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Long-term associations between the alternative healthy eating index (AHEI) score and two predictive indicators for CVD, pericardial adipose tissue (PAT) and coronary artery calcification (CAC) volume, are lacking. Our study aims to investigate the longitudinal associations of the AHEI score with measures of CAC and PAT in adults with and without type 1 diabetes (T1D). The prospective Coronary Artery Calcification in T1D (CACTI) study included 652 people with T1D and 764 people without diabetes (non-DM) (19–56 years old) and was conducted in 2000–2002, 2003–2004, and 2006–2007. At each visit, food frequency questionnaires were collected and PAT and CAC were measured using electron beam computed tomography. Two variables were used for CAC analyses: a continuous variable for the square-root tranformed volume (SRV) for each visit and a second variable identified CAC progression from baseline to visit 3. Mixed effect models and a logistic regression model were used to conduct statistical analyses. A one-point increase in the AHEI score was significantly associated with a −0.12 cm3 (95% CI: −0.17, −0.08; p-value<0.0001) decrease in PAT volume in combined analyses, a −0.16 cm3 (95% CI: −0.22, −0.09; p-value<0.0001) decrease in the non-DM group, a marginally significant −0.07 cm3 (95% CI: −0.14, 0.002; p-value = 0.0571) decrease in the T1D group, and was not associated with either CAC outcome. The AHEI score is inversely associated with PAT; the association revealed greater magnitude of PAT reduction in the non-DM group. The AHEI score did not associate with CAC progression. • AHEI is a common diet quality index to assess CVD risk. • Pericardial adiposity and calcium deposits are independent CVD risks. • Higher AHEI associated with lower pericardial adiposity but not with artery calcium deposits. • These results were observed in adults with and without type 1 diabetes. • Adhering to the AHEI dietary pattern may have a protective effect in CVD. [ABSTRACT FROM AUTHOR]

Background The role of diet on Coronavirus Disease 2019 (COVID-19) is emerging. We investigated the association between usual diet before the onset of the pandemic and risk and severity of subsequent SARS-CoV-2 infection. Methods We included 42,935 participants aged 55–99 y in 2 ongoing cohort studies, the Nurses' Health Study II and Health Professionals Follow-up Study, who completed a series of COVID-19 surveys in 2020 and 2021. Using data from FFQs before COVID-19, we assessed diet quality using the Alternative Healthy Eating Index (AHEI)-2010, the alternative Mediterranean Diet (AMED) score, an Empirical Dietary Index for Hyperinsulinemia (EDIH), and an Empirical Dietary Inflammatory Pattern (EDIP). We calculated multivariable-adjusted ORs and 95% CIs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and severity of COVID-19 after controlling for demographic, medical, and lifestyle factors. Results Among 19,754 participants tested for SARS-CoV-2, 1941 participants reported a positive result. Of these, 1327 reported symptoms needing assistance and another 109 were hospitalized. Healthier diets, represented by higher AHEI-2010 and AMED scores and lower EDIH and EDIP scores, were associated with lower likelihood of SARS-CoV-2 infection (quartile 4 compared with quartile 1: OR: 0.80; 95% CI: 0.69, 0.92 for AHEI-2010; OR: 0.78; 95% CI: 0.67, 0.92 for AMED; OR: 1.36; 95% CI: 1.16, 1.57 for EDIH; and OR: 1.13; 95% CI: 0.99, 1.30 for EDIP; all P -trend ≤ 0.01). In the analysis of COVID-19 severity, participants with healthier diet had lower likelihood of severe infection and were less likely to be hospitalized owing to COVID-19. However, associations were no longer significant after controlling for BMI and pre-existing medical conditions. Conclusions Diet may be an important modifiable risk factor for SARS-CoV-2 infection, as well as for severity of COVID-19. This association is partially mediated by BMI and pre-existing medical conditions. [ABSTRACT FROM AUTHOR]

