scholarly journals Adherence to Recommended Eating Patterns Is Associated With Lower Risk of Peripheral Arterial Disease: Results From the Women’s Health Initiative

Hypertension ◽  
2021 ◽  
Author(s):  
Guo-Chong Chen ◽  
Rhonda Arthur ◽  
Yasmin Mossavar-Rahmani ◽  
Xiaonan Xue ◽  
Bernhard Haring ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Healthy Eating ◽  
Diet Quality ◽  
Lower Risk ◽  
Arterial Disease ◽  
Healthy Eating Index ◽  
Eating Patterns ◽  
Quality Indices ◽  
Health Initiative ◽  
Peripheral Arterial

The potential role of nutritional factors in the development of peripheral arterial disease (PAD) remains poorly understood. We evaluated multiple recommended eating patterns as reflected by predefined diet quality indices in relation to long-term risk of PAD. We included 138 506 US postmenopausal women in the Women’s Health Initiative who had no known PAD at baseline (1993–1998). Four diet quality indices, including alternate Mediterranean diet index, alternate Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension diet index, and Healthy Eating Index-2015, were derived using dietary information collected by a validated food frequency questionnaire at baseline. Incident cases of symptomatic PAD in the lower extremities were ascertained and adjudicated through March 2019 via medical record review. During a median 18.6 years of follow-up, 1036 incident PAD cases were identified. After multivariable adjustment, all diet quality scores were significantly and inversely associated with 21% (for alternate Healthy Eating Index 2010) to 34% (for Dietary Approaches to Stop Hypertension index) lower risk of PAD when comparing the highest with the lowest quartiles (all P -for-trend values ≤0.010). Among contributing food groups and nutrients, intakes of legumes, dietary fiber, and vegetable protein were associated lower risk of PAD, while intakes of unprocessed red meat, processed meat, and regular soft drinks were associated with higher risk. In a broad sample of US postmenopausal women, adhering to different recommended eating patterns is associated with lower risk of PAD. Our findings suggest that current clinical and public health strategies that recommend healthful eating patterns may also be applicable to PAD prevention.

Abstract P247: Dietary Intake and Peripheral Arterial Disease Incidence in Middle Aged Adults: the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Rachel P Ogilvie ◽  
Pamela L Lutsey ◽  
Gerardo Heiss ◽  
Aaron R Folsom ◽  
Lyn M Steffen
Keyword(s):  
Peripheral Arterial Disease ◽  
Dietary Intake ◽  
Lower Risk ◽  
Meat Consumption ◽  
Arterial Disease ◽  
Food Groups ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is a costly source of morbidity and mortality among older persons in the United States. Dietary intake plays a role in the development of atherosclerotic cardiovascular disease; however, few studies have examined the relation of food intake or diet patterns with PAD. Objectives: We examined the relationship between habitual dietary intake at midlife and incident PAD over approximately 20 years of follow-up. Methods: Among 14,082 participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study initially free of PAD, dietary intake was assessed at baseline in 1987-1989 using a Harvard food frequency questionnaire. Food groups were created and principal components analysis was used to develop “healthy” and “Western” dietary patterns; both were categorized into quintiles or quartiles. Incident PAD was defined by an ankle-brachial index (ABI) measure of < 0.90 at either of two subsequent exams (1993-1995, 1996-1998), or a hospital discharge diagnosis of PAD, leg amputation, or leg revascularization procedures through 2012. Cox proportional hazards models adjusted for relevant confounders assessed the relations of each food group or diet pattern with incident PAD. Results: During a mean follow up of 19.9 years, 1569 participants developed incident PAD. A total of 64.7% of cases had their incident event defined via ICD-9 codes, while 35.3% had incident PAD defined by ABI. In models adjusted for demographics, behaviors, and food groups, the hazard ratios for incident PAD increased across quintiles of meat consumption (Q2 vs. Q1 1.38 [95% CI 1.16, 1.64], Q3 vs. Q1 1.40 [1.18, 1.67], Q4 vs. Q1 1.47 [1.23, 1.77], Q5 vs. Q1 1.66 [1.36, 2.03], p for trend <0.001). Compared to those who drank no alcohol, those who had 1-6 drinks per week had a lower risk of incident PAD (HR=0.78 [95% CI 0.68, 0.89]). For coffee, there was a modest inverse association with incident PAD (Q5 vs. Q1 0.84 [0.75, 1.00], p for trend = 0.014). There was no association between other food groups or patterns and incident PAD. Conclusions: In this prospective population-based cohort study, greater meat consumption was associated with higher risk of incident PAD, while both moderate alcohol consumption and coffee consumption were associated with lower risk of incident PAD. Whether these associations are causal remains to be seen.

