Changes in Diet Quality over 10 Years Are Associated with Baseline Sociodemographic and Lifestyle Factors in the Multiethnic Cohort Study

ABSTRACT Background Trends in diet quality among US adults indicate a steady improvement, but data on longitudinal individual-level changes in diet quality are still limited. Objective We examined changes in diet quality over 10 y and sought to determine whether baseline sociodemographic and lifestyle factors predicted the changes in a multiethnic population. Methods Data were from 63,255 African American, Native Hawaiian, Japanese American, Latino, and white men and women (45–75 y old at baseline) in the Multiethnic Cohort, who completed a quantitative food frequency questionnaire at baseline (1993–1996) and 10-y follow-up (2003–2007) and had no prevalent cancer or heart disease at either survey. Overall diet quality was measured by use of the Healthy Eating Index–2015 (HEI-2015), the Alternative Healthy Eating Index–2010 (AHEI-2010), the alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) score. We used a general linear model with adjustment for covariates to compare diet quality changes by baseline characteristics in men and women separately. Results Overall diet quality improved over 10 y by 3.2 points in men and 2.9 in women assessed using the HEI-2015, although scores for some components worsened (saturated and trans fats, indicating increased intake) or remained unchanged at a low quality level (whole grains, dairy, and sodium). In multivariable models where changes in HEI-2015, AHEI-2010, and DASH were harmonized to a 100-point score, greater increases in scores in both men and women were found for Japanese American ethnicity (increase by 0.5–4.7 in the 3 scores, P < 0.03), higher education (by 0.5–1.5, P ≤ 0.001), normal weight (BMI 18.5 to <25, by 0.6–2.5, P ≤ 0.01), nonsmoking (by 1.5–2.7, P < 0.001), higher moderate/vigorous physical activity level (by 0.3–0.8, P ≤ 0.04), and multivitamin use (by 0.4–0.7, P < 0.001) at baseline. Conclusions Sociodemographic and lifestyle factors, closely associated with diet quality, also predicted subsequent changes in diet quality over time in this multiethnic population.

Download Full-text

A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort

British Journal Of Nutrition ◽

10.1017/s0007114517002033 ◽

2017 ◽

Vol 118 (4) ◽

pp. 312-320 ◽

Cited By ~ 26

Author(s):

Simone Jacobs ◽

Carol J. Boushey ◽

Adrian A. Franke ◽

Yurii B. Shvetsov ◽

Kristine R. Monroe ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ethnic Groups ◽

Diet Quality ◽

Healthy Eating Index ◽

Japanese American ◽

Dash Score ◽

Model Assessment ◽

Quality Indices ◽

Multiethnic Cohort

AbstractDietary indices have been related to risk for type 2 diabetes (T2D) predominantly in white populations. The present study evaluated this association in the ethnically diverse Multiethnic Cohort and examined four diet quality indices in relation to T2D risk, homoeostatic model assessment-estimated insulin resistance (HOMA-IR) and biomarkers of dyslipidaemia, inflammation and adipokines. The T2D analysis included 166 550 white, African American, Native Hawaiian, Japanese American and Latino participants (9200 incident T2D cases). Dietary intake was assessed at baseline using a quantitative FFQ and T2D status was based on three self-reports and confirmed by administrative data. Biomarkers were assessed about 10 years later in a biomarker subcohort (n 10 060). Sex- and ethnicity-specific hazard ratios were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED) and the Dietary Approaches to Stop Hypertension (DASH). Multivariable-adjusted means of biomarkers were compared across dietary index tertiles in the biomarker subcohort. The AHEI-2010, aMED (in men only) and DASH scores were related to a 10–20 % lower T2D risk, with the strongest associations in whites and the direction of the relationships mostly consistent across ethnic groups. Higher scores on the four indices were related to lower HOMA-IR, TAG and C-reactive protein concentrations, not related to leptin, and the DASH score was directly associated with adiponectin. The AHEI-2010 and DASH were directly related to HDL-cholesterol in women. Potential underlying biological mechanisms linking diet quality and T2D risk are an improved lipid profile and reduced systemic inflammation and, with regards to DASH alone, an improved adiponectin profile.