Background Maternal intake of several nutrients during pregnancy is linked to offspring cognition. The relation between maternal dietary patterns and offspring cognition is less established. Objectives We aimed to examine associations of maternal diet quality during pregnancy with child cognition and behavior. Methods Among 1580 mother–child pairs in Project Viva, a prospective prebirth cohort, we assessed maternal diet during pregnancy using FFQs and evaluated diet quality using versions modified for pregnancy of the Mediterranean Diet Score (MDS-P) and Alternate Healthy Eating Index (AHEI-P). Child cognitive and behavioral outcomes were assessed using standardized tests and questionnaires at infancy and in early and mid-childhood. We conducted multivariable linear regression analyses. Results Mothers were predominantly white, college-educated, and nonsmokers. After adjustment for child age and sex and maternal sociodemographic and lifestyle characteristics, maternal high (6–9) compared with low (0–3) MDS-P during pregnancy was associated with higher child Kaufman Brief Intelligence Test (KBIT-II) nonverbal (mean difference for first trimester: 4.54; 95% CI: 1.53, 7.56) and verbal scores (3.78; 95% CI: 1.37, 6.19) and lower Behavioral Rating Inventory of Executive Function (BRIEF) Metacognition Index (−1.76; 95% CI: −3.25, −0.27), indicating better intelligence and fewer metacognition problems in mid-childhood. Maternal Q4 compared with Q1 AHEI-P during pregnancy was associated with higher Wide Range Assessment of Visual Motor Abilities matching scores in early childhood (mean difference for first trimester: 2.79; 95% CI: 0.55, 5.04) and higher KBIT-II verbal scores (2.59; 95% CI: 0.13, 5.04) and lower BRIEF Global Executive Composite scores in mid-childhood (−1.61; 95% CI: −3.20, −0.01), indicating better visual spatial skills, verbal intelligence, and executive function. Conclusions Maternal intake of a better-quality diet during pregnancy was associated with better visual spatial skills in the offspring at early childhood and with better intelligence and executive function in the offspring at mid-childhood. [ABSTRACT FROM AUTHOR]

Background and Aims: To examine the mediating role of adiposity on the associations of diet quality with longitudinal changes in insulin sensitivity and beta-cell function.Methods and Results: Adults at-risk for type 2 diabetes (T2D) in the PROMISE cohort had 4 assessments over 9 years (n = 442). Alternate Healthy Eating Index (AHEI) scores were used to assess diet quality. Generalized Estimating Equations (GEE) evaluated the associations between the AHEI and longitudinal changes in insulin sensitivity (HOMA2-%S and ISI) and beta-cell function (IGI/HOMA-IR and ISSI-2). The proportion of the mediating effect of waist circumference changes was estimated using the difference method. In the primary longitudinal analysis, AHEI was positively associated with insulin sensitivity and beta-cell function over time (% difference per standard deviation increase of AHEI for HOMA2-%S (β = 11.0, 95%CI 5.43-17.0), ISI (β = 10.4, 95%CI 4.35-16.8), IGI/HOMA-IR (β = 7.12, 95%CI 0.98-13.6) and ISSI-2 (β = 4.38, 95%CI 1.05-7.80), all p < 0.05). There was no significant association between AHEI and dysglycemia incidence (OR = 0.95, 95%CI 0.77-1.17). Adjustments for longitudinal changes in waist circumference substantially attenuated all associations of AHEI with insulin sensitivity and beta-cell function. Mediation analysis indicated that waist circumference mediated 73%, 70%, 83% and 81% of the association between AHEI and HOMA2-%S, ISI, IGI/HOMA-IR, and ISSI-2, respectively (all p < 0.01).Conclusion: In a Canadian population at-risk for T2D, AHEI score was positively associated with changes in insulin sensitivity and beta-cell function. These associations were substantially mediated by waist circumference, suggesting that changes in adiposity may represent an important pathway linking diet quality with risk phenotypes for T2D. [ABSTRACT FROM AUTHOR]

