Alternate Healthy Eating Index Score Research Articles

Is any association between alternate healthy eating index (AHEI) with lipid profile and liver enzymes? A cross-sectional Study.

Based on evidence, there is a significant relationship between diet quality and the chronic conditions such as dyslipidemia and liver disorders. In the current study, we investigated the relationship between alternative healthy eating index (AHEI) and some biochemical measurements (lipid profile and liver enzymes). In this cross-sectional study, 127 hospital employees were randomly selected (of 250 screened volunteers). AHEI was estimated based on a 168 items food frequency questionnaire. The laboratory data [triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), alanine transaminase (ALT), aspartate transaminase (AST)] were extracted from periodic examinations. The physical activity was also estimated with international physical activity questionnaire (IPAQ). Among 127 completed data, the mean AHEI score was 47.1. There was a direct relationship between AHEI score and HDL (P = 0.02). Among the AHEI components, the score of nuts and soybeans was directly associated with HDL level (P = 0.007). There was no association between the other AHEI components and selected biomarkers. Nuts and soybeans consumption-one unit per day-may increase HDL levels. More studies are needed to evaluate the diet quality with the other dietary indices. The online version contains supplementary material available at 10.1007/s40200-021-00898-w.

Association of macronutrients and dietary patterns with risk of systemic lupus erythematosus in the Black Women’s Health Study

Systemic lupus erythematosus (SLE) affects African-American (AA) women disproportionately. The few prospective studies assessing dietary intake in relation to risk of SLE have been conducted in predominantly white populations and have been null. The present study assessed associations of macronutrients and dietary patterns with risk of SLE in AA women. Data from the Black Women's Health Study was collected prospectively via biennial questionnaires starting in 1995. Participants completed a self-administered 68-item FFQ in 1995. Self-reported SLE was verified through medical record review. We used multivariable (MV) Cox regression models to estimate HRs and 95% CIs for macronutrients, carbohydrates, proteins, total fats, PUFAs, ω-3 fatty acids, ω-6 fatty acids, MUFAs, saturated fats, trans fatty acids, Alternative Healthy Eating Index score, vegetable/fruit and meat/fried food dietary patterns, and a reduced rank regression (RRR)-derived dietary pattern in relation to SLE risk. We confirmed a total of 114 incident cases of SLE among 51,934 women during 1995-2015. MVHRs and 95% CIs for the highest quintile of intake versus the lowest were HR: 1.96, 95% CI: 1.02, 3.67 for carbohydrates; HR: 0.66, 95% CI: 0.37, 1.18 for protein; and HR: 0.54, 95% CI: 0.28, 1.01 for total fats. MUFAs, saturated fatty acids, and trans fatty acids were significantly associated with a lower risk of SLE. An RRR-derived factor, rich in fruits and sugar-sweetened drinks and low in margarines and butter, red and processed meats, fried chicken, poultry, and eggs, which explained 53.4% of the total variation of macronutrients, was the only food pattern associated with increased SLE risk (HR: 1.88, 95% CI: 1.06, 3.35). These analyses suggest that a diet high in carbohydrates and low in fats is associated with increased SLE risk in AA women.

Healthy dietary patterns and common pregnancy complications: a prospective and longitudinal study

Adherence to alternate Healthy Eating Index (AHEI), alternate Mediterranean diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) has been linked to lower risks of chronic diseases. However, their associations with common pregnancy complications are unclear. This study investigates the associations of AHEI, AMED, and DASH during periconception and pregnancy with common pregnancy complication risks. The study included 1887 pregnant women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons. Women responded to an FFQ at 8-13 gestational weeks, and they performed a 24-h dietary recall at 16-22 and 24-29 wk. Gestational diabetes (GDM), gestational hypertension, preeclampsia, and preterm delivery were ascertained using medical records. Healthier diet indicated by higher AHEI, AMED, and DASH scores was generally related to lower risks of pregnancy complications. Significant inverse associations were observed between AHEI score reported at 16-22 wk and GDM risk [adjusted RR (95% CI), highest (Q4) vs. lowest quartile (Q1): 0.32 (0.16, 0.66), P-trend=0.002]; DASH score reported at both 8-13 [adjusted RR (95% CI), Q4 vs. Q1: 0.45 (0.17, 1.17), P-trend=0.04] and 16-22 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.19 (0.05, 0.65), P-trend=0.01] and gestational hypertension risk; AHEI score reported at 24-29 wk and preeclampsia risk [adjusted RR (95% CI), Q4 vs. Q1: 0.31 (0.11, 0.87), P-trend=0.03]; AMED score reported at 8-13 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50 (0.25, 1.01), P-trend=0.03] and DASH score reported at 24-29 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50, (0.26, 0.96), P-trend=0.03] and preterm delivery risk. Adherence to AHEI, AMED, or DASH during periconception and pregnancy was related to lower risks of GDM, gestational hypertension, preeclampsia, and preterm delivery.This study was registered at ClinicalTrials.gov as NCT00912132.

