and the Taiwanese version of the AHEI (AHEI-Taiwan) was calculated using 3-day dietary records, and calculated scores were divided into quartiles. Laboratory data were collected from medical records. rCKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Logistic regression analysis was performed to analyze the associations. This study included 102 RTRs. The RTRs with higher AHEI, AHEI-Taiwan, and AHEI-2010 scores were older and had higher eGFRs and lower odds of rCKD. As compared with the lowest quartile, patients with the highest quartiles of the AHEI [odds ratio (OR), 0.10; 95% confidence interval (95% CI): 0.02, 0.49; p-trend = 0.004), AHEI-2010 (OR, 0.17; 95% CI: 0.04, 0.72; p-trend = 0.016], and AHEI-Taiwan (OR, 0.13; 95% CI: 0.03-0.59; p-trend = 0.008) had lower odds of rCKD, respectively. As compared with the lowest quartile, patients who consumed the highest quartiles of red and processed meat had 11.43 times higher odds of rCKD (OR, 11.43; 95% CI: 2.30-56.85; p for trend <0.01). Higher dietary quality indices are associated with lower odds of rCKD in Taiwanese RTRs. Particularly, a positive association between a higher intake of red meat and processed meat and higher odds of rCKD remained exists after transplantation in Taiwanese RTRs. Further dietary guidelines and individualized dietary education were necessary for RTRs to prevent graft function deterioration.