Higher Alternate Healthy Eating Index-2010 Research Articles

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.

Associations of healthy dietary patterns with mortality among people with prediabetes.

To examine the associations of healthy dietary patterns with cardiometabolic biomarkers and all-cause mortality among individuals with prediabetes. This cohort study included 8363 adults with prediabetes from the National Health and Nutrition Examination Survey 1999-2014. Healthy dietary patterns including Alternate Healthy Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet score (AMED), Dietary Approaches to Stop Hypertension score (DASH), and Healthy Eating Index-2015 (HEI-2015) were calculated based on 24-h dietary recall data. Mortality status was obtained by linkage to National Death Index records. Cardiometabolic biomarkers, including blood glucose, insulin, HbA1c, C-reactive protein (CRP), and lipids, were measured at recruitment. During 61,991 person-years of follow-up, 991 deaths occurred. Comparing the extreme quartiles, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were 0.65 (0.49, 0.85) for AHEI-2010 (P-trend = 0.002), 0.68 (0.50, 0.92) for AMED (P-trend = 0.004), 0.72 (0.53, 0.98) for DASH (P-trend = 0.03), and 0.78 (0.58, 1.05) for HEI-2015 (P-trend = 0.08). Besides, the HRs (95% CIs) for all-cause mortality per 20-percentile increment in scores were 0.78 (0.67, 0.90) for AHEI-2010 (P = 0.001), 0.73 (0.62, 0.86) for AMED (P < 0.001), 0.84 (0.69, 1.02) for DASH (P = 0.08), and 0.86 (0.74, 1.00) for HEI-2015 (P = 0.04). In addition, higher dietary scores were associated with favorable blood glucose, insulin, HOMA-IR, blood lipids, and CRP (all P-trend < 0.05). The high-density lipoprotein cholesterol and CRP explained 1.53-9.21% of the associations between dietary patterns and all-cause mortality (P < 0.05). Diets with higher AHEI-2010, AMED, DASH, and HEI-2015 were associated with improved cardiometabolic factors and lower all-cause mortality among individuals with prediabetes. These findings suggest that multiple healthy dietary patterns instead of a one-size-fits-all diet plan might be beneficial and acceptable for individuals with prediabetes.

Diet Quality Scores Inversely Associated with Postmenopausal Breast Cancer Risk Are Not Associated with Premenopausal Breast Cancer Risk in the California Teachers Study

BackgroundEvidence for the association between diet and breast cancer risk is inconsistent Thus, research that compares indexes of overall diet quality may provide new insight. ObjectiveWe examined the association between diet quality indexes and pre- and postmenopausal breast cancer risk in a large prospective cohort. MethodsThis was a prospective analysis of 96,959 women, aged 22–104 y, in the California Teachers Study cohort (1995–2011). Diet quality was characterized by 4 different indexes. Specifically, we examined Alternate Mediterranean Diet (aMED), Alternative Healthy Eating Index–2010 (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH), and Paleolithic index (PALEO) scores with the risk of developing breast cancer. We used multivariable Cox proportional hazards regression models to derive HRs and 95% CIs for breast cancer risk. ResultsIn the analysis of 42,517 women at risk of premenopausal breast cancer, there was no association between any of the indexes and incident breast cancer (346 cases). In the analysis of 54,442 women at risk of postmenopausal breast cancer at baseline, higher AHEI-2010, aMED, and DASH scores were inversely associated with incident breast cancer (3523 incident cases). Respectively, HRs (95% CIs) comparing quintile 5 to quintile 1 (reference) for AHEI-2010, aMED, and DASH indexes were 0.87 (0.78, 0.97; P-trend = 0.004), 0.91 (0.82, 1.02; P-trend = 0.03), and 0.89 (0.80, 1.00; P-trend = 0.03). The PALEO score was not associated with postmenopausal breast cancer (HR for quintile 5 compared with quintile 1: 1.05; 95% CI: 0.94, 1.17). ConclusionsDiet quality indexes that emphasize intake of whole grains, vegetables, fruits, legumes, and nuts and seeds and de-emphasize red and processed meats and sugar-sweetened beverages were modestly associated with a lower risk of incident postmenopausal breast cancer risk. However, they were not associated with premenopausal breast cancer, and the PALEO score was not associated with cancer risk regardless of menopausal status.