Quality and environmental footprints of diets by socio-economic status in Argentina

Food consumption and production plays a major role on human health and environmental sustainability. In addition, socio-economic status (SES) could be an important determinant on these impacts. Here we investigated the quality and environmental footprints of diets of different SES in Argentina. Dietary data was obtained from a recent national-wide representative survey (21,547 households), and individual intake was estimated by applying the Adult-Male Equivalent (AME) approach. Dietary quality was assessed by comparing the apparent consumption of foods and nutrients with the level of intake associated with the lowest risk of mortality, and applying the Alternate Healthy Eating Index 2010 (AHEI-2010). The environmental footprints were assessed with a set of six environmental indicators: greenhouse gas (GHG) emissions, total land occupation, cropland demand, fossil energy use, freshwater consumption and eutrophying emissions. Per capita total expenditure was utilized as an indicator of SES. We found a suboptimal intake of healthy and excess of unhealthy foods and nutrients in all SES, as well as a low AHEI-2010 score (34.7 ± 3.56 over 100). Regarding environmental footprints per AME, we estimated 8.91 ± 2.49 kg CO2-eq/day for GHG emissions, 9.30 ± 2.93 MJ/day for fossil energy use, 54.2 ± 14.8 m2/day for total land occupation, 7.07 ± 1.90 m2/day for cropland demand, 205 ± 65.3 L/day for freshwater consumption and 19.8 ± 6.43 g PO4-eq/day for eutrophying emissions. The Argentinian diet was found to be both unhealthy and unsustainable in all socio-economic levels.

Changes in adiposity mediate the associations of diet quality with insulin sensitivity and beta-cell function

Background and aimsTo examine the mediating role of adiposity on the associations of diet quality with longitudinal changes in insulin sensitivity and beta-cell function. Methods and resultsAdults at-risk for type 2 diabetes (T2D) in the PROMISE cohort had 4 assessments over 9 years (n = 442). Alternate Healthy Eating Index (AHEI) scores were used to assess diet quality. Generalized Estimating Equations (GEE) evaluated the associations between the AHEI and longitudinal changes in insulin sensitivity (HOMA2-%S and ISI) and beta-cell function (IGI/HOMA-IR and ISSI-2). The proportion of the mediating effect of waist circumference changes was estimated using the difference method. In the primary longitudinal analysis, AHEI was positively associated with insulin sensitivity and beta-cell function over time (% difference per standard deviation increase of AHEI for HOMA2-%S (β = 11.0, 95%CI 5.43–17.0), ISI (β = 10.4, 95%CI 4.35–16.8), IGI/HOMA-IR (β = 7.12, 95%CI 0.98–13.6) and ISSI-2 (β = 4.38, 95%CI 1.05–7.80), all p < 0.05). There was no significant association between AHEI and dysglycemia incidence (OR = 0.95, 95%CI 0.77–1.17). Adjustments for longitudinal changes in waist circumference substantially attenuated all associations of AHEI with insulin sensitivity and beta-cell function. Mediation analysis indicated that waist circumference mediated 73%, 70%, 83% and 81% of the association between AHEI and HOMA2-%S, ISI, IGI/HOMA-IR, and ISSI-2, respectively (all p < 0.01). ConclusionIn a Canadian population at-risk for T2D, AHEI score was positively associated with changes in insulin sensitivity and beta-cell function. These associations were substantially mediated by waist circumference, suggesting that changes in adiposity may represent an important pathway linking diet quality with risk phenotypes for T2D.

