Adherence to healthy eating pattern prevents CVD, death in adults

Adults who consume a high-quality diet, such as unrefined, minimally processed foods, have lower risks of cardiovascular disease (CVD) and mortality in the long term, as well as longer CVD-free survival, regardless of their sex or age at dietary assessment, a US study has found.

“Adopting a healthy eating pattern as early as possible and maintaining that … over time may be an advantageous approach to maximize cardiovascular benefits of a healthy diet,” the researchers said.

The study obtained and analysed data from six prospective cohorts in 1985–2016 (n=29,497). Baseline diet quality was assessed by the following: alternate Healthy Eating Index 2010 (aHEI-2010), alternate Mediterranean (aMED) diet score, and Dietary Approaches to Stop Hypertension (DASH) score.

The researchers estimated absolute risks using modified Kaplan-Meier analysis and CVD-free survival using Irwin’s restricted mean. They stratified analyses by sex and baseline age: young (20–39 years), middle-aged (40–59 years), and older (60–79 years).

Comparisons of participants in the lowest and the highest quintiles of aHEI-2010 score showed 40-year risks for incident CVD to be 14.3 percent (95 percent confidence interval [CI], 10.0–18.6) vs 5.9 percent (95 percent CI, 3.0–8.9) in young men, 8.8 percent (95 percent CI, 4.3–13.3) vs 3.0 percent (95 percent CI, 1.6–4.4) in young women, 39.6 percent (95 percent CI, 36.1–43.2) vs 30.8 percent (95 percent CI, 26.2–35.3) in middle-aged men, and 32.9 percent (95 percent CI, 28.0–37.8) vs 19.5 percent (95 percent CI, 16.6–22.4) in middle-aged women. [Am J Med 2021;134:490-498.E24]

The 30-year risks for incidence CVD among older adults were also higher for those in the lowest quintile of aHEI-2010 score: 54.7 percent (95 percent CI, 49.3–60.2) vs 49.7 percent (95 percent CI, 44.5–55.0) in men and 48.3 percent (95 percent CI, 44.0–52.5) vs 42.4 percent (95 percent CI, 38.2–46.7) in women.

Inverse associations were also observed for all-cause mortality. Participants in the highest quintile of aHEI-2010 score had ~0.5-2.2 years of longer CVD-free survival than those in the lowest quintile. Results based on DASH score, but not aMED score, were similar to those based on aHEI-2010 score.

These findings were consistent with those of two previous studies, which reported the association of adherence to a healthier diet with longer life expectancy overall and free of major chronic diseases in predominantly middle-aged and older White populations. [Circulation 2018;138:345-355; BMJ 2020;368:l6669]

Data from adults aged <50 years and from more diverse populations were limited, but diet quality of US people and associated risks for CVD and death differed by age, sex, and race/ethnicity. [J Acad Nutr Diet 2013;113:297-306; Circulation 2016;133:e38-360]

“This study addressed this gap by providing absolute measures across the adult life span for the long-term age- and sex-stratified associations of diet quality with cardiovascular disease and mortality in a racially and ethnically diverse sample,” the researchers said.

“Given that dietary behaviours established in early life may track into adulthood, adopting a healthy eating pattern as early as possible and maintaining that … over time may be an advantageous approach to maximize various health benefits of a healthy diet,” they added. [Br J Nutr 2005;93:923-931]