Association between healthy eating patterns and lower heart disease risk

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Four different healthy eating patterns — all emphasising higher intake of whole grains, vegetables, fruits, legumes, and nuts, and lower intakes of red and processed meats and sugar-sweetened beverages — were found to be associated with a lower risk of cardiovascular disease, according to a large Harvard analysis.

Greater adherence to a variety of healthy eating patterns was associated with a lower risk of cardiovascular disease (CVD), according to new research led by Harvard TH Chan School of Public Health. The findings add support for the 2015-2020 Dietary Guidelines for Americans, which focus on healthy eating patterns rather than individual ingredients and nutrients to better account for diverse cultural and personal food traditions and preferences.

“Although each healthy eating pattern represents a different combination of dietary constituents, our study indicates that greater adherence to any of the four healthy eating patterns we looked at is associated with lower risk of cardiovascular disease and the health benefits persist across racial and ethnic groups,” said Zhilei Shan, first author on the paper and a research associate in the nutrition department.

Few studies have examined how adhering to recommended healthy eating patterns influence long-term risk of CVD. For this study, researchers focused on dietary scores for four healthy eating patterns: Healthy Eating Index–2015 (HEI-2015); Alternate Mediterranean Diet Score (AMED); Healthful Plant-Based Diet Index (HPDI); and Alternate Healthy Eating Index (AHEI). Despite different scoring methods, each of these patterns emphasises higher intake of whole grains, vegetables, fruits, legumes, and nuts, and lower intakes of red and processed meats and sugar-sweetened beverages.

To assess the associations of each pattern with CVD risk, the researchers looked at data from 74,930 women enrolled in the Nurses’ Health Study, 90,864 women in the Nurses’ Health Study II, and 43,339 men in the Health Professionals Follow-Up Study.

Participants in each study were asked every two to four years about their dietary habits, including how often, on average, they consumed a standard portion size of various foods.

Using the dietary data, which was collected over several decades via validated dietary questionnaires, the researchers created four dietary scores for each participant. Higher dietary scores represented greater adherence to healthy eating patterns. After adjusting for numerous factors, including age, BMI, and smoking status, the analysis found that greater adherence to any of the healthy eating patterns was consistently associated with lower risk of CVD. The study found that participants who adhered most to healthy eating patterns (those in the top quartile of the scores) had a 14% to 21% lower risk of CVD when compared with those who adhered least (in the bottom quartile of the scores).

The findings also showed that these different healthy eating patterns were similarly effective at lowering CVD risk across racial and ethnic groups and other subgroups studied, and that they were statistically significantly associated with lower risk of both coronary heart disease and stroke.

“These data provide further evidence to support current dietary guidelines that following healthy eating patterns confers long-term health benefits on cardiovascular disease prevention,” said corresponding author Frank Hu, Fredrick J Stare professor of nutrition and epidemiology and chair of the department of nutrition. “There is no one-size-fits-all diet that is best for everyone. One can combine foods in a variety of flexible ways to achieve healthy eating patterns according to individuals’ health needs, food preferences, and cultural traditions.”

Abstract
Importance: The 2015-2020 Dietary Guidelines for Americans recommend multiple healthy eating patterns. However, few studies have examined the associations of adherence to different dietary patterns with long-term risk of cardiovascular disease (CVD).
Objective: To examine the associations of dietary scores for 4 healthy eating patterns with risk of incident CVD.
Design, Setting, and Participants: Prospective cohort study of initially healthy women from the Nurses’ Health Study (NHS) (1984-2016) and the NHS II (1991-2017) and men from the Health Professionals Follow-up Study (HPFS) (1986-2012). The dates of analysis were July 25 to December 4, 2019.
Exposures: Healthy Eating Index–2015 (HEI-2015), Alternate Mediterranean Diet Score (AMED), Healthful Plant-Based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI).
Main Outcomes and Measures: Cardiovascular disease events, including fatal and nonfatal coronary heart disease (CHD) and stroke.
Results: The final study sample included 74 930 women in the NHS (mean [SD] baseline age, 50.2 [7.2] years), 90 864 women in the NHS II (mean [SD] baseline age, 36.1 [4.7] years), and 43 339 men in the HPFS (mean [SD] baseline age, 53.2 [9.6] years). During a total of 5 257 190 person-years of follow-up, 23 366 incident CVD cases were documented (18 092 CHD and 5687 stroke) (some individuals were diagnosed as having both CHD and stroke). Comparing the highest with the lowest quintiles, the pooled multivariable-adjusted hazard ratios (HRs) of CVD were 0.83 (95% CI, 0.79-0.86) for the HEI-2015, 0.83 (95% CI, 0.79-0.86) for the AMED, 0.86 (95% CI, 0.82-0.89) for the HPDI, and 0.79 (95% CI, 0.75-0.82) for the AHEI (P for trend <.001 for all). In addition, a 25-percentile higher dietary score was associated with 10% to 20% lower risk of CVD (pooled HR, 0.80 [95% CI, 0.77-0.83] for the HEI-2015; 0.90 [95% CI, 0.87-0.92] for the AMED; 0.86 [95% CI, 0.82-0.89] for the HPDI; and 0.81 [95% CI, 0.78-0.84] for the AHEI). These dietary scores were statistically significantly associated with lower risk of both CHD and stroke. In analyses stratified by race/ethnicity and other potential risk factors for CVD, the inverse associations between these scores and risk of CVD were consistent in most subgroups.
Conclusions and Relevance: In 3 large prospective cohorts with up to 32 years of follow-up, greater adherence to various healthy eating patterns was consistently associated with lower risk of CVD. These findings support the recommendations of the 2015-2020 Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.

Authors
Zhilei Shan; Yanping Li, Megu Y Baden, Shilpa N Bhupathiraju, Dong D Wang, Qi Sun, Kathryn M Rexrode, Eric B Rimm, Lu Qi, Walter C Willett, JoAnn E Manson, Qibin Qi, Frank B Hu

 

Harvard TH Chan School of Public Health material

 

JAMA Internal Medicine abstract

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