Dietary quality modifies the association between multimorbidity and change in mobility limitations among older Americans

To identify potentially modifiable risk-factors in the age-related disablement process, we examined the association between change in mobility limitations and multimorbidity and how dietary quality moderates this association. Information from 3320 adults aged 65 and older in 2012 was drawn from the Health and Retirement Study and the Health Care and Nutrition Study. Mobility limitations reported in 2012 and change in mobility limitations from 2012 to 2014 were regressed on multimorbidity measured as number of chronic conditions in 2012, dietary quality measured in 2013 using the Alternative Healthy Eating Index-2010 (AHEI-2010), and their interaction term using Poisson regression. Respondents reported an average of 2.9 (SD, 2.9) mobility limitations in 2012 and 3.1 (SD, 3.0) mobility limitations in 2014, an average of 2.64 (SD, 1.4) chronic conditions in 2012, and mean AHEI-2010 score in 2013 of 57.1 (SD, 10.9). Greater AHEI-2010 scores were associated with fewer mobility limitations at baseline (p < .001) and slower progression of mobility limitations over the two-year observational window (p < .001). For those with AHEI-2010 scores ≥48.4, dietary quality appeared to moderate the association between multimorbidity and change in mobility limitations. These results suggest that improving dietary quality may be an effective means of reducing the progression of mobility limitations among older adults and that dietary quality may modify the effect of multimorbidity on progressive disablement. Our work adds to research supporting dietary quality as a potentially intervenable factor in the reduction of disablement in aging populations.

Impact of Dietary Counselling on Cardiometabolic Health Outcomes and Dietary Quality in Singapore Older Adults: A Randomized Controlled Trial

Abstract Objectives Dietary counselling is an effective nutritional strategy for improving dietary quality and cardiometabolic health, but these beneficial effects have not been well studied in older adults, especially in Asia. Therefore, this study aimed to assess the impact of dietary counselling on cardiometabolic health outcomes and dietary quality in older Singaporean adults. Methods This was a 12-week, parallel design, randomized controlled trial. Twenty-six women aged above 60 y were randomized where the intervention group received dietary counselling (n = 14) and the control group did not receive dietary counselling (n = 12). Anthropometric measurement, blood pressure, fasting lipid-lipoprotein, glucose and insulin levels were examined at baseline and week 12. The interactive dietary counselling sessions were conducted by a qualified nutritionist every week and each session took 60 minutes. The counselling topics included healthy eating pattern, proper food proportioning, food label reading and several age-related diseases. All participants completed a 3-day food record and the dietary quality was assessed using the Alternative Healthy Eating Index 2010 (AHEI-2010). All results were reported as least square means ± SD. Results A significant decrease in serum low density lipoprotein cholesterol level was detected in the intervention group (3.3 mmol/L ± 1.0 to 3.1 mmol/L ± 0.8, P &amp;lt; 0.05) whereas the control group unchanged (3.8 mmol/L ± 0.6 to 3.7 mmol/L ± 0.7). Moreover, although there was an increase in waist circumference in the control group (76 cm ± 7 to 80 cm ± 6, P &amp;lt; 0.05), no change was observed in the intervention group (76 cm ± 7 to 77 cm ± 9). Other anthropometric and cardiometabolic measurements were not changed after intervention. Both groups showed an increase in dietary quality based on the AHEI-2010 score after intervention however change was only significant in the intervention group (44.0 ± 9.1 to 48.9 ± 8.7, P &amp;lt; 0.05). l group, but a significant time effect was observed (P = 0.009). Conclusions The provision of dietary counselling confers the benefits in the cardiometabolic health outcomes and these benefits may be explained by the improvement in dietary quality in Singaporean older adults. Funding Sources National University of Singapore (NUS), NUS-Mind Science Centre.

Higher Protein Intake During Energy Restriction Alters Dietary Patterns and Maintains Diet Quality

Abstract Objectives A higher protein diet can be a successful approach to weight loss and improved health outcomes. However, the effect of a higher protein diet on other foods in the diet is not known. Evidence suggests diet quality scores provide a comprehensive representation of dietary intake and the complex interconnected nature of nutrient intake. In this study, the objective was to examine the effect of protein intake during moderate weight loss using four diet quality scores in overweight and obese adults. Methods Overweight and obese adults (n = 235) were counseled, bimonthly, to reduce energy intake over 6 months following the ADA food lists. The diets were individualized so range of macronutrient intake varied, but all individuals were encouraged to consume &amp;gt; 0.8 g/kg protein. Dietary intake was assessed and validated at baseline and ≥ 6 days during the intervention. In addition to the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), Mediterranean Diet Quality Score (MDS), and Dietary Approaches to Stop Hypertension diet quality score (DASH) were adjusted for energy intake and used to calculate diet quality. Results Subjects (55 ± 11 years) were overweight and obese (BMI 28.9 ± 4.0 kg/m2) and consumed 17.5 ± 5.3% energy from protein at baseline. During the intervention, subjects lost 4.5 ± 5.4% body weight, with a 333 ± 605 kcal deficit and 18.7 ± 3.5% protein intake. During the intervention, only the HEI score correlated with protein intake (r = 0.240, P &amp;lt; 0.001); however, all scoring methods (HEI AHEI, MDS, DASH) showed consistent patterns of food groups changing with higher protein intake. As expected, there was greater intake of meat, but also intake of vegetables. In addition, diet quality scores that measured dairy (HEI, DASH, MDS), unsaturated fatty acids (AHEI, MDS) and sodium (HEI, AHEI) showed an increase with higher protein intake. Conclusions In individuals following a weight loss diet, higher protein intake consistently altered dietary patterns of low-protein food components including higher intake of vegetables, unsaturated fat, and sodium. In an overweight and obese population with no comorbidities, HEI, AHEI, MDS, and DASH diet scores are effective methods of measuring diet quality and food patterns during moderate weight loss. Funding Sources Financial support by North American Branch-ILSI and National Institute of Health-NIA is appreciated.