Background Adherence to a healthy diet has been associated with reduced risk of chronic diseases. Identifying nutritional biomarkers of diet quality may be complementary to traditional questionnaire-based methods and may provide insights concerning disease mechanisms and prevention. Objective To identify metabolites associated with diet quality assessed via the Alternate Healthy Eating Index (AHEI) and its components. Methods This cross-sectional study used FFQ data and plasma metabolomic profiles, mostly lipid related, from the Nurses' Health Study (NHS, n  = 1460) and Health Professionals Follow-up Study (HPFS, n  = 1051). Linear regression models assessed associations of the AHEI and its components with individual metabolites. Canonical correspondence analyses (CCAs) investigated overlapping patterns between AHEI components and metabolites. Principal component analysis (PCA) and explanatory factor analysis were used to consolidate correlated metabolites into uncorrelated factors. We used stepwise multivariable regression to create a metabolomic score that is an indicator of diet quality. Results The AHEI was associated with 83 metabolites in the NHS and 96 metabolites in the HPFS after false discovery rate adjustment. Sixty-three of these significant metabolites overlapped between the 2 cohorts. CCA identified "healthy" AHEI components (e.g. nuts, whole grains) and metabolites (n  = 27 in the NHS and 33 in the HPFS) and "unhealthy" AHEI components (e.g. red meat, trans fat) and metabolites (n  = 56 in the NHS and 63 in the HPFS). PCA-derived factors composed of highly saturated triglycerides, plasmalogens, and acylcarnitines were associated with unhealthy AHEI components while factors composed of highly unsaturated triglycerides were linked to healthy AHEI components. The stepwise regression analysis contributed to a metabolomics score as a predictor of diet quality. Conclusion We identified metabolites associated with healthy and unhealthy eating behaviors. The observed associations were largely similar between men and women, suggesting that metabolomics can be a complementary approach to self-reported diet in studies of diet and chronic disease. [ABSTRACT FROM AUTHOR]

Abstract: Diet quality has not been well studied in relation to positive psychological traits. Our purpose was to investigate the relationship between optimism and diet quality in postmenopausal women enrolled in the Women's Health Initiative observational study (OS) and clinical trials (CTs), and to determine whether optimism was associated with diet change after a 1-year dietary intervention. Diet quality was scored with the Alternate Healthy Eating Index (AHEI) and optimism assessed with the Life Orientation Test-Revised. Baseline characteristics were compared across AHEI quintiles or optimism tertiles using regression models with each variable of interest as a function of quintiles or tertiles (OS, n=87,630; CT, n=65,360). Association between optimism and baseline AHEI and change in AHEI over 1 year were tested using multivariate linear regression (CT, n=13,645). Potential interaction between optimism and trial arm and demographic/lifestyle factors on AHEI change was tested using likelihood ratio test (CT intervention, n=13,645; CT control, n=20,242). Women reporting high AHEI were non-Hispanic white, educated, physically active, past or never smokers, hormone therapy users, had lower body mass index and waist circumference, and were less likely to have chronic conditions. In the CT intervention, higher optimism was associated with higher AHEI at baseline and with greater change over 1 year (P=0.001). Effect modification by intervention status was observed (P=0.014), whereas control participants with highest optimism achieved threefold greater AHEI increase compared with those with the lowest optimism. These data support a relationship between optimism and dietary quality score in postmenopausal women at baseline and over 1 year. [Copyright &y& Elsevier]

