ResearchReviewDiet Quality as Assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension Score, and Health Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies
Section snippets
Methods
The review protocol has been registered in PROSPERO: The International Prospective Register of Systematic Reviews (crd.york.ac.uk/prospero/index.asp Identifier: CRD42013006561).
Literature Search and Study Characteristics
The detailed steps of the article selection process are given as a flow chart in Figure 3.
Altogether, 15 cohort studies (34 reports) extracted from 6,506 articles met the inclusion criteria and were included in the meta-analysis.12, 13, 14, 15, 16, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53
General study characteristics are given in Table 1. Sample size varied between 862 and 537,218 with a follow-up time ranging from 5 to
Discussion
There is an urgent need for interventions to reduce the incidence of CVD, cancer, type 2 diabetes mellitus, and neurodegenerative diseases, which continue to be the most common causes of death in the Western world since 1970.54, 55 In recent years, dietary pattern analysis has been used increasingly as an alternative method to traditional single nutrient analysis.56 The use of dietary patterns avoids focusing on single foods or nutrients that can be correlated with, or interact with, each other
Conclusions
Our systematic review and meta-analysis shows that high-quality diets, as assessed by the HEI, AHEI, and DASH scores, are associated with a reduced risk of all-cause mortality, manifestation of type 2 diabetes, and incidence or mortality due to cardiovascular disease and overall cancer, particularly colorectal cancer. This underlines the relevance of these indexes in clinical as well as public health settings.
L. Schwingshackl is a doctoral degree student, Department of Nutritional Sciences, University of Vienna, Austria.
References (74)
- et al.
Nutrients, foods, and dietary patterns as exposures in research: A framework for food synergy
Am J Clin Nutr
(2003) - et al.
The Healthy Eating Index: Design and applications
J Am Diet Assoc
(1995) - et al.
Development of the Healthy Eating Index-2005
J Am Diet Assoc
(2008) - et al.
Update of the Healthy Eating Index: HEI-2010
J Acad Nutr Diet
(2013) - et al.
The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans
J Nutr
(2014) - et al.
Diet quality and major chronic disease risk in men and women: Moving toward improved dietary guidance
Am J Clin Nutr
(2002) - et al.
Alternative dietary indices both strongly predict risk of chronic disease
J Nutr
(2012) - et al.
Degree of concordance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease
Am J Hypertens
(2007) - et al.
Coronary heart disease prevention: Nutrients, foods, and dietary patterns
Clin Chim Acta
(2011) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986)
Diet quality indexes and mortality in postmenopausal women: The Iowa Women's Health Study
Am J Clin Nutr
Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men
Am J Clin Nutr
Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women
Am J Clin Nutr
Comparison of 4 established DASH diet indexes: Examining associations of index scores and colorectal cancer
Am J Clin Nutr
Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women
J Nutr
Diet quality and the risk of cardiovascular disease: The Women's Health Initiative (WHI)
Am J Clin Nutr
Alternative Healthy Eating Index and mortality over 18 y of follow-up: Results from the Whitehall II cohort
Am J Clin Nutr
Comparison of associations of adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet with risks of cardiovascular disease and venous thromboembolism
J Thromb Haemost
Prospective study of dietary pattern and risk of Parkinson disease
Am J Clin Nutr
The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and colorectal cancer
Am J Clin Nutr
Relation of consistency with the dietary approaches to stop hypertension diet and incidence of heart failure in men aged 45 to 79 years
Am J Cardiol
Index-based dietary patterns and risk of head and neck cancer in a large prospective study
Am J Clin Nutr
A priori-defined dietary patterns are associated with reduced risk of stroke in a large Italian cohort
J Nutr
Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults
J Nutr
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010
Lancet
Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases–incidence: A systematic review and meta-analysis on observational prospective studies
Nutrition
Indexes of overall diet quality: A review
J Am Diet Assoc
Polyphenols and disease risk in epidemiologic studies
Am J Clin Nutr
Habitual salt intake and risk of gastric cancer: A meta-analysis of prospective studies
Clin Nutr
Accruing evidence on benefits of adherence to the Mediterranean diet on health: An updated systematic review and meta-analysis
Am J Clin Nutr
Dietary assessment in food environment research: A systematic review
Am J Prev Med
A prospective study of diet quality and mortality in women
JAMA
Diet quality—What is it and does it matter?
Public Health Nutr
Impact of diet, body mass index, and physical activity on cancer survival
Curr Nutr Rep
Dietary advice for reducing cardiovascular risk
Cochrane Database Syst Rev
Dietary pattern analysis and biomarkers of low-grade inflammation: A systematic literature review
Nutr Rev
Dietary patterns and risk of colorectal cancer: A systematic review of cohort studies (2000-2011)
Asian Pac J Cancer Prev
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L. Schwingshackl is a doctoral degree student, Department of Nutritional Sciences, University of Vienna, Austria.
G. Hoffmann is a professor of nutritional sciences, Department of Nutritional Sciences, University of Vienna, Austria.
Supplementary materials: Figures 1, 2, 10, 11, and 12 and Tables 3 through 8 are available online at www.andjrnl.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.