Investigating Racial/Ethnic Disparities in the Association Between AHEI-2010 and Change in Cystatin C in a Representative Sample of Older Americans

ObjectivesCystatin C (Cys C) is a promising biomarker for early-stage chronic kidney disease. Dietary intake plays an essential role in the prevention of kidney function decline, which has yet to be examined in relation to changes in Cys C among older adults. Our objective was to test whether scores on the Alternative Healthy Eating Index-2010 (AHEI-2010) were associated with change in Cys C from 2012–2016 and if this varied by race/ethnicity. MethodsObservations were drawn from the Health and Retirement Study. Blood spot collection and examination occurred in 2012 and 2016, participant attributes were measured in 2012, and dietary assessment was conducted by a validated dietary frequency questionnaire in 2013. The sample was restricted to respondents aged ≥65 years who were White (n = 789), Black (n = 108), or Hispanic (n = 61) and had biomarkers measured in 2012 and 2016 (n = 958). Serum Cys C (mg/L) was constructed to be equivalent to the 1999–2002 NHANES scale. Dietary quality was measured using AHEI-2010. Autoregressive linear modeling adjusting for covariates and sampling design was used to examine the associations of interest. ResultsMean serum Cys C was 1.20 ± 0.44 mg/L (SD) in 2012 and 1.25 ± 0.45 mg/L in 2016, and mean AHEI-2010 score was 58.11 ± 11.0. Greater AHEI-2010 was associated with lower serum Cys C level at baseline (b = –.004, SE = .013, P = .002) and less rapid increase in the Cys C level from 2012–2016 (b = –.003, SE = .012, P = .024). The association between AHEI-2010 and change in serum Cys C was significantly different for Whites and Hispanics (b = .128, SE = .031, P < .001), but null when comparing Whites and Blacks. AHEI-2010 was negatively associated with change in Cys C for Whites, and positively associated with change in Cys C among Hispanics. Stratified analyses suggested that AHEI-2010 was not significantly different for Whites and Hispanics. Hispanics had significantly lower household income, assets, and educational attainment than Whites, and greater levels of food insecurity. ConclusionsOur results indicate that dietary quality has a divergent association with change in serum Cys C for White and Hispanic older adults. These results suggest the need for examination of how disparities in socioeconomic status may influence the effect of dietary intake on kidney function for older adults from different racial/ethnic backgrounds. Funding SourcesNo funding.

Mediterranean, DASH, and Alternate Healthy Eating Index Dietary Patterns and Risk of Death in the Physicians' Health Study.

Objective: Our primary objective was to examine the associations of the Mediterranean (MED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternate Healthy Eating Index (AHEI) diet with total mortality. Our secondary objective was to examine the association of these three dietary patterns with cardiovascular disease (CVD) and cancer mortality. Research: Design and Methods: We prospectively studied 15,768 men from the Physicians’ Health Study who completed a semi-quantitative food-frequency questionnaire. Scores from each dietary pattern were divided into quintiles. Multivariable Cox regression models were used to estimate hazard ratio’s (95% confidence intervals) of mortality. Results: At baseline, average age was 65.9 ± 8.9 years. There were 1763 deaths, including 488 CVD deaths and 589 cancer deaths. All diet scores were inversely associated with risk for all-cause mortality: Hazard ratios (95% CI) of all-cause mortality from lowest to highest quintile for MED diet were 1.0 (reference), 0.85 (0.73–0.98), 0.80 (0.69–0.93), 0.77 (0.66–0.90), and 0.68 (0.58–0.79); corresponding values were 1.0 (reference), 0.96 (0.82–1.12), 0.95 (0.82–1.11), 0.88 (0.75–1.04), and 0.83 (0.71–0.99) for DASH diet and 1.0 (reference), 0.88 (0.77–1.02), 0.82 (0.71–0.95), 0.69 (0.59, 0.81), and 0.56 (0.47–0.67) for AHEI diet, after adjusting for age, energy, smoking, exercise, BMI, hypertension, coronary heart disease, congestive heart failure, diabetes, and atrial fibrillation. For cause-specific mortality, MED and AHEI scores were inversely associated with lower risk for CVD mortality, whereas AHEI and MED scores were inversely associated with lower risk for cancer mortality. Conclusion: Within this cohort of male physicians, AHEI, MED, and DASH scores were each inversely associated with mortality from all causes.