Download Full-text

Diet Quality and Risk of Lung Cancer in the Multiethnic Cohort Study

Nutrients ◽

10.3390/nu13051614 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1614

Author(s):

Song-Yi Park ◽

Carol J. Boushey ◽

Yurii B. Shvetsov ◽

Michael D. Wirth ◽

Nitin Shivappa ◽

...

Keyword(s):

Lung Cancer ◽

Cohort Study ◽

Squamous Cell ◽

Healthy Eating ◽

Diet Quality ◽

Smoking Status ◽

Healthy Eating Index ◽

Dash Score ◽

Inverse Association ◽

Multiethnic Cohort

Diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED) score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII®), was examined in relation to risk of lung cancer in the Multiethnic Cohort Study. The analysis included 179,318 African Americans, Native Hawaiians, Japanese Americans, Latinos, and Whites aged 45–75 years, with 5350 incident lung cancer cases during an average follow-up of 17.5 ± 5.4 years. In multivariable Cox models comprehensively adjusted for cigarette smoking, the hazard ratios (95% confidence intervals) for the highest vs. lowest quality group based on quintiles were as follows: 0.85 (0.77–0.93) for HEI-2015; 0.84 (0.77–0.92) for AHEI-2010; 0.83 (0.76–0.91) for aMED; 0.83 (0.73–0.91) for DASH; and 0.90 (0.82–0.99) for DII. In histological cell type-specific analyses, the inverse association was stronger for squamous cell carcinoma than for adeno-, small cell, and large cell carcinomas for all indexes. There was no indication of differences in associations by sex, race/ethnicity, and smoking status. These findings support that high-quality diets are associated with lower risk of lung cancer, especially squamous cell carcinomas, in a multiethnic population.

Download Full-text

Diet Quality and All-Cause and Cancer-Specific Mortality in Older Adults with Invasive Cancer: The Multiethnic Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_055 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 555-555

Author(s):

Song-Yi Park ◽

Yurii Shvetsov ◽

Minji Kang ◽

V Wendy Setiawan ◽

Carol Boushey ◽

...

Keyword(s):

Older Adults ◽

Diet Quality ◽

Cancer Mortality ◽

Healthy Eating Index ◽

Invasive Cancer ◽

Japanese American ◽

Multiethnic Cohort ◽

Specific Mortality ◽

Cancer Specific Mortality

Abstract Objectives We examined the association of postdiagnostic diet quality with all-cause and cancer-specific mortality in older adults diagnosed with invasive cancer, in comparison with those without invasive cancer, in the Multiethnic Cohort. Methods Data were from 66,374 African American, Native Hawaiian, Japanese American, Latino, and White men and women, who had no prevalent cancer, heart disease, or stroke at baseline (1993–1996, 45–75 years) and completed a quantitative food frequency questionnaire at both baseline and 10-year follow-up (2003–2007). Overall diet quality was measured by the Healthy Eating Index (HEI)-2015, the Alternative HEI-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and the Dietary Approaches to Stop Hypertension (DASH) scores. Invasive cancer cases between the baseline and 10-year surveys and deaths after the 10 year survey were identified through linkage to cancer registries and to state death files and the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in multivariate Cox models for the dietary indexes at 10-year follow-up with subsequent mortality. Results Age-adjusted mean scores of the 4 dietary indexes at baseline (prediagnosis) and 10-year follow-up (postdiagnosis) were similar or slightly lower in participants with cancer (n = 5998), compared to those without cancer (n = 60,376). Among participants with cancer (71.5 ± 8.0 years), 2006 all-cause and 1005 cancer-specific deaths were identified during a mean follow-up of 8 years after the 10-year survey. Postdiagnostic scores from all 4 indexes were associated with lower risk of all-cause and cancer mortality: for the highest vs. lowest quartiles, HR (95% CI) for all-cause mortality was 0.72 (0.62–0.82) for HEI-2015, 0.84 (0.73–0.96) for AHEI-2010, 0.74 (0.63–0.86) for aMED, and 0.76 (0.66–0.87) for DASH. The corresponding HRs (95% CIs) for cancer mortality were 0.81 (0.66–0.99), 0.81 (0.66–0.99), 0.72 (0.58–0.89), and 0.79 (0.65–0.97). These HRs were similar to those for participants without cancer. Conclusions Postdiagnostic high-quality diet was related to lower all-cause and cancer mortality in older adults with invasive cancer, with risk reduction comparable to that among participants without cancer. Funding Sources National Cancer Institute.

