Mattei Josiemer, Sotos-Prieto Mercedes, Bigornia Sherman J, Noel Sabrina E, Tucker Katherine L
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA;
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
J Nutr. 2017 Apr;147(4):661-669. doi: 10.3945/jn.116.245431. Epub 2017 Mar 8.
Multiple diet quality scores have been used to evaluate adherence to specific dietary recommendations or to consumption of healthful foods and nutrients. It remains unknown which score can more strongly predict longitudinal changes in cardiometabolic risk factors. We aimed to determine associations of 5 diet quality scores [AHA diet score (AHA-DS), Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI)-2005, Mediterranean diet score (MeDS), and Alternative Healthy Eating Index (AHEI)] with 2-y changes in cardiometabolic risk factors in adults 45-75 y old. Data from the Boston Puerto Rican Health Study were analyzed ( = 1194). Diet quality scores were calculated from a baseline-validated food-frequency questionnaire. Multivariable-adjusted, repeated-subjects, mixed-effects models, adjusted for baseline measures, estimated associations between each score and 14 individual cardiometabolic factors measured at 2 y. MeDS was significantly associated with lower 2-y waist circumference (β coefficient ± SE: -0.52 ± 0.26, = 0.048); body mass index (BMI; -0.23 ± 0.08, = 0.005); log-insulin (-0.06 ± 0.02, = 0.005); log-homeostasis model assessment of insulin resistance (HOMA-IR; -0.05 ± 0.02, = 0.030), and log-C-reactive protein (-0.13 ± 0.03, = 0.0002). Similar but weaker associations were observed for the AHEI with BMI, insulin, and HOMA-IR. The AHA-DS was inversely associated with BMI (-0.17 ± 0.08, = 0.033). Neither the HEI-2005 nor DASH was significantly associated with any variable. Traditional Puerto Rican foods consumed by individuals with high MeDSs included vegetables and meats in homemade soups, orange juice, oatmeal, beans and legumes, fish, whole milk, corn oil, and beer. The MeDS comprises food components and scores associated with a favorable cardiometabolic profile over 2 y in Puerto Rican adults. An overall healthy diet may be particularly beneficial for maintaining a lower BMI. These results can help identify suitable measures of diet quality in epidemiologic studies and craft meaningful nutritional messages and dietary recommendations for the intended population. This study was registered at clinicaltrials.gov as NCT01231958.
多种饮食质量评分已被用于评估对特定饮食建议的遵循情况或健康食品及营养素的摄入量。目前尚不清楚哪种评分能更有力地预测心血管代谢危险因素的纵向变化。我们旨在确定5种饮食质量评分[美国心脏协会（AHA）饮食评分（AHA-DS）、终止高血压饮食疗法（DASH）、健康饮食指数（HEI）-2005、地中海饮食评分（MeDS）和替代健康饮食指数（AHEI）]与45至75岁成年人心血管代谢危险因素2年变化之间的关联。对来自波士顿波多黎各健康研究的数据（n = 1194）进行了分析。饮食质量评分通过一份经基线验证的食物频率问卷计算得出。多变量调整的重复测量混合效应模型，经基线测量调整后，估计了每种评分与2年时测量的14种个体心血管代谢因素之间的关联。MeDS与2年时较低的腰围显著相关（β系数±标准误：-0.52±0.26，P = 0.048）；体重指数（BMI；-0.23±0.08，P = 0.005）；对数胰岛素（-0.06±0.02，P = 0.005）；胰岛素抵抗的对数稳态模型评估（HOMA-IR；-0.05±0.02，P = 0.030），以及对数C反应蛋白（-0.13±0.03，P = 0.0002）。AHEI与BMI、胰岛素和HOMA-IR之间观察到类似但较弱的关联。AHA-DS与BMI呈负相关（-0.17±0.08，P = 0.033）。HEI-2005和DASH均与任何变量无显著关联。MeDS评分高的个体所食用的传统波多黎各食物包括自制汤中的蔬菜和肉类、橙汁、燕麦片、豆类和豆制品、鱼类、全脂牛奶、玉米油和啤酒。MeDS包含与波多黎各成年人2年中心血管代谢状况良好相关的食物成分和评分。总体健康饮食可能对维持较低的BMI特别有益。这些结果有助于在流行病学研究中确定合适的饮食质量衡量指标，并为目标人群制定有意义的营养信息和饮食建议。本研究已在clinicaltrials.gov上注册，注册号为NCT01231958。