Abstract PR05: Dietary quality and ovarian cancer risk in African American women

Abstract Background: Ovarian cancer is the fifth leading cause of cancer death among women in the US. Considering the poor survival rates, identifying modifiable lifestyle factors including dietary interventions for ovarian cancer is needed. Compared to single foods or nutrients, examining dietary exposures as dietary patterns may allow us to accommodate the multidimensional aspects of diet and to better capture the role of diet in ovarian cancer carcinogenesis. Healthy Eating Index (HEI) is a measure of dietary quality to assess adherence to the Dietary Guidelines for Americans. Compared to HEI-2005 edition, HEI-2010 has an increased emphasis on dietary quality and reflects the most recent dietary guidelines. Alternate Healthy Eating Index-2010 (AHEI-2010), grounded in a different eating guide, the Healthy Eating Pyramid, was based on dietary predictors of chronic diseases. To our knowledge, this is the first study to evaluate the impact of dietary quality on ovarian cancer risk in African-American women. Objective: We aimed to evaluate three index-based dietary patterns–HEI-2005, HEI-2010, AHEI-2010–in relation to ovarian cancer risk in African-American women. Methods: Analyses were conducted among 415 cases of ovarian cancer and 629 controls using data from the African American Cancer Epidemiology Study (AACES). AACES is an ongoing population-based case-control study of ovarian cancer in African-American women in 11 sites in the US. Cases were identified through rapid case ascertainment and age- and site-matched controls were identified by random-digit-dialing. Information on risk factors related to ovarian cancer was collected by computer-assisted telephone interview. Dietary information 1 year before diagnosis (cases) or interview (controls) was obtained using a Block food frequency questionnaire (FFQ). AACES FFQ data were linked to the MyPyramid Equivalents Database 2.0 or based on published descriptions to generate equivalent intake for food groups under HEIs and AHEI-2010. Both HEIs includes 12 components, with total scores ranging from 0 to 100. AHEI-2010 includes 10 components with overall scores from 0 to 110. Higher scores indicate better adherence to a healthy diet. We used multivariate unconditional logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potential socio-demographic and lifestyle risk factors. Results: Only higher AHEI-2010 scores were associated with lower risk of ovarian cancer among all African-American women [OR comparing the highest quartile (Q4) vs. lowest (Q1) =0.66, 95% CI 0.45-0.98, p-trend =0.05]. The relationships between HEIs or AHEI and ovarian cancer risk were modified by menopausal status. Among post-menopausal women, we found lower risk of ovarian cancer with higher adherence of HEI-2010 (OR Q4 vs. Q1 =0.57, 95% CI 0.36-0.92, p-trend =0.03) and AHEI-2010 (OR Q4 vs. Q1 =0.49, 95% CI 0.31-0.78, p-trend =0.01). We observed no associations among pre-menopausal women. HEI-2005 was not associated with ovarian cancer risk among all or by menopausal status. Analyses evaluating individual score components with ovarian cancer risk suggested that in our sample of African-American women the benefits of HEI-2010 mainly come from higher intake of total vegetables, greens and beans, seafood and plant proteins and lower intake of empty calories (i.e., calories from solid fats, alcohol and added sugars). Consistently, the associations with AHEI-2010 were mainly driven by higher vegetable intake and lower intake of sugar-sweetened beverages and fruit juice. Conclusion: Our findings suggest, for the first time, that a healthy diet is associated with lower risk of ovarian cancer in African Americans. Adherence to the current Dietary Guidelines for Americans may reduce ovarian cancer risk among post-menopausal African-American women. This abstract is also presented as Poster A67. Citation Format: Bo Qin, Patricia G. Moorman, Anthony J. Alberg, Jill S. Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ellen Funkhouser, Edward S. Peters, Ann G. Schwartz, Paul Terry, Joellen M. Schildkraut, Elisa V. Bandera. Dietary quality and ovarian cancer risk in African American women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr PR05.