scholarly journals The interaction between brain-derived neurotrophic factor (BDNF) Val66met polymorphism and dietary indices, The Healthy Eating Index (HEI), The Diet Quality Index-International (DQI-I) , and Phytochemical index (PI) , on anthropometric indices, inflammatory, and oxidative stress markers in patient with type2 diabetes

2021 ◽  
Author(s):  
Zeinab Naeini ◽  
Negin Aghazadeh ◽  
Elmira Karimi ◽  
Zahra Esmaeily ◽  
Faezeh Abaj ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Healthy Eating ◽  
Diet Quality ◽  
Quality Index ◽  
Healthy Eating Index ◽  
Quality Indices ◽  
Val66met Polymorphism ◽  
Diet Quality Index ◽  
Bdnf Val66met Polymorphism ◽  
And Oxidative Stress

Abstract Background: Although many studies suggest an association between BDNF Val66Met with eating disorders and obesity especially in type 2 diabetes mellitus (T2DM), the interaction between BDNF Val66Met polymorphism and diet quality indices in diabetic patients have not been investigated yet. The current study was aimed to evaluate the interaction between the diet quality indices including Healthy Eating Index (HEI), Diet Quality Index-International (DQI-I), Phytochemical Index (PI) and BDNF Val66Mat (rs6265) polymorphism on markers of inflammation, and oxidative stress in T2DM patients.Methods: This current cross-sectional study was conducted on 634 Iranian T2DM patients aged 35–65 years of both genders were randomly recruited. Dietary intakes was estimated by a food frequency questionnaire (FFQ) with 148 food items. All participants were categorized into three categories, based on DQI, HEI, and PI scores. The interactions were tested using analysis of covariance (ANCOVA) in adjusted and unadjusted models.Results: There were significant gene-diet interactions between BDNF Val66Met polymorphism and HEI, DQI, and PI scores in modulating body mass index (BMI) and waist circumference (WC) values. Our results showed that higher scores for all diet-quality indices were significantly associated with a lower BMI and WC values after adjustment (P Interactions < 0.05). We also observed a significant interaction between the DQI scores and Val66Met polymorphism on level of superoxide dismutase (SOD) (p-interaction= 0.01). The highest quartile of DQI was associated with elevated level of SOD in the Val/Met and Met/Met genotype group. Moreover, the interaction between the DQI scores and Val66Met polymorphism on total antioxidant capacity (TAC) tended to be significant.Conclusions: Higher scores for all diet-quality indices were significantly associated with a lower BMI and WC values. There were significant differences for PTX and PGF2A among HEI tertiles. The interaction between the polymorphism and DQI on TAC and SOD levels were significant.

scholarly journals Greater Adherence to Dietary Guidelines were Associated with Lower Risk of Cardiovascular Diseases in Chinese Patients with Type 2 Diabetes: A Case-Control Study

2020 ◽  
Author(s):  
Shang-Ling Wu ◽  
Yan-Bin Ye ◽  
Long-Yun Peng ◽  
Yu-Ming Chen ◽  
Fang-Fang Zeng ◽  
...  
Keyword(s):  
Healthy Eating ◽  
Diet Quality ◽  
Lower Risk ◽  
Case Control Study ◽  
Case Control ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Chinese Patients ◽  
Control Study

