Eating Healthy = Longer Healthier Life; Who Knew!

The investigators analyzed associations of intake of 9 dietary components (vegetables; fruit; nuts and soy; white or red meat; trans fat; polyunsaturated or saturated fat; fiber; multivitamin use; and alcohol) scored on the AHEI with mortality risk.

Indexes of diet quality have been shown to be associated with a decreased risk for mortality in several countries. The AHEI has particularly been targeted for mortality research, because it was originally designed to provide dietary guidelines to combat major chronic diseases. In the United States, it has been associated with decreased risks for CVD and type 2 diabetes. Previous findings from the British Whitehall II study suggested that adherence to the AHEI is related to a roughly 2-fold higher odds of reversal of the metabolic syndrome.

Whole Grains
Healthy Fats and Oils
Vegetables and Fruits
Nuts, Seeds, Beans, and Tofu
Fish, Poultry, and Eggs
Dairy (1 to 2 Servings Per Day) or Vitamin D/Calcium Supplements
Use Sparingly: Red Meat, Processed Meat, and Butter
Use Sparingly: Refined Grains—White Bread, Rice, and Pasta; Potatoes; Sugary Drinks and Sweets; Salt
Multivitamin with Extra Vitamin D (For Most People)
Optional: Alcohol in Moderation (Not for Everyone)

Amplify’d from www.medscape.org

Alternative Healthy Eating Index Diet May Reduce Risk for CVD Death CME

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD

June 10, 2011 — Encouraging adherence to the Alternative Healthy Eating Index (AHEI) dietary recommendations would decrease the risk for premature death from cardiovascular disease (CVD), according to results from the Whitehall II cohort reported online May 25 in the American Journal of Clinical Nutrition.

“Indexes of diet quality have been shown to be associated with decreased risk of mortality in several countries,” write Tasnime N. Akbaraly, from the Department of Epidemiology and Public Health, University College London, United Kingdom, and colleagues. “It remains unclear if the …AHEI, designed to provide dietary guidelines to combat major chronic diseases, is related to mortality risk.”

The goal of the study was to evaluate the association between adherence to the AHEI in a British working population and cause-specific mortality during 18 years of follow-up. The study sample consisted of 7319 participants in the Whitehall II Study. Mean age was 49.5 years (range, 39 – 63 years); 30.3% were women. Using proportional hazards regression models, the investigators analyzed associations of intake of 9 dietary components (vegetables; fruit; nuts and soy; white or red meat; trans fat; polyunsaturated or saturated fat; fiber; multivitamin use; and alcohol) scored on the AHEI with mortality risk.

After controlling for potential confounders, participants in the highest vs the lowest third of the AHEI score had an approximately 25% lower all-cause mortality risk (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.61 – 0.95) and 40% lower risk for CVD mortality (HR, 0.58; 95% CI, 0.37 – 0.91). The most important independent contributors to lower mortality risk appeared to be intake of nuts and soy and moderate alcohol consumption. No associations were observed of the AHEI with cancer deaths or with deaths from causes other than cancer or CVD.

Limitations of this study include assessment of dietary intake with use of a semiquantitative food frequency questionnaire, use of cutoff values for some AHEI components that might not be optimal in a British population, and a possible underestimation of the association between AHEI and mortality risk reported in the general population.

“To the best of our knowledge, this study is the first to provide epidemiologic evidence that adherence to dietary recommendations of the AHEI may decrease the long-term risk of all-cause and CVD mortality,” the study authors write. “Our findings emphasize the benefit of adherence to the AHEI and suggest that encouragement of the consumption of nuts and soy products and white meat instead of red meat, a high fiber intake, and moderate alcohol consumption may have a significant benefit in terms of a decrease in all-cause and cardiovascular mortality. Our analyses underline the importance and usefulness of observational studies to evaluate the benefit of the introduction of dietary recommendations into public health promotion packages.”

The British Medical Research Council; the British Heart Foundation; the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute; the National Institute on Aging; and the Agency for Health Care Policy and Research supported this study. The study authors also received support from the British United Provident Association Foundation, United Kingdom; the Medical Research Council; the British Heart Foundation; the Academy of Finland; the New European Union New and Emerging Risks in Occupational Safety and Health research programme; the European Science Foundation; and/or the National Institute on Aging.

Am J Clin Nutr. Published online May 25, 2011. Full text

Clinical Context

Overall diet approach has been considered when the association between diet and mortality is examined. Indexes of diet quality have been shown to be associated with a decreased risk for mortality in several countries. The AHEI has particularly been targeted for mortality research, because it was originally designed to provide dietary guidelines to combat major chronic diseases. In the United States, it has been associated with decreased risks for CVD and type 2 diabetes. Previous findings from the British Whitehall II study suggested that adherence to the AHEI is related to a roughly 2-fold higher odds of reversal of the metabolic syndrome. However, it remains unclear if the AHEI, designed to provide dietary guidelines to combat major chronic diseases, is related to mortality risk.

The aim of this study was to examine the association between adherence to the AHEI and cause-specific mortality during 18 years of follow-up in a British working population.

Study Highlights

  • Analyses were based on 7319 participants (mean age, 49.5 years; age range, 39 – 63 years; 30.3% women) from phase 3 of the Whitehall II Study.
  • Baseline screening involved a clinical examination and a self-administered questionnaire. This step was followed by health behaviors, and baseline health status was obtained.
  • Dietary intake was assessed by use of a semiquantitative food frequency questionnaire with 127 food items.
  • Cox proportional hazards regression models were performed to analyze associations of the AHEI (scored on the basis of intake of 9 components: vegetables; fruit; nuts and soy; white or red meat; trans fat; polyunsaturated or saturated fat; fiber; multivitamin use; and alcohol) with mortality risk.
  • During the 18-year follow-up, 534 participants (7.3%) died, and a majority of participants died of cancer (49.1%; n = 259) or CVD (26.8%; n = 141).
  • Results demonstrated that after potential confounders were controlled for, participants in the top vs the bottom third of the AHEI score showed approximately a 25% lower all-cause mortality risk (HR, 0.76; 95% CI, 0.61 – 0.95) and a 40% lower mortality risk from CVD (HR, 0.58; 95% CI, 0.37 – 0.91).
  • The 9 components of the AHEI did not predict mortality risk equally.
  • Consumption of nuts and soy and moderate alcohol intake appeared to be the most important independent contributors to decreased mortality risk.
  • To a lesser extent, the ratio of white to red meat and total fiber was also associated with a decreased risk for mortality.
  • The AHEI was not associated with cancer mortality or noncancer and non-CVD mortality risks.
  • Limitations of this study included less precise assessment of the dietary intake and lack of generalizability of the results.

Clinical Implications

  • The AHEI was designed to provide dietary guidelines to combat major chronic diseases such as CVD and type 2 diabetes; previous findings have suggested that adherence to the AHEI is related to a roughly 2-fold higher odds of reversal of the metabolic syndrome.
  • Adherence to the AHEI dietary recommendations may lead to significant benefits regarding a decrease in all-cause and cardiovascular mortality risks.

CME Test

Read more at www.medscape.org

 

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