Abstract P051: Lifestyle Change In Mid-life And Long-term Weight Gain In Women With And Without History Of Gestational Diabetes Mellitus

Introduction: Identifying strategies to mitigate gradual long-term weight gain is critical for preventing obesity and its related chronic diseases, particularly for persons at high risk, such as women with a history of gestational diabetes mellitus (GDM). We prospectively examined the independent associations between lifestyle changes in mid-life with long-term weight change among women with and without a history of GDM. Hypothesis: We hypothesized that favorable improvements in lifestyle would be associated with less long-term weight gain, particularly among women with a history of GDM. Methods: We used data from the longitudinal Nurses’ Health Study II, with self-reported lifestyle, diet via food frequency questionnaire, and body weight updated every 2-4 years. We analyzed repeated 4-year changes of the following lifestyle factors among parous women after age 40: adherence to a healthy dietary pattern (Alternate Healthy Eating Index score [AHEI]), physical activity (MET-hrs/wk), moderate alcohol intake (servings/d), and non-smoking, in relation to concurrent 4-year change in body weight (lb). We used multivariable generalized estimating equation models to estimate the least-squares mean of 4-year weight change and 95% confidence interval (CI) for each lifestyle change category (e.g., decrease, remain stable, and increase). Results: Our analysis included 61,637 women, of which 3,444 (5.6%) had a history of GDM. Mean of repeated 4-year weight change after age 40 was 3.0 lb (SD=14.3). Improving diet was associated with favorable 4-year weight change, particularly among women with a history of GDM vs. without GDM (AHEI score change from low to high: -6.3 lb [CI: -9.3, -3.4] vs. -2.7 lb [CI: -3.2, -2.2], respectively; p-interaction=0.04). Increasing physical activity was associated with weight maintenance for GDM women only (MET-hrs/wk change from low to high: 0.6 lb [95% CI: -0.6, 1.7] vs. 2.0 lb [95% CI: 1.8, 2.2] for GDM vs. non-GDM, respectively; p-interaction=0.01). Reducing alcohol (decreased servings/d: 1.9 lb [95% CI: 1.2, 2.6] and 2.8 lb [95% CI: 2.6, 2.9] for GDM vs. non-GDM, respectively) and smoking cessation (recent quitter: 9.8 lb [95% CI: 7.1, 12.5] and 8.5 lb [95% CI: 8.0, 9.1] for GDM vs. non-GDM, respectively) were associated with similar patterns in weight change for women with and without prior GDM. Further, the joint association of improving both diet and physical activity from low to high was related to -12.3 lb (95% CI: -19.5, -5.0) and -6.1 lb (95% CI: -8.0, -4.2) of weight loss for GDM vs. non-GDM women, respectively. Conclusions: We observed that attainable improvements in diet quality and physical activity were associated with weight gain prevention. These findings support continued efforts to improve lifestyle as a beneficial strategy to prevent long-term weight gain, particularly among women with a history of GDM.

Higher Diet Quality in African-American Adolescents Is Associated with Lower Odds of Metabolic Syndrome: Evidence from the NHANES.