Download Full-text

Fecal Microbial Diversity and Structure Are Associated with Diet Quality in the Multiethnic Cohort Adiposity Phenotype Study

Journal of Nutrition ◽

10.1093/jn/nxz065 ◽

2019 ◽

Vol 149 (9) ◽

pp. 1575-1584 ◽

Cited By ~ 6

Author(s):

Gertraud Maskarinec ◽

Meredith A J Hullar ◽

Kristine R Monroe ◽

John A Shepherd ◽

Jeani Hunt ◽

...

Keyword(s):

Community Structure ◽

Microbial Community ◽

Healthy Eating ◽

Diet Quality ◽

Microbial Community Structure ◽

Alpha Diversity ◽

Clinic Visit ◽

Healthy Eating Index ◽

Dietary Index ◽

Multiethnic Cohort

ABSTRACT Background Variation in gut microbial community structure is partly attributed to variations in diet. A priori dietary indexes capture diet quality and have been associated with chronic disease risk. Objectives The aim of this study was to examine the association of diet quality, as assessed by the Healthy Eating Index, Alternative Healthy Eating Index-2010, alternate Mediterranean Diet, and the Dietary Approaches to Stop Hypertension Trial, with measures of fecal microbial community structure assessed in the Adiposity Phenotype Study (APS), an ethnically diverse study population with varied food intakes. Methods Multiethnic Cohort Study members completed a validated quantitative food frequency questionnaire (QFFQ) at cohort entry (1993–1996) and, for the APS subset, at clinic visit (2013–2015), when they also provided a stool sample. DNA was extracted from stool, and the V1-V3 region of the 16S rRNA gene was amplified and sequenced. Dietary index scores were computed based on the QFFQ and an extensive nutritional database. Using linear regression adjusted for relevant covariates, we estimated associations of dietary quality with microbiome measures and computed adjusted mean values of microbial measures by tertiles of dietary index scores. Results The 858 men and 877 women of white, Japanese American, Latino, Native Hawaiian, and African American ancestry had a mean age of 69.2 years at stool collection. Alpha diversity according to the Shannon index increased by 1–2% across tertiles of all 4 diet indexes measured at clinic visit. The mean relative abundance of the phylum Actinobacteria was 13–19% lower with higher diet quality across all 4 indexes (difference between tertile 3 and tertile 1 divided by tertile 1). Of the 104 bacterial genera tested, 21 (primarily from the phylum Firmicutes) were positively associated with at least 1 index after Bonferroni adjustment. Conclusion Diet quality was strongly associated with fecal microbial alpha diversity and beta diversity and several genera previously associated with human health.

Download Full-text

Diet Quality Association with Nonalcoholic Fatty Liver Disease by Cirrhosis Status: The Multiethnic Cohort

Current Developments in Nutrition ◽

10.1093/cdn/nzaa024 ◽

2020 ◽

Vol 4 (3) ◽

Cited By ~ 2

Author(s):

