Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
VLCDs of <800 kcal/day are associated with increased risk of dehydration, electrolyte imbalance, and cholelithiasis.
“These risks include dehydration, electrolyte imbalance, and cholelithiasis [55].”
From Nutritional considerations with antiobesity medications (2024) · cites this paper as [55]
The Study Population section discusses calorie-intake exclusions, and the dietary-score tables examine cardiovascular disease risk; neither addresses adverse effects of very-low-calorie diets. Searches for dehydration, electrolyte imbalance, cholelithiasis, and diets below 800 kcal/day found no passage supporting the cited risk statement. Page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDietary fats are important to aid in the absorption of fat-soluble vitamins (A, D, E, and K) and to stimulate gallbladder emptying during weight reduction, which may reduce the risk of gallstone formation.
“Dietary fats are important to aid in the absorption of fat-soluble vitamins (A, D, E, and K) and to stimulate gallbladder emptying during weight reduction, which may reduce the risk of gallstone formation [55].”
From Nutritional considerations with antiobesity medications (2024) · cites this paper as [55]
The Introduction and Abstract address healthy eating patterns and cardiovascular disease, not the proposed effects of dietary fat during weight reduction. Searches for fat-soluble vitamin absorption, gallbladder emptying, and gallstone formation found no passage in our copy addressing those points. Page numbers were not provided. (LLM, conf=0.75)
Experimental — accuracy not yet measuredKetone body production with very low-carbohydrate (ketogenic) diets may promote increased urination, dehydration, and electrolyte imbalance.
“Ketone body production with very low-carbohydrate (ketogenic) diets may promote increased urination, dehydration, and electrolyte imbalance [55].”
From Nutritional considerations with antiobesity medications (2024) · cites this paper as [55]
The dietary-score analysis and Strengths and Limitations sections address healthy eating patterns and cardiovascular disease risk, not physiological effects of ketogenic diets. Searches for ketone production, ketosis, urination, dehydration, and electrolyte loss found no passage in our copy addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Reproducibility and validity of a semiquantitative food frequency questionnaire
WILLETT, W. C., SAMPSON, L., STAMPFER, M. J., ROSNER, B., BAIN, C., WITSCHI, J., HENNEKENS, C. H., & SPEIZER, F. E. (1985) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114086 · Cited by 4,274 · see citing works
Self-citationMozaffarian, D. (2016) · Circulation · doi:10.1161/circulationaha.115.018585 · Cited by 2,216 · see citing works
Wang, X., Ouyang, Y., Liu, J., Zhu, M., Zhao, G., Bao, W., & Hu, F. B. (2014) · BMJ · doi:10.1136/bmj.g4490 · Cited by 1,596 · see citing works
Schwingshackl, L., & Hoffmann, G. (2015) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2014.12.009 · Cited by 1,022 · see citing works
Aune, D., Keum, N., Giovannucci, E., Fadnes, L. T., Boffetta, P., Greenwood, D. C., Tonstad, S., Vatten, L. J., Riboli, E., & Norat, T. (2016) · BMJ · doi:10.1136/bmj.i2716 · Cited by 1,013 · see citing works
COLDITZ, G. A., MARTIN, P., STAMPFER, M. J., WILLETT, W. C., SAMPSON, L., ROSNER, B., HENNEKENS, C. H., & SPEIZER, F. E. (1986) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114319 · Cited by 992 · see citing works
Self-citationHealthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults
Satija, A., Bhupathiraju, S. N., Spiegelman, D., Chiuve, S. E., Manson, J. E., Willett, W., Rexrode, K. M., Rimm, E. B., & Hu, F. B. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.05.047 · Cited by 991 · see citing works
Self-citationMediterranean diet and incidence of and mortality from coronary heart disease and stroke in women
Fung, T. T., Rexrode, K. M., Mantzoros, C. S., Manson, J. E., Willett, W. C., & Hu, F. B. (2009) · Circulation · doi:10.1161/circulationaha.108.816736 · Cited by 916 · see citing works
Self-citationThe Mediterranean Diet and Cardiovascular Health: A Critical Review
Martínez-González, M. A., Gea, A., & Ruiz-Canela, M. (2019) · Circulation Research · doi:10.1161/circresaha.118.313348 · Cited by 878 · see citing works
Flagged first, then by citations
Research works printed but not linked: 28
- Yu E, Malik VS, Hu FB. Cardiovascular disease prevention by diet modification: JACC Health Promotion Series. J Am Coll Cardiol. 2018;72(8): 914-926. doi:10.1016/j.jacc.2018.02.085 · DOI
- Benjamin EJ, Muntner P, Alonso A, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139 (10):e56-e528. doi:10.1161/CIR. 0000000000000659 · DOI · Paper page