Development of clinical risk factors linked to metabolic syndrome (MetS) in adolescence is associated with higher incidence of atherosclerotic cardiovascular events in adulthood. Given the increasing burden of obesity and MetS in African-American (AA) youth, there is a need to establish the relation of MetS with modifiable risk factors such as diet quality, because these data may enhance preventative and treatment approaches. The purpose of this study was to assess diet quality, measured by the Alternative Healthy Eating Index 2010 (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) pattern score, in AA adolescents and youth (aged 12-21 y) from the NHANES, and to investigate the association of diet quality with MetS and its components. This study is a cross-sectional analysis of NHANES data from the 2005-2016 cycles (n=2459). Survey-weighted logistic regression models were used to assess the association of diet quality with the prevalence of MetS and individual cardiometabolic components [overweight/obesity, hypertensive blood pressure (BP), impaired fasting glucose, low HDL cholesterol, hypertriglyceridemia]. The mean±SD AHEI-2010 score was 38.9±9.7 and DASH pattern score was 21.8±4.4, which is equivalent to 35% adherence to recommendations to achieve an optimal diet quality and 45% adherence to the DASH-style dietary pattern, respectively. Compared with those within the lowest quartile of DASH pattern score, individuals in the fourth quartile group had 0.63 (95% CI: 0.41, 0.97) times the odds of having hypertensive BP. Among individuals with complete clinical measures (n=1007), individuals within the highest-quartile AHEI-2010 group had 0.25 (95% CI: 0.06, 0.99) times the odds of having MetS compared with those within the lowest quartile. Diet quality in US AA youth is low. Higher DASH pattern scores were associated with lower odds of hypertensive BP and higher AHEI-2010 scores were associated with lower odds of MetS.

Healthful dietary patterns and risk of end-stage kidney disease: the Singapore Chinese Health Study

Although adherence to healthful dietary patterns has been associated with a lower risk of kidney function decline in Western populations, evidence in Asian populations remains scanty. We examined predefined dietary patterns, namely, the Alternate Healthy Eating Index-2010 (AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH), and the alternate Mediterranean diet (aMED), in relation to risk of end-stage kidney disease (ESKD). We included 56,985 Chinese adults (aged 45-74 y) in the Singapore Chinese Health Study who were free of cancer, stroke, coronary artery disease, and ESKD at recruitment (1993-1998). Dietary pattern scores were calculated based on a validated 165-item FFQ. AHEI-2010 and aMED scores were modified by excluding the alcohol intake component because daily drinking has been associated with a higher risk of ESKD in our study population. We identified 1026 ESKD cases over a median follow-up of 17.5 y via linkage with the nationwide Singapore Renal Registry. Multivariable Cox regression models were used to compute HRs and their 95% CIs. Higher scores of all 3 dietary patterns were associated with lower ESKD risk in a dose-dependent manner. Compared with the lowest quintiles, the multivariable-adjusted HRs (95% CIs) of ESKD were 0.75 (0.61, 0.92) for the highest quintile of AHEI-2010, 0.67 (0.54, 0.84) for DASH, and 0.73 (0.59, 0.91) for aMED (all P-trend≤0.004). These inverse associations were stronger with increasing BMI (in kg/m2), and the HRs for the diet-ESKD association were lowest in the obese (BMI≥27.5), followed by the overweight (BMI=25 to <27.5) participants, compared with those in lower BMI categories; the P-interaction values between BMI and diet scores were 0.03 for AHEI-2010, 0.004 for aMED, and 0.06 for DASH. Adherence to healthful dietary patterns was associated with a lower ESKD risk in an Asian population, especially in overweight or obese individuals.

Association Between Combined Lifestyle Factors and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study.

The aim of the study was to examine the relations of individual lifestyle factors and its composite score with healthy ageing among Chinese adults. We included 14 159 participants aged 45-74 years at baseline from the Singapore Chinese Health Study, a population-based prospective cohort. A protective lifestyle score (0-5 scale) was calculated at baseline (1993-1998) and updated at the second follow-up visit (2006-2010) on the basis of optimal body mass index (18.5-22.9 kg/m2), healthy diet (upper 40% of the Alternative Healthy Eating Index score), being physically active (≥2 h/wk of moderate activity or ≥0.5 h/wk of strenuous activity), nonsmoking (never smoking), and low-to-moderate alcohol drinking (>0 to ≤14 drinks/wk for men and >0 to ≤7 drinks/wk for women). Healthy ageing was assessed at the third follow-up visit (2014-2016) and was defined as absence of specific chronic diseases, absence of cognitive impairment and limitations in instrumental activities of daily living, good mental and overall self-perceived health, good physical functioning, and no function-limiting pain. About 20.0% (2834) of the participants met the criteria of healthy ageing after a median follow-up of 20 years. Each 1-point increase in the protective lifestyle score computed at baseline and second follow-up visits was associated with higher likelihood of healthy ageing by 25% (95% CI: 20%-30%) and 24% (18%-29%), respectively. The population-attributable risk percent of adherence to 4-5 protective lifestyle factors was 34.3% (95% CI: 25.3%-42.3%) at baseline and 31.3% (23.0%-38.7%) at second follow-up visits for healthy ageing. In addition, positive increase in lifestyle scores from baseline to second follow-up visits was also significantly associated with a higher likelihood of healthy ageing with an odds ratio of 1.18 (95% CI: 1.12%-1.24%) for each increment in protective lifestyle score. Our findings confirmed that adopting healthy lifestyle factors, even after midlife, was associated with healthy ageing at old age.