Abstract Background The evidence regarding the impact of the healthy eating index on the risk of cardiovascular events among patients with type 2 diabetes (T2D) is limited. To examine the associations of adherence to the Chinese and American dietary guidelines and the risk of cardiovascular disease (CVD) among Chinese individuals with T2D. Methods This 1:1 matched case-control study included 419 enrolled pairs hospital-based CVD cases and controls who were matched by age and sex, in Guangdong province, China, all of whom had T2D. A structured questionnaire and a 79-item food-frequency questionnaire was used to collect general information and dietary intake information. Diet quality scores were calculated according to the Chinese Healthy Eating Index (CHEI) and the Healthy Eating Index-2015 (HEI-2015). Results After adjustment for various confounding factors, the higher diet quality scores on the CHEI and HEI-2015 showed a significant association with a lower risk of CVD. The odds ratios (95% confidence interval) per 5-score increment were 0.88(0.83,0.92) in the CHEI and 0.80(0.74,0.88) in the HEI-2015, respectively. In stratified analyses, the protective associations remained significant in the subgroups of sex, smoking status, tea-drinking, hypertension state, dyslipidemia state, BMI, and T2D duration, but not among the drinkers in CHEI. Conclusion Greater adherence to the most recent Chinese or American dietary guidelines were associated with a lower risk of CVD incidents among Chinese patients with T2D.

Dietary Patterns And Risk Of Cancer: Current Evidence And Future Directions

2018 ◽  
Author(s):  
Fang Fang Zhang
Keyword(s):  
Healthy Eating ◽  
Cancer Incidence ◽  
Diet Quality ◽  
Dietary Patterns ◽  
Healthy Eating Index ◽  
Quality Indices ◽  
Alternative Healthy Eating Index ◽  
Incidence And Mortality ◽  
Risk Of Cancer ◽  
Diet Score

Dietary patterns capture the overall diet and its constituent foods and nutrients, representing a powerful approach to identifying the effect of nutrition on health and disease. In this review, we describe the two main approaches being used to characterize dietary patterns: a prior approach that defines dietary patterns using predefined diet quality indices, and a posterior approach that derives dietary patterns using factor or cluster analysis. Methods to define diet quality indices (Healthy Eating Index, Alternative Healthy Eating Index, Alternative Mediterranean Diet Score, Dietary Approaches to Stop Hypertension Score) are presented, and their similarities and differences are discussed among the different approaches. We review the recent evidence on the relationships between dietary patterns and cancer outcomes, including all-cancer incidence and mortality and the incidence of colorectal, breast, prostate, and lung cancers. Despite the different methods that are used to characterize dietary patterns in different studies, results consistently suggest that adherence to existing dietary guidelines is associated with a reduced risk of cancer incidence and mortality. Given the important role of dietary patterns in cancer prevention, clinicians need to consider providing appropriate nutrition counseling  to improve patients’ dietary patterns. Continuous efforts need to be devoted to better characterize the relationships between dietary patterns and cancer risk by studying specific cancer types, different cancer subtypes, and population subgroups, with a better approach that can accurately assess dietary patterns throughout the life cycle. This review contains 3 figures, 6 tables and 91 references Key words: Alternative Healthy Eating Index, breast cancer, cancer incidence, cancer mortality, cluster analysis, colorectal cancer, Dietary Approaches to Stop Hypertension, dietary patterns, diet quality index, factor analysis, Healthy Eating Index, lung cancer, Mediterranean Diet Score, prostate cancer, Recommended Food Score

Abstract P360: Dietary Saturated Fats From Different Food Sources Show Inconsistent Associations With Various Indices of Diet Quality in the Canadian Population

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Stephanie Harrison ◽  
Didier Brassard ◽  
Simone Lemieux ◽  
Benoit Lamarche
Keyword(s):  
Healthy Eating ◽  
Diet Quality ◽  
Nutritive Value ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Food Sources ◽  
Dietary Intakes ◽  
Trans Fat ◽  
Quality Indices ◽  
Saturated Fats