Song-Yi Park ◽

Mazen Noureddin ◽

Carol Boushey ◽

Lynne R Wilkens ◽

Veronica W Setiawan

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Healthy Eating ◽

Diet Quality ◽

Dietary Patterns ◽

Fatty Liver Disease ◽

Healthy Eating Index ◽

Nonalcoholic Fatty Liver ◽

Multiethnic Cohort

ABSTRACT Background Epidemiological data on the role of overall dietary patterns in nonalcoholic fatty liver disease (NAFLD) are limited, especially from population-based prospective studies. Objectives We investigated the associations between dietary patterns assessed by predefined diet quality indexes (DQIs) and NAFLD risk by cirrhosis status in African Americans, Japanese Americans, Latinos, Native Hawaiians, and whites from the Multiethnic Cohort (MEC). Methods A nested case-control analysis was conducted within the MEC. NAFLD cases were identified by linkage to 1999–2016 Medicare claims. Four DQIs—Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index-2010, alternate Mediterranean diet score, and Dietary Approaches to Stop Hypertension (DASH) score—were calculated from a validated FFQ administered at baseline. Conditional logistic regression was used to estimate the ORs and 95% CIs with adjustment for multiple covariates. Results Analyses included 2959 NAFLD cases (509 with cirrhosis; 2450 without cirrhosis) and 29,292 matched controls. Higher scores for HEI-2015 (i.e., highest compared with lowest quintile OR: 0.83; 95% CI: 0.73, 0.94; P for trend = 0.002) and DASH (OR: 0.78; 95% CI: 0.69, 0.89; P for trend < 0.001), reflecting favorable adherence to a healthful diet, were inversely associated with NAFLD risk. Whereas there were no differences by sex or race/ethnicity, the inverse association was stronger for NAFLD with cirrhosis than for NAFLD without cirrhosis (P for heterogeneity = 0.03 for HEI-2015 and 0.05 for DASH). Conclusions Higher HEI-2015 and DASH scores were inversely associated with NAFLD risk in this ethnically diverse population. The findings suggest that having better diet quality may reduce NAFLD risk with more benefit to NAFLD with cirrhosis.

Download Full-text

Association of Diet Quality and Breast Cancer Incidence in the Multiethnic Cohort (MEC)

Current Developments in Nutrition ◽

10.1093/cdn/nzaa044_017 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 318-318

Author(s):

Rica Dela Cruz ◽

Song-Yi Park ◽

Yurii Shvetsov ◽

Carol Boushey ◽

Kristine Monroe ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Healthy Eating ◽

Cancer Incidence ◽

Diet Quality ◽

Breast Cancer Incidence ◽

Healthy Eating Index ◽

Native Hawaiians ◽

Multiethnic Cohort

Abstract Objectives Healthy eating patterns assessed by diet quality indexes (DQIs) have been related to lower risk of cancer incidence and mortality; however, the association between DQIs and breast cancer risk is still unclear. This study investigated the relation of DQIs with breast cancer incidence among diverse women from the Multiethnic Cohort (MEC). Methods At baseline (1993–1996), 101,291 female participants of five major racial/ethnic groups (African Americans, Native Hawaiians, Japanese Americans, Latinos and whites) aged 45–75 years completed a survey including a validated food frequency questionnaire. Scores for Healthy Eating Index 2015 (HEI-2015), Alternate Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean diet score (aMED), and Dietary Approaches to Stop Hypertension (DASH) score were calculated and divided into quintiles (Q1-Q5). Cox regression was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between DQIs and breast cancer risk, with adjustment for known risk factors including body mass index (BMI) among others. Results During a mean follow-up of 17.4 years, 7769 breast cancer cases were identified through linkage to tumor registries. The respective HRs for Q5 vs. Q1 were: 1.06 (95% CI, 0.98–1.14) for HEI-2015, 0.96 (95% CI, 0.90–1.04) for AHEI-2010, 1.01 (95% CI, 0.94–1.09) for aMED, and 0.95 (95% CI, 0.88–1.02) for DASH. No significant dose-response relations of DQIs with breast cancer risk were observed (all Ptrend ≥ 0.07). HRs analyzed by ethnic group also resulted in null findings with no significant dose-response relations and no significant Q5 vs. Q1 associations of DQIs with breast cancer risk (all Ptrend ≥ 0.14). For example, the respective HRs for the HEI-2015 by race/ethnicity were: 0.96 (95% CI, 0.81–1.14) for African Americans, 1.15 (95% CI, 0.90–1.46) for Native Hawaiians, 1.02 (95% CI, 0.89–1.17) for Japanese, 1.08 (95% CI, 0.88–1.33) for Latinas, and 1.08 (95% CI, 0.92–1.27) for whites. Conclusions Although adherence to DQIs was not associated with breast cancer risk overall or within racial/ethnic groups, nutrition remains important in breast cancer prevention as obesity, a strong modifiable risk factor, may be influenced by diet quality. Funding Sources This work was supported by grants from the National Cancer Institute.