Nut consumption, risk of cardiovascular mortality, and potential mediating mechanisms: The Women's Health Study

The link between nut consumption and cardiovascular (CV) mortality remains unclear. to examine whether nut consumption is associated with CV mortality and estimate the proportion of reduced risk of CV mortality explained by intermediate factors. We studied 39,167 women from the Women's Health Study; 28,034 provided blood samples. Nut consumption was self-reported at baseline and at follow-up using a food frequency questionnaire. Our primary outcome was cardiovascular death, which was ascertained via medical records, confirmed with the national death index and death certificates. During a mean follow-up of 19 years, 959 CV deaths occurred. In a multivariable Cox regression model adjusting for age, body mass index, smoking, alcohol use, physical activity, postmenopausal status, marital status, family history of premature myocardial infarction and the alternate healthy eating index score, hazard ratios for CV mortality were 0.93 (0.76-1.14) for nut consumption of 1-3 times/month, 0.84 (0.69-1.01) for nut intake of 1 time/week, and 0.73 (0.61-0.87) for nut consumption of ≥2 times/week when compared to women who did not consume nuts (p = 0.0004). LDL and total cholesterol accounted for about 19%, HbA1c 18% and all mediating factors together accounted for about 6.6% of the lower risk of CV mortality for those who consumed nuts ≥2 times/week. For the secondary outcome of CV events, although the effect was noted to be in the same direction with increasing nut consumption associated with lower risk of CV events, it was not statistically significant (p=0.07). This study suggests that nut consumption is inversely associated with cardiovascular mortality in women. Lipids, inflammatory markers and glucose metabolism account for a modest proportion of the lowered CV mortality observed with nut consumption, assuming a causal nut-CV mortality association.

Dietary Pattern Trajectories in Middle Age and Physical Function in Older Age.

Increasingly, lifestyle factors in midlife are reported to impact health and functional status in old age. This work examines associations between dietary trajectories in middle age and subsequent impairments in physical function. Data are from 851 participants (61% men, mean age at first dietary assessment = 47 years, range 30-59 years) from the Baltimore Longitudinal Study of Aging. We used latent class analysis to derive dietary trajectories based on adherence to the Alternative Healthy Eating Index-2010 (AHEI), and further classified them based on tertiles, as poor (score <39.3), intermediate (39.3-48.9), or good (>48.9). Physical function was assessed with the Short Physical Performance Battery (SPPB). Random effects tobit regression models were used to examine associations between dietary trajectories and later physical function. Two latent classes of AHEI scores were generated and labeled "greatly improved" or "moderately improved." In the greatly improved class, participants showed a trend in overall AHEI score from poor/intermediate to good diet categories across dietary assessments with age, over time. In the moderately improved class, the overall AHEI score shifted from poor to intermediate diet categories over time, and the prevalence of the good diet category remained low. Mean AHEI score between ages 30 and 59 years was higher in the greatly, than moderately, improved class. The moderately improved class had 1.6 points lower SPPB score (indicating poorer physical function) at older age than the greatly improved class (p = .022). Findings suggest that improving diet quality in middle age may contribute to better physical function in older age.

Diet quality during pregnancy predicts maternal concentrations of phthalates and phthalate alternatives