Background: Canadian dietary guidelines include a recommendation to limit the consumption of foods high in saturated fats (SFA), regardless of their dietary source. The same guidelines also recommend consumption of lean red meat and low-fat dairy products. Yet, the association between the consumption of SFA from different food sources and diet quality is currently unknown. The objective of this study was to examine associations between SFA from various food sources and different indices of diet quality. Methods: Analyses are based on a sample of 11 106 respondents representative of Canadian adults (19-70 y) from the 2015 Canadian Community Health Survey (CCHS 2015). Dietary intakes and diet quality indices were calculated using a single interview-administered 24-hour recall. Food sources of SFA were classified according to the 2019 Canada’s Food Guide categories: 1) vegetables and whole fruits, 2) whole grain foods and 3) protein foods (including dairy and meat, among others). Foods not included in these three categories were grouped as All other foods . The 2010 alternative Healthy eating index (aHEI), the 2015 Healthy eating index (HEI-2015) and the 2007 Canadian Healthy eating index (C-HEI) were calculated. Due to the unreliability of data for trans-fat consumption in the CCHS 2015 database, the trans-fat subscore of the aHEI was removed from the original score. Results: While total SFA intake and SFA from All other foods were inversely correlated with all indices of diet quality (-0.55<r<-0.10, all p<0.001), associations with SFA from dairy and meat were inconsistent. SFA from dairy were inversely correlated (p<0.001) with the aHEI (r=-0.14) and the HEI-2015 (r=-0.16) but showed a weak positive correlation with the C-HEI (r=0.05, p<0.001). SFA from meat were negatively correlated with the aHEI (r=-0.21, p<0.001) and positively correlated with the C-HEI (r=0.11, p<0.001). Removing subscores directly related to SFA intake in diet quality indices yielded positive correlations between SFA from dairy and the HEI-2015 (r=0.13, p<0.001) and the C-HEI (r=0.19, p<0.001). Conclusion: Consumption of SFA from different food sources are inconsistently associated with different indices of overall diet quality. Unsurprisingly, SFA from All other foods , which include low nutritive value foods, showed the strongest negative correlation with all diet quality scores. These results provide further support to the notion that guidance on SFA in future health policies should focus on food sources rather than on total intake of SFA.

scholarly journals The interaction between brain-derived neurotrophic factor (BDNF) Val66met polymorphism and dietary indices, The Healthy Eating Index (HEI), The Diet Quality Index-International (DQI-I), and Phytochemical index (PI), on anthropometric indices, inflammatory, and oxidative stress markers in patient with type2 diabetes

2021 ◽  
Author(s):  
Fariba Koohdani ◽  
Zeinab Naeini ◽  
Negin Aghazadeh ◽  
Elmira Karimi ◽  
Zahra Esmaeily ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Healthy Eating ◽  
Diet Quality ◽  
Quality Index ◽  
Healthy Eating Index ◽  
Quality Indices ◽  
Val66met Polymorphism ◽  
Diet Quality Index ◽  
Bdnf Val66met Polymorphism ◽  
And Oxidative Stress

Abstract Background: Although many studies suggest an association between BDNF Val66Met with eating disorders and obesity especially in type 2 diabetes mellitus (T2DM), the interaction between BDNF Val66Met polymorphism and diet quality indices in diabetic patients have not been investigated yet. The current study was aimed to evaluate the interaction between the diet quality indices including Healthy Eating Index (HEI), Diet Quality Index-International (DQI-I), Phytochemical Index (PI) and BDNF Val66Mat (rs6265) polymorphism on markers of inflammation, and oxidative stress in T2DM patients.Methods: This current cross-sectional study was conducted on 634 Iranian T2DM patients aged 35–65 years of both genders were randomly recruited. Dietary intakes was estimated by a food frequency questionnaire (FFQ) with 148 food items. All participants were categorized into three categories, based on DQI, HEI, and PI scores. The interactions were tested using analysis of covariance (ANCOVA) in adjusted and unadjusted models.Results: There were significant gene-diet interactions between BDNF Val66Met polymorphism and HEI, DQI, and PI scores in modulating body mass index (BMI) and waist circumference (WC) values. Our results showed that higher scores for all diet-quality indices were significantly associated with a lower BMI and WC values after adjustment (P Interactions < 0.05). We also observed a significant interaction between the DQI scores and Val66Met polymorphism on level of superoxide dismutase (SOD) (p-interaction= 0.01). The highest quartile of DQI was associated with elevated level of SOD in the Val/Met and Met/Met genotype group. Moreover, the interaction between the DQI scores and Val66Met polymorphism on total antioxidant capacity (TAC) tended to be significant.Conclusions: Higher scores for all diet-quality indices were significantly associated with a lower BMI and WC values. There were significant differences for PTX and PGF2A among HEI tertiles. The interaction between the polymorphism and DQI on TAC and SOD levels were significant.