Abstract: Objective: Adherence to a healthy diet has been shown to decrease the incidence of obesity and associated comorbidities. C-reactive protein (CRP) is an established inflammatory marker and irisin was recently identified as a molecule which may play a role in energy regulation and obesity but whether diet alters irisin levels remains unknown. We aimed to investigate the association between circulating irisin, leptin, and CRP levels and dietary quantity and quality using the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet Score (aMED). Materials/Methods: The study evaluated dietary data and biomarker levels of 151 participants between 2009 and 2011 (71 male vs. 80 female, over 35years old, obese 43.7%). AHEI and aMED scores were calculated based on data derived from self-administered 110-item food-frequency questionnaires estimating usual nutrient intake over the past year. Cross-sectional associations between dietary quantity, quality, body composition by bioelectric impedance, and biomarker levels including irisin, leptin, and CRP after fasting were assessed. Results: CRP, but not irisin, was negatively correlated with AHEI (r =−0.34) and aMED (r =−0.31). Irisin was positively correlated with BMI (r =0.22), fat mass (r =0.21), waist circumference (r =0.24), waist–hip ratio (r =0.20), leptin (r =0.32), and CRP (r =0.25). Participants with the highest AHEI scores tended to have 11.6% lower concentrations of irisin (P for trend =0.09), but they were not significant after adjustment for potential confounders. Better diet quality was associated with lower CRP concentrations (P for trend=0.02) in multivariate model. Percentage of energy from carbohydrate was inversely associated with CRP. Conclusions: Unlike CRP, irisin is not associated with dietary quality or quantity. [Copyright &y& Elsevier]

Objective: To examine whether short-term participation in the Supplemental Nutrition Assistance Program (SNAP) affects food security and dietary quality among low-income adults recruited from a Massachusetts-wide emergency food hotline. Methods: A 3-month, longitudinal study was conducted among 107 adults recruited at the time of SNAP application assistance. Outcomes included household food security (10-item US Department of Agriculture Food Security Survey Module), dietary intake (eg, grains, fruit) and diet quality (modified Alternate Healthy Eating Index). Data were analyzed using paired t tests and multivariable linear regression. Results: Supplemental Nutrition Assistance Program participation was not associated with improved household food security over 3 months (P = .25). Compared with non-participants, SNAP participants increased refined grain intake by 1.1 serving/d (P = .02), from baseline to follow-up. No associations were observed with other foods, nutrients, or dietary quality. Conclusion and Implications: Policies that simultaneously improve household food security and dietary quality should be implemented to support the health of low-income Americans participating in this crucial program. [ABSTRACT FROM AUTHOR]

Suboptimal diet quality has a large impact on noncommunicable disease burden. This study aimed to update the body of evidence on the associations between diet quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and the Dietary Approaches to Stop Hypertension score, and health status. Moreover, results of the previous systematic reviews and meta-analyses were extended by evaluating the credibility of the evidence. PubMed, Embase, and Scopus databases were searched to identify eligible studies published between May 15, 2017 and March 14, 2020. Pooled relative risk (RR) with 95% CI for highest vs lowest category of diet quality were estimated using a random-effects model. Heterogeneity was explored using Cochran's Q test and I 2 statistic with 95% CI. Presence of publication bias was detected by using funnel plots and Egger's regression test. The NutriGrade tool was used to assess the credibility of evidence. The current update identified 47 new reports, resulting in a total of 113 reports including data from 3,277,684 participants. Diets of the highest quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores, were inversely associated with risk of all-cause mortality (RR 0.80, 95% CI 0.79 to 0.82, I 2 = 68%, n= 23), cardiovascular disease incidence or mortality (RR 0.80, 95% CI 0.78 to 0.82, I 2 = 59%, n= 45), cancer incidence or mortality (RR 0.86, 95% CI 0.84 to 0.89, I 2 = 73%, n= 45), incidence of type 2 diabetes (RR 0.81, 95% CI 0.78 to 0.85, I 2 = 76%, n= 16), and incidence of neurodegenerative diseases (RR 0.82, 95% CI 0.75 to 0.89, I 2 = 71%, n= 12). In cancer survivors, the highest diet quality was linked with lower risk of all-cause (RR 0.83, 95% CI 0.77 to 0.88, I 2 = 45%, n= 12) and cancer mortality (RR 0.82, 95% CI 0.75 to 0.89, I 2 = 44%, n= 12). The credibility of evidence for identified associations between overall healthy dietary patterns and included health outcomes was moderate. This updated systematic review and meta-analysis suggests that high diet quality (assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension) is inversely associated with risk of all-cause mortality, cardiovascular disease incidence or mortality, cancer incidence or mortality, type 2 diabetes, and neurodegenerative disease, as well as all-cause mortality and cancer mortality among cancer survivors. Moderate credibility of evidence for identified associations complements the recent 2020 Dietary Guidelines Advisory Committee report recommending healthy dietary patterns for disease prevention. [ABSTRACT FROM AUTHOR]

