McCullough Marjorie L, Feskanich Diane, Stampfer Meir J, Giovannucci Edward L, Rimm Eric B, Hu Frank B, Spiegelman Donna, Hunter David J, Colditz Graham A, Willett Walter C
American Cancer Society, Atlanta, GA 30329, USA.
Am J Clin Nutr. 2002 Dec;76(6):1261-71. doi: 10.1093/ajcn/76.6.1261.
Adherence to the Dietary Guidelines for Americans, measured with the US Department of Agriculture Healthy Eating Index (HEI), was associated with only a small reduction in major chronic disease risk. Research suggests that greater reductions in risk are possible with more specific guidance.
We evaluated whether 2 alternate measures of diet quality, the Alternate Healthy Eating Index (AHEI) and the Recommended Food Score (RFS), would predict chronic disease risk reduction more effectively than did the HEI.
A total of 38 615 men from the Health Professional's Follow-up Study and 67 271 women from the Nurses' Health Study completed dietary questionnaires. Major chronic disease was defined as the initial occurrence of cardiovascular disease (CVD), cancer, or nontraumatic death during 8-12 y of follow-up.
High AHEI scores were associated with significant reductions in risk of major chronic disease in men [multivariate relative risk (RR): 0.80; 95% CI: 0.71, 0.91] and in women (RR: 0.89; 95% CI: 0.82, 0.96) when comparing the highest and lowest quintiles. Reductions in risk were particularly strong for CVD in men (RR: 0.61; 95% CI: 0.49, 0.75) and in women (RR: 0.72; 95% CI: 0.60, 0.86). In men but not in women, the RFS predicted risk of major chronic disease (RR: 0.93; 95% CI: 0.83, 1.04) and CVD (RR: 0.77; 95% CI: 0.64, 0.93).
The AHEI predicted chronic disease risk better than did the RFS (or the HEI, in our previous research) primarily because of a strong inverse association with CVD. Dietary guidelines can be improved by providing more specific and comprehensive advice.
采用美国农业部健康饮食指数（HEI）衡量的对《美国人膳食指南》的依从性，仅与主要慢性病风险的小幅降低相关。研究表明，提供更具体的指导可能会更大程度地降低风险。
我们评估了两种替代饮食质量衡量指标，即替代健康饮食指数（AHEI）和推荐食物得分（RFS），是否比HEI更有效地预测慢性病风险的降低。
来自健康专业人员随访研究的38615名男性和来自护士健康研究的67271名女性完成了饮食问卷。主要慢性病定义为随访8 - 12年期间首次发生的心血管疾病（CVD）、癌症或非创伤性死亡。
比较最高和最低五分位数时，高AHEI得分与男性[多变量相对风险（RR）：0.80；95%置信区间（CI）：0.71，0.91]和女性（RR：0.89；95%CI：0.82，0.96）主要慢性病风险的显著降低相关。男性（RR：0.61；95%CI：0.49，0.75）和女性（RR：0.72；95%CI：0.60，0.86）中，风险降低对CVD尤为显著。在男性而非女性中，RFS预测主要慢性病风险（RR：0.93；95%CI：0.83，1.04）和CVD风险（RR：0.77；95%CI：0.64，0.93）。
AHEI比RFS（或我们之前研究中的HEI）能更好地预测慢性病风险，主要是因为与CVD有很强的负相关。通过提供更具体和全面的建议可改进膳食指南。