Established diet quality indices are not universally associated with body composition in young adult women

2021 ◽  
pp. 1-24
Author(s):  
Sofija E. Zagarins ◽  
Alayne G. Ronnenberg ◽  
Elizabeth R. Bertone-Johnson
Keyword(s):  
Body Composition ◽  
Body Fat ◽  
Young Women ◽  
Healthy Eating ◽  
Diet Quality ◽  
Healthy Eating Index ◽  
Healthy Plant ◽  
Adult Women ◽  
Quality Indices ◽  
Diet Score

Abstract Objective: To determine which established diet quality indices best predict weight-related outcomes in young women. Design: In this cross-sectional analysis, we collected dietary information using the Harvard Food Frequency Questionnaire (FFQ), and measured body fat percentage (BF%) by duel-energy X-ray absorptiometry. We used FFQ data to derive five diet quality indices: Recommended Food Score (RFS), Healthy Eating Index 2015 (HEI-2015), Alternate Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean Diet Score (aMED), Healthy Plant-Based Diet Index (HPDI). Setting: University of Massachusetts at Amherst Participants: n=260 healthy women aged 18-30 Results: The AHEI-2010 and HPDI were associated with body mass index (BMI) and BF%, such that a 10-point increase in either diet score was associated with a 1.2 percentage-point lower BF% and a 0.5 kg/m2 lower BMI (P<0.05). Odds of excess body fat (i.e., BF%>32%) were 50% lower for those in the highest vs. lowest tertile of the AHEI-2010 (P=0.04). Neither the RFS nor HEI-2015 were associated with BMI or BF%; the aMED was associated with BMI but not BF%. Conclusions: These results suggest that diet quality tends to be inversely associated with BMI and BF% in young women, but that this association is not observed for all diet quality indices. Diet indices may have limited utility in populations where the specific healthful foods and food groups emphasized by the index are not widely consumed. Future research should aim to replicate these findings in longitudinal studies that compare body composition changes over time across diet indices in young women.

scholarly journals Diet Quality in Association with All-Cause, Cardiovascular, and Cancer Mortality Among US Adults: NHANES 1999–2010 (OR14-04-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Jiaqi Wang ◽  
Danielle Haslam ◽  
Mengyuan Ruan ◽  
Fan Chen ◽  
Mengxi Du ◽  
...  
Keyword(s):  
Healthy Eating ◽  
Diet Quality ◽  
Cancer Mortality ◽  
Lower Risk ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Mortality Data ◽  
Eating Pattern ◽  
All Cause Mortality ◽  
Risk Of Cancer

Abstract Objectives The 2015 Dietary Guidelines for Americans (DGA) recommend a healthy eating pattern for chronic disease prevention. This study aimed to prospectively evaluate diet quality by adherence to the 2015 DGA in association with mortality outcomes among a representative sample of US adults. Methods Using dietary data collected by 24-hour diet recalls among 29,098 US adults aged 20+ years from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2010, we estimated adherence to the 2015 DGA using the Healthy Eating Index-2015 (HEI-2015). Mortality from all cause, cardiovascular diseases (CVD), and cancer were obtained from linkage to the National Death Index Mortality data. Cox proportional-hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after multivariable adjustments. Results The mean (SE) of total HEI-2015 was 50.1 (0.2). During a median follow-up of 6.2 years, 2861 total deaths occurred, including 726 CVD and 671 cancer deaths. Compared to individuals in the lowest quartile of HEI-2015, those in the highest quartile had a 16% lower risk of all-cause mortality (Q4 vs. Q1: HR = 0.84; 95% CI: 0.72–0.90; P-trend = 0.04) and a 31% lower risk of cancer mortality (Q4 vs. Q1: HR = 0.69; 95% CI: 0.50–0.95; P-trend = 0.06). The lower all-cause and cancer mortality among those with higher HEI-2015 scores was confined to individuals with comorbidity conditions at baseline (all-cause mortality: Q4 vs. Q1: HR = 0.79; 95% CI: 0.67–0.94; p-trend = 0.005; cancer mortality: Q4 vs. Q1: HR = 0.46; 95% CI: 0.30–0.69; p-trend = 0.001), former smokers (all-cause mortality: Q4 vs. Q1: HR = 0.65; 95% CI: 0.49–0.88; p-trend = 0.006; cancer mortality: Q4 vs. Q1: HR = 0.47; 95% CI: 0.29–0.74; p-trend = 0.005), and those with a body mass index of 18.5–25 kg/m2 (all-cause mortality: Q4 vs. Q1: HR = 0.60; 95% CI: 0.46–0.79; p-trend < 0.001; cancer mortality: Q4 vs. Q1: HR = 0.40; 95% CI: 0.22–0.70; p-trend = 0.001). Similar associations were found between men and women. No significant associations were observed between HEI-2015 and CVD mortality. Conclusions Better adherence to the 2015 Dietary Guidelines of Americans is associated with lower all-cause and cancer mortality among US adults. Funding Sources National Institute of Health/National Institute of Minority Health and Health Disparities. Supporting Tables, Images and/or Graphs    

