Abstract
Background
The Dietary Guidelines for Americans (DGAs) provide dietary recommendations for the general population with the intent of preventing chronic disease such as cardiovascular disease. An evaluation of whether updated versions of the DGAs accomplish this goal is lacking.
Objective
The objective of this project was to determine whether updates to DGAs over time, reflected in subsequent versions of diet quality indices, strengthened the associations between diet quality and risk of cardiovascular disease outcomes.
Methods
Dietary data collected using a food frequency questionnaire in the Framingham Heart Study Offspring cohort was used to assess adherence to sequential versions of the Healthy Eating Index (1990, 2005, 2010, and 2015) and Alternative Healthy Eating Index (2000 and 2010) (N = 3,267). We conducted prospective analyses using Cox regression to estimate the association between diet indices and incident cardiovascular disease outcomes.
Results
Among the 3,267 study participants, 54% were female, mean age was 55 years, and mean body mass index was 27 kg/m2. There were a total of 544 events for the composite outcome of cardiovascular diseases (324 coronary heart disease events, 153 stroke events, and 187 heart failure events). Adherence to any dietary index was inversely associated with risk of cardiovascular disease, coronary heart disease, and heart failure, but not stroke. Compared to HEI-1990, scores for the more recent diet indices were more strongly associated with coronary heart disease risk, but not cardiovascular disease, heart failure, or stroke.
Conclusions
More recent iterations of diet indices, reflecting updates to the DGAs over time, are more strongly associated with risk of incident coronary heart disease than the original diet index (HEI-1990).
A prospective randomised trial to determine the efficacy of a low glycaemic index diet given in addition to healthy eating and weight loss advice in patients with coronary heart disease