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 [published correction appears in Lancet. 2019;393(10190):e44]. Lancet. 2018;392(10159): 1789-1858. doi:10.1016/S0140-6736(18)32279-7 · DOI · Paper page
- GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958- 1972. doi:10.1016/S0140-6736(19)30041-8 · DOI · Paper page
- Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002; 13(1):3-9. doi:10.1097/00041433-200202000- 00002 · DOI · Paper page
- Schulze MB, Hu FB. Dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease. Curr Atheroscler Rep. 2002; 4(6):462-467. doi:10.1007/s11883-002-0051-1 · DOI
- Cespedes EM, Hu FB. Dietary patterns: from nutritional epidemiologic analysis to national guidelines. Am J Clin Nutr. 2015;101(5):899-900. doi:10.3945/ajcn.115.110213 · DOI
- George SM, Ballard-Barbash R, Manson JE, et al. Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observational Study: evidence to inform national dietary guidance. Am J Epidemiol. 2014;180(6):616-625. doi:10.1093/aje/ kwu173 · DOI
- Reedy J, Krebs-Smith SM, Miller PE, et al. Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults. J Nutr. 2014;144(6): 881-889. doi:10.3945/jn.113.189407 · DOI
- Harmon BE, Boushey CJ, Shvetsov YB, et al. Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project. Am J Clin Nutr. 2015;101 (3):587-597. doi:10.3945/ajcn.114.090688 · DOI · Paper page
- Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790-797. doi: 10.1056/NEJMoa010492 · DOI · Paper page
- Bao Y, Bertoia ML, Lenart EB, et al. Origin, methods, and evolution of the three Nurses' Health Studies. Am J Public Health. 2016;106(9):1573-1581. doi:10.2105/AJPH.2016.303338 · DOI
- Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet. 1991;338 (8765):464-468. doi:10.1016/0140-6736(91)90542- W 17. Willett WC, Green A, Stampfer MJ, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med. 1987;317(21):1303-1309. doi:10.1056/ NEJM198711193172102 · DOI
- Salvini S, Hunter DJ, Sampson L, et al. Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. Int J Epidemiol. 1989;18(4):858-867. doi:10.1093/ije/18.4.858 · DOI
- Yuan C, Spiegelman D, Rimm EB, et al. Validity of a dietary questionnaire assessed by comparison with multiple weighed dietary records or 24-hour recalls. Am J Epidemiol. 2017;185(7):570-584. doi: 10.1093/aje/kww104 · DOI · Paper page
- Yuan C, Spiegelman D, Rimm EB, et al. Relative validity of nutrient intakes assessed by questionnaire, 24-hour recalls, and diet records as compared with urinary recovery and plasma concentration biomarkers: findings for women. Am J Epidemiol. 2018;187(5):1051-1063. doi:10.1093/ aje/kwx328 · DOI
- Reedy J, Lerman JL, Krebs-Smith SM, et al. Evaluation of the Healthy Eating Index-2015 [published correction appears in J Acad Nutr Diet. 2019;119(10):1759]. J Acad Nutr Diet. 2018;118(9): 1622-1633. doi:10.1016/j.jand.2018.05.019 · DOI · Paper page
- Chiuve SE, Fung TT, Rimm EB, et al. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012;142(6):1009-1018. doi:10. 3945/jn.111.157222 · DOI · Paper page
- Mendis S, Thygesen K, Kuulasmaa K, et al; Writing Group on Behalf of the Participating Experts of the WHO Consultation for Revision of WHO Definition of Myocardial Infarction. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol. 2011; 40(1):139-146. doi:10.1093/ije/dyq165 · DOI
- Stampfer MJ, Willett WC, Speizer FE, et al. Test of the National Death Index. Am J Epidemiol. 1984; 119(5):837-839. doi:10.1093/oxfordjournals.aje. a113804 · DOI
- Hu EA, Steffen LM, Coresh J, Appel LJ, Rebholz CM. Adherence to the Healthy Eating Index-2015 and other dietary patterns may reduce risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality. J Nutr. 2020;150(2):312-321. doi:10.1093/jn/nxz218 · DOI
- Guasch-Ferré M, Liu X, Malik VS, et al. Nut consumption and risk of cardiovascular disease. J Am Coll Cardiol. 2017;70(20):2519-2532. doi:10. 1016/j.jacc.2017.09.035 · DOI
- Miller V, Mente A, Dehghan M, et al; Prospective Urban Rural Epidemiology (PURE) Study Investigators. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017;390(10107):2037-2049. doi:10.1016/S0140- 6736(17)32253-5 · DOI
- Sotos-Prieto M, Bhupathiraju SN, Mattei J, et al. Changes in diet quality scores and risk of cardiovascular disease among US men and women. Circulation. 2015;132(23):2212-2219. doi:10.1161/ CIRCULATIONAHA.115.017158 · DOI
- Chowdhury R, Stevens S, Gorman D, et al. Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis. BMJ. 2012;345:e6698. doi:10.1136/bmj.e6698 · DOI · Paper page