Background/Objectives: Phthalates are endocrine disrupting chemicals that may be particularly disruptive during pregnancy. Pregnancy diet is a vehicle for some phthalate exposures. Therefore, we evaluated whether diet quality predicts urinary phthalate/phthalate alternative biomarkers concentrations in pregnant women.Methods: This study includes 427 pregnant women from Champaign-Urbana, Illinois. Alternative Healthy Eating Index (AHEI) scores were estimated from 3-month food frequency questionnaires administered at 34-37 weeks gestation, with higher AHEI scores representing lower chronic diseases risk. We quantified 19 phthalate/phthalate alternative metabolites in cross-pregnancy pools of five first-morning urines in three approximately equal batches based on year of enrollment (2013-2019). In analyses, we used individual metabolites, molar-sums of metabolites of the same parent phthalates (e.g., di(2-ethylhexyl) phthalate (SumDEHP), dibutyl phthalate (SumDBP), di-isononyl phthalate (SumDiNP)) or phthalate replacements (1,2-cyclohexane,dicarboxylic acid diisononyl ester (SumDiNCH), di(2-ethylhexyl) terephthalate (SumDEHTP)). Linear regression models evaluated associations between AHEI and ln-transformed specific-gravity adjusted biomarker concentrations while controlling for demographic/lifestyle characteristics, and stratified by chemical analysis batch.Results: Median AHEI score in these predominantly White, college-educated women was 55.9 (possible 110, range: 24.9-82.4) and varied little across time. Biomarker concentrations were similar to U.S. women and many varied over time: monobenzyl phthalate (MBzP), mono(carboxyisononyl) phthalate (MCNP), mono(3-carboxypropyl) phthalate (MCPP), SumDEHP, and SumDiNP decreased from 2013 to 2019, whereas SumDiNCH and SumDEHTP increased. Women with higher AHEI scores had lower SumDEHP, SumDEHTP, and SumDiNP regardless of time, and MBzP, MCNP, MCPP, and SumDBP only in the earliest batch. The strongest association was between AHEI and SumDEHTP, which decreased by 2.5% for each unit increase in AHEI (95%CI: -3.8, -1.3). Conclusions: In this cohort, pregnant women with high diet quality were the least exposed to plasticizer phthalates/alternatives. While these patterns should be confirmed in other populations, we also noted that associations between diet quality and some phthalates/phthalate alternatives have changed over time.

Associations Between Perceived Stress and Dietary Intake in Adults in Puerto Rico

BackgroundPsychological stress may influence health by negatively affecting dietary intake. However, there are few studies on the connection between stress and dietary intake in Puerto Rico (PR), a population with documented poor diet quality. ObjectiveTo explore the association between perceived stress and intake of macronutrients and diet quality among adults in PR. DesignCross-sectional data came from the Puerto Rico Assessment of Diet, Lifestyle, and Diseases study (2015). ParticipantsThis analysis included data from 238 adults (30-75 years old) in the San Juan metro area. Main outcome measuresDietary intake was measured with a food frequency questionnaire adapted and validated to the PR population. The Alternate Healthy Eating Index (AHEI) score was calculated to measure diet quality. Statistical analysesMultivariate linear models adjusted for sociodemographics, anthropometrics, behavioral factors, and social support were used to determine adjusted mean macronutrient intake and AHEI scores by perceived stress category. ResultsIn models adjusted for sociodemographic characteristics, high perceived stress was significantly associated with higher intake of total energy, added sugars, and saturated fats; lower intake of dietary fiber and vegetable protein; and lower AHEI score compared with low perceived stress (all P < .05). With further adjustment for lifestyle behaviors, central obesity, and social support, high perceived stress remained significantly associated with added sugars, saturated fats, and vegetable protein only. ConclusionsHigher perceived stress was associated with unhealthy dietary intake in adults residing in the San Juan area, PR. Future longitudinal studies with larger sample size are needed to build on these findings and to test the potential mediating and moderating roles of behavioral and social support factors in this population.

Role of alternate healthy eating index (AHEI) in communicating the quality of diet

The food habits of global population has been evolving in such a way that makes unhealthy foods cheaper and widely available and healthy foods costly and less available. Being surrounded by such foods and living in an environment with lesser requirement for physical activity is the primary reason for the pandemic explosion in overweight and obesity. This study is an attempt to analyze the quality of diet with an aim to study the significance of Alternate Healthy Eating Index (AHEI) in predicting the quality of dietary intake. Methodology: The study was conducted in 66 respondents (44 females and 22 males) aged 18-65 years with BMI between 23 kg/m2 to 50 kg/m2. The respondent’s data were collected using a pretested standard questionnaire. The nutrient consumption was calculated from the 24 hour recall and the AHEI scores were derived from recall and food use frequency data. The data were analysed using SAS software. Results: The intake of Energy, protein, fat and carbohydrates were more than their requirement while intake of fibre was not meeting the requirement. The AHEI scores obtained ranged from 36 to 76 with a mean value of 55.6 ± 9.54. A positive linear association for AHEI with BMI (0.0362) and energy intake (0.13) was established through Pearson’s correlation while the association was negative with BMR (-0.14). Paired t test comparing AHEI against the difference between intake and requirement of macronutrients revealed that when the diet quality was good (as indicated by AHEI&gt;51), the difference in intake exhibited a significant linear relationship with p values &lt;0.001 while no relation was established when the diet quality was poor. Conclusion: AHEI encompasses all nutrients and food groups relevant to metabolic health and it can be used as a good tool to assess the quality of dietary habits of overweight and obese subjects.

Red Hair Color Is Associated with Elevated CRP Levels among US Women

Red Hair Color Is Associated with Elevated CRP Levels among US Women