Download Full-text

Changes in diet quality and body weight over 10 years: the Multiethnic Cohort Study

British Journal Of Nutrition ◽

10.1017/s000711452100012x ◽

2021 ◽

pp. 1-9

Author(s):

Minji Kang ◽

Carol J. Boushey ◽

Yurii B. Shvetsov ◽

Veronica W. Setiawan ◽

Hee-Young Paik ◽

...

Keyword(s):

Body Weight ◽

Cohort Study ◽

Weight Gain ◽

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

High Quality ◽

Multiethnic Cohort ◽

Race Ethnicity ◽

Over Time

Abstract High-quality diets have been found to be beneficial in preventing long-term weight gain. However, concurrent changes in diet quality and body weight over time have rarely been reported. We examined the association between 10-year changes in diet quality and body weight in the Multiethnic Cohort Study. Analyses included 53 977 African Americans, Native Hawaiians, Japanese Americans, Latinos and Whites, who completed both baseline (1993–1996, 45–69 years) and 10-year follow-up (2003–2008) surveys including a FFQ and had no history of heart disease or cancer. Using multivariable regression, weight changes were regressed on changes in four diet quality indexes, Healthy Eating Index-2015, Alternative Healthy Eating Index-2010, alternate Mediterranean Diet and Dietary Approaches to Stop Hypertension scores. Mean weight change over 10 years was 1·2 (sd 6·8) kg in men and 1·5 (sd 7·2) kg in women. Compared with stable diet quality (< 0·5 sd change), the greatest increase (≥ 1 sd increase) in the diet scores was associated with less weight gain (by 0·55–1·17 kg in men and 0·62–1·31 kg in women). Smaller weight gain with improvement in diet quality was found in most subgroups by race/ethnicity, baseline age and baseline BMI. The inverse association was stronger in younger age and higher BMI groups. Ten-year improvement in diet quality was associated with a smaller weight gain, which varied by race/ethnicity and baseline age and BMI. Our findings suggest that maintaining a high-quality diet and improving diet quality over time may prevent excessive weight gain.

Download Full-text

Higher diet quality is associated with higher diet costs when eating at home and away from home: National Health and Nutrition Examination Survey, 2005-2016

Public Health Nutrition ◽

10.1017/s1368980021002810 ◽

2021 ◽

pp. 1-29

Author(s):

Zach Conrad ◽

Sarah Reinhardt ◽

Rebecca Boehm ◽

Acree McDowell

Keyword(s):

Healthy Eating ◽

National Health ◽

Diet Quality ◽

Healthy Eating Index ◽

Food Prices ◽

Nutrition Examination Survey ◽

Food Away From Home ◽

Health And Nutrition ◽

Food Consumed ◽

At Home

Abstract Objectives: To evaluate the association between diet quality and cost for foods purchased for consumption at home and away from home. Design: Cross-sectional analysis. Multivariable linear regression models evaluated the association between diet quality and cost for all food, food at home, and food away from home. Setting: Daily food intake data from the National Health and Nutrition Examination Survey (2005-2016). Food prices were derived using data from multiple, publicly available databases. Diet quality was assessed using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010. Participants: 30,564 individuals ≥20 y with complete and reliable dietary data. Results: Mean per capita daily diet cost was $14.19 (95% CI: $13.91-14.48), including $6.92 ($6.73-7.10) for food consumed at home and $7.28 ($7.05-7.50) for food consumed away from home. Diet quality was higher for food at home compared to food away from home (P<0.001). Higher diet quality was associated with higher food costs overall, at home, and away from home (P<0.001 for all comparisons). Conclusions: These findings demonstrate that higher diet quality is associated with higher costs for all food, food consumed at home, and food consumed away from home. This research provides policymakers, public health professionals, and clinicians with information needed to support healthy eating habits. These findings are particularly relevant to contemporary health and economic concerns that have worsened because of the COVID-19 pandemic.

Download Full-text