- Jayedi A, Zargar MS, Shab-Bidar S. Fish consumption and risk of myocardial infarction: a systematic review and dose-response meta-analysis suggests a regional difference. Nutr Res. 2019;62:1-12. doi:10.1016/j.nutres.2018.10.009 · DOI
- Shan Z, Rehm CD, Rogers G, et al. Trends in dietary carbohydrate, protein, and fat intake and diet quality among US adults, 1999-2016. JAMA. 2019;322(12):1178-1187. doi:10.1001/jama.2019.13771 · DOI
- Wang DD, Leung CW, Li Y, et al. Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern Med. 2014;174 (10):1587-1595. doi:10.1001/jamainternmed.2014. 3422 · DOI
Cited by
Sorted by citations
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300 · see citing works
Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001052 · Cited by 5,987 · see citing works
Precision medicine in the era of artificial intelligence: implications in chronic disease management
Subramanian, M., Wojtusciszyn, A., Favre, L., Boughorbel, S., Shan, J., Letaief, K. B., Pitteloud, N., & Chouchane, L. (2020) · Journal of Translational Medicine · doi:10.1186/s12967-020-02658-5 · Cited by 362 · see citing works
Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study
Juul, F., Vaidean, G., Lin, Y., Deierlein, A. L., & Parekh, N. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.01.047 · Cited by 227 · see citing works
Nutritional considerations with antiobesity medications
Almandoz, J. P., Wadden, T. A., Tewksbury, C., Apovian, C. M., Fitch, A., Ard, J. D., Li, Z., Richards, J., Butsch, W. S., Jouravskaya, I., et al. (2024) · Obesity · doi:10.1002/oby.24067 · Cited by 134 · see citing works
Laparoscopically Confirmed Endometriosis and Risk of Incident Stroke: A Prospective Cohort Study
Farland, L. V., Degnan, W. J., Bell, M. L., Kasner, S. E., Liberman, A. L., Shah, D. K., Rexrode, K. M., & Missmer, S. A. (2022) · Stroke · doi:10.1161/strokeaha.122.039250 · Cited by 67 · see citing works
Self-citationLook AHEAD Research Group, Wing, R. R., Bray, G. A., Cassidy-Begay, M., Clark, J. M., Coday, M., Egan, C., Evans, M., Foreyt, J. P., Glasser, S., et al. (2022) · Diabetes Care · doi:10.2337/dc21-1805 · Cited by 61 · see citing works
Landry, M. J., Crimarco, A., Perelman, D., Durand, L. R., Petlura, C., Aronica, L., Robinson, J. L., Kim, S. H., & Gardner, C. D. (2021) · Nutrients · doi:10.3390/nu13030967 · Cited by 60 · see citing works
Kris-Etherton, P. M., Petersen, K. S., Després, J.-P., Braun, L., de Ferranti, S. D., Furie, K. L., Lear, S. A., Lobelo, F., Morris, P. B., Sacks, F. M., et al. (2021) · Circulation · doi:10.1161/cir.0000000000001014 · Cited by 43 · see citing works
Impact of a Digital Lifestyle Intervention on Diabetes Self-Management: A Pilot Study
Bretschneider, M. P., Klásek, J., Karbanová, M., Timpel, P., Herrmann, S., & Schwarz, P. E. H. (2022) · Nutrients · doi:10.3390/nu14091810 · Cited by 39 · see citing works
Kronsteiner-Gicevic, S., Tello, M., Lincoln, L. E., Kondo, J. K., Naidoo, U., Fung, T. T., Willett, W. C., & Thorndike, A. N. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.05.023 · Cited by 32 · see citing works
Self-citation
- Authors
- Shan, Z., Li, Y., Baden, M. Y., Bhupathiraju, S. N., Wang, D. D., Sun, Q., Rexrode, K. M., Rimm, E. B., Qi, L., Willett, W. C., Manson, J. E., Qi, Q., & Hu, F. B.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Tulane University (US)
- Albert Einstein College of Medicine (US)
- Corresponding author
- Hu, Frank B.
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2020-08-01
- Volume
- 180
- Issue
- 8
- Pages
- 1090
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC7296454
- OpenAlex
- W3035463546
- Cited by
- 448
- References
- 9
- Citations by year
- 2026: 56 · 2025: 82 · 2024: 89 · 2023: 78 · 2022: 74 · 2021: 53 · 2020: 16
- FWCI
- 41.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL060712, R01HL140976, K01HL129892, R01HL034594, R01HL088521)
- National Cancer Institute (UM1CA186107, U01CA176726, U01CA167552)
- National Institute of Diabetes and Digestive and Kidney Diseases (K99DK119412, R01DK119268, R01DK120870)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
- Keywords
- healthy eating patterns, cardiovascular disease, coronary artery disease, stroke, Healthy Eating Index-2015, alternate Mediterranean diet score, healthful plant-based diet index, Alternative Healthy Eating Index, dietary adherence, diet score, Nurses' Health Study, Health Professionals Follow-up Study, women, men, Mediterranean diet, plant-based diet, Dietary Guidelines for Americans
- MeSH terms
- Diet, Healthy, Adult, Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Food Preferences, Humans, Male, Middle Aged, Prospective Studies, Risk, Incidence, Diet, Mediterranean
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