Abstract 37: Healthy Eating Patterns and Risk of Cardiovascular Disease: Results From Three Large Prospective Cohort Studies

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Zhilei Shan ◽  
Yanping Li ◽  
Shilpa N Bhupathiraju ◽  
Dong Wang ◽  
Kathryn M Rexrode ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Healthy Eating ◽  
Dietary Patterns ◽  
Lower Risk ◽  
Healthy Eating Index ◽  
Health Study ◽  
Eating Patterns ◽  
Cvd Risk ◽  
Eating Pattern

Introduction: The 2015-2020 Dietary Guidelines for Americans (DGAs) recommend three major healthy dietary patterns: the Healthy US-Style Eating Pattern, the Healthy Mediterranean-Style Eating Pattern, and the Healthy Vegetarian Eating Pattern, for all Americans with diverse cultural and personal food traditions. However, few studies have systematically examined the potential differences in associations of adherence to these recommended dietary patterns with long-term risk of cardiovascular disease (CVD). Hypothesis: We hypothesized that all three DGA-recommended dietary patterns were associated with lower risk of CVD, coronary heart disease (CHD), and stroke. Method: We evaluated data on 74 661 women in the Nurses’ Health Study (NHS), 90 864 women in NHS II, and 41 837 men in the Health Professionals Follow-Up Study (HPFS), who had repeated dietary data and had no history of type 2 diabetes, CVD, or cancer at baseline. Using the food and nutrient components, we calculated the Healthy Eating Index (HEI)-2015, Alternate Mediterranean Diet score (AMED), Healthful Plant-based Diet Index (HPDI), to measure adherence to the Healthy US-Style Eating Pattern, Healthy Mediterranean-Style Eating Pattern, and Healthy Vegetarian Eating Pattern, respectively. Multivariable Cox proportional-hazards regression was used to assess the associations of healthy eating index with CVD risk. Results: We documented 9 262 incident CVD cases (6 628 CHD and 2 701 stroke) during 1 976 026 person years of follow-up in the NHS, 1 916 CVD cases (1 267 CHD and 660 stroke) during 2 173 162 person years of follow-up in NHS II, and 10 203 CVD cases (8 750 CHD and 1 775 stroke) during 873 053 person years of follow-up in HPFS. When comparing the highest to the lowest quintiles, the pooled HRs (95% CIs) of CVD were 0.80 (0.77 to 0.84) for HEI-2015, 0.83 (0.79 to 0.87) for AMED, and 0.85 (0.81 to 0.89) for HPDI (all P for trend <0.001). In addition, a 25-percentile increase in healthy eating scores was associated with 10% to 22% lower risk of CVD (pooled HR: HEI-2015, 0.78 [0.75 to 0.82]; AMED, 0.90 [0.88 to 0.92]; HPDI, 0.84 [0.81 to 0.88]). For CHD, the pooled HRs (95% CIs) per 20-percentile increase were 0.76 (0.73 to 0.80) for HEI-2015, 0.90 (0.87 to 0.92) for AMED, and 0.83 (0.79 to 0.87) for HPDI. For stroke, the pooled HRs (95% CIs) per 20-percentile increase were 0.86 (0.78 to 0.94) for HEI-2015, 0.90 (0.85 to 0.95) for AMED, and 0.90 (0.83 to 0.98) for HPDI. The inverse associations between healthy eating index and CVD risk persisted in analyses stratified by potential risk factors. Conclusions: In three large prospective cohorts with up to 32 years of follow-up, higher adherence to various healthy eating patterns was associated with lower risk of CVD, CHD, and stroke. Our findings support the DGA recommendations for multiple healthy eating patterns.

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