Background Diets of the highest quality have been associated with a significantly lower risk of noncommunicable diseases. Objective It was the aim of this study to update a previous systematic review investigating the associations of diet quality as assessed by the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), and Dietary Approaches to Stop Hypertension (DASH) score and multiple health outcomes. As an additional topic, the associations of these diet quality indices with all-cause mortality and cancer mortality among cancer survivors were also investigated. Design A literature search for prospective cohort studies that were published up to May 15, 2017 was performed using the electronic databases PubMed, Scopus, and Embase. Summary risk ratios (RRs) and 95% CIs were estimated using a random effects model for high vs low adherence categories. Results The updated review process showed 34 new reports (total number of reports evaluated=68; including 1,670,179 participants). Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction for all-cause mortality (RR 0.78, 95% CI 0.77 to 0.80; I 2 =59%; n=13), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.76 to 0.80; I 2 =49%; n=28), cancer (incidence or mortality) (RR 0.84, 95% CI 0.82 to 0.87; I 2 =66%; n=31), type 2 diabetes (RR 0.82, 95% CI 0.78 to 0.85; I 2 =72%; n=10), and neurodegenerative diseases (RR 0.85, 95% CI 0.74 to 0.98; I 2 =51%; n=5). Among cancer survivors, the association between diets for the highest quality resulted in a significant reduction in all-cause mortality (RR 0.88, 95% CI 0.81 to 0.95; I 2 =38%; n=7) and cancer mortality (RR 0.90, 95% CI 0.83 to 0.98; I 2 =0%; n=7). Conclusions In the updated meta-analyses, diets that score highly on the HEI, AHEI, and DASH were associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative disease by 22%, 22%, 16%, 18%, and 15%, respectively. Moreover, high-quality diets were inversely associated with overall mortality and cancer mortality among cancer survivors. [ABSTRACT FROM AUTHOR]

Dietary patterns consider synergistic effects compared with isolated foods or nutrients on health outcomes. The aim of this systematic review and meta-analysis was to examine the associations of diet quality as assessed by the Healthy Eating Index (HEI), the Alternate Healthy Eating Index (AHEI), and the Dietary Approaches to Stop Hypertension (DASH) score and the risk of all-cause mortality, cardiovascular mortality or incidence, cancer mortality or incidence, type 2 diabetes mellitus, and neurodegenerative diseases. A literature search was performed using the electronic databases MEDLINE, SCOPUS, and EMBASE with an end date of May 10, 2014. Study-specific risk ratios were pooled using a random effect model by the Cochrane software package Review Manager 5.2. Fifteen cohort studies (34 reports), including 1,020,642 subjects, met the criteria and were included in the meta-analysis. Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction (RR) for all-cause mortality (RR 0.78, 95% CI 0.76 to 0.80; P <0.00001; I 2 =61%, 95% CI 20% to 81%), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.75 to 0.81; P <0.00001; I 2 =45%, 95% CI 13% to 66%), cancer (incidence or mortality) (RR 0.85, 95% CI 0.82 to 0.88; P <0.00001; I 2 =77%, 95% CI 68% to 84%), and type 2 diabetes mellitus (RR 0.78, 95% CI 0.72 to 0.85; P <0.00001; I 2 =74%, 95% CI 52% to 86%). Differences observed for neurodegenerative diseases were not significant. Egger regression tests provided no evidence of publication bias. Diets that score highly on the HEI, AHEI, and DASH are associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, and type 2 diabetes mellitus by 22%, 22%, 15%, and 22%, respectively, and therefore is of high public health relevance. [ABSTRACT FROM AUTHOR]