Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index
Open accessAbstract
Objective: The Healthy Eating Index (HEI), designed to assess adherence to the Dietary Guidelines for Americans and the Food Guide Pyramid, was previously associated with only a small reduction in major chronic disease risk in US adult men and women. We assessed whether an alternate index would better predict risk. Design: Dietary intake reported by men and women from two prospective cohorts was scored according to an a priori designed Alternate Healthy Eating Index (AHEI). In contrast with the original HEI, the AHEI distinguished quality within food groups and acknowledged health benefits of unsaturated oils. The score was then used to predict development of CVD, cancer or other causes of death in the same population previously tested. Subjects: 67 271 women from the Nurses' Health Study and 38 615 men from the Health Professionals' Follow-up Study. Results: Men and women with AHEI scores in the top vs. bottom quintile had a significant 20% and 11% reduction in overall major chronic disease, respectively. Reductions were stronger for CVD risk in men (RR = 0.61, 95% CI 0.49–0.75) and women (RR = 0.72, 95% CI 0.60–0.86). The score did not predict cancer risk. Conclusions: The AHEI was twice as strong at predicting major chronic disease and CVD risk compared to the original HEI, suggesting that major chronic disease risk can be further reduced with more comprehensive and detailed dietary guidance.
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The healthy eating index used in the study predicts risk for chronic disease, especially cardiovascular disease.
“This index predicts risk for chronic disease, especially cardiovascular disease (McCullough & Willett, 2006; McCullough et al., 2002; Chiuve et al., 2012).”
From Culture and Healthy Eating: The Role of Independence and Interdependence in the United States and Japan (2016) · cites this paper as McCullough & Willett, 2006
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References 36 · Cited by 267
Research works printed but not linked: 29
- Willett WC. Diet and health: What should we eat? Science 1994; 264: 532-7.
- Sacks FM, Obarzanek E, Windhauser MM, Svetky LP, Vollmer WM, McCullough MM, et al. Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Annals of Epidemiology 1995; 5: 108-18.
- Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Current Opinion in Lipidology 2002; 13: 3-9.
- Huijbregts P, Feskens E, Rasanen L, Fidanza F, Nissinen A, Menotti A, et al. Dietary pattern and 20 year mortality in elderly men in Finland Italy, and the Netherlands: longitudi- nal cohort study. British Medical Journal 1997; 315: 13-7.
- Kant AK, Schatzkin A, Ziegler RG. Dietary diversity and subsequent cause-specific mortality in the NHANES I Epidemiologic Follow-up Study. Journal of the American College of Nutrition 1995; 14: 233 -8.
- Kant AK, Schatzkin A, Graubard BI, Schairer C. A prospective study of diet quality and mortality in women. Journal of the American Medical Association 2000; 283: 2109-15.
- Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. New England Journal of Medicine 2003; 348: 2599 -608.
- Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: design and applications. Journal of the American Dietetic Association 1995; 95: 1103 -8.
- McCullough ML, Feskanich D, Stampfer MJ, Rosner BA, Hu FB, Hunter DJ, et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. American Journal of Clinical Nutrition 2000; 72: 1214 -22.
- McCullough ML, Feskanich D, Rimm EB, Giovannuci EL, Ascherio A, Variyam JN, et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. American Journal of Clinical Nutrition 2000; 72: 1223 -31.
- Mensink RPM, Katan MB. Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. New England Journal of Medicine 1990; 323: 439-45.
- Katan MB, Grundy SM, Willett WC. Should a low-fat, high- carbohydrate diet be recommended for everyone? Beyond low-fat diets. New England Journal of Medicine 1997; 337: 563-7.
- Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA, et al. Dietary fat intake and the risk of coronary heart disease in women. New England Journal of Medicine 1997; 337: 1491 -9.
- de Lorgeril M, Salen P, Martin JL, Manjaud I, Boucher P, Mamelle N. Mediterranean dietary pattern in a randomized trial. Prolonged survival and possible reduced cancer rate. Archives of Internal Medicine 1998; 158: 1181 -7.
- Kolonel LN. Fat, meat and prostate cancer. Epidemiologic Reviews 2001; 23: 72-81.
- Klatsky AL, Armstrong MA, Friedman GD. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers, and nondrinkers. American Journal of Cardiology 1990; 66: 1237 -42.
- McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. American Journal of Clinical Nutrition 2002; 76: 1261-71.
- Feskanich D, Rimm EB, Giovannucci EL, Colditz GA, Stampfer MJ, Litin LB, et al. Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. Journal of the American Dietetic Association 1993; 93: 790-6.
- Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. Reproducibility and validity of a expanded self- administered semiquantitative food frequency questionnaire among male health professionals. American Journal of Epidemiology 1992; 135: 1114 -26.
- Salvini S, Hunter DJ, Sampson L, Stampfer MJ, Colditz GA, Rosner B, et al. Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. International Journal of Epidemiology 1989; 18: 858-67.
- Michaud DS, Giovannucci EL, Ascherio A, Rimm EB, Forman MR, Sampson L, et al. Associations of plasma carotenoid concentrations and dietary intake of specific carotenoids in samples of two prospective cohort studies using a new carotenoid database. Cancer Epidemiology, Biomarkers & Prevention 1998; 7: 283 -90.
- Walker AE, Robins M, Weinfeld FD. The national survey of stroke. Clinical findings. Stroke 1981; 12: I13 -I44.
- Stampfer MJ, Willett WC, Speizer FE, Dysert DC, Lipnick R, Rosner B, et al. Test of the National Death Index. American Journal of Epidemiology 1984; 119: 837 -9.
- Cupples LA, D'Agostino RB, Anderson K, Kannel WB. Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study. Statistics in Medicine 1988; 7: 205-22.
- Sacks F. Dietary fats and coronary heart disease. Overview. Journal of Cardiovascular Risk 1994; 1: 3-8.
- Kushi LH. Health implications of the Mediterranean diets in light of contemporary knowledge. 2. Meat, wine, fats and oils. American Journal of Clinical Nutrition 1995; 61: 1416S-27S.
- Giovannucci E. Tomatoes, tomato-based products, lyco- pene, and cancer: review of the epidemiologic literature. Journal of the National Cancer Institute 1999; 91: 317-31.
- Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW, Sandler RS, et al. Calcium supplements for the prevention of colorectal adenomas. New England Journal of Medicine 1999; 340: 101-7.
- Platz EA, Giovannucci E. Vitamin D and calcium in colorectal and prostate cancers. In: Heber D, Blackburn GL, Go VLW, eds. Nutritional Oncology. San Diego, CA: Academic Press, 1999; 223-52.
- Authors
- McCullough, M. L., & Willett, W. C.
- Affiliations
- American Cancer Society (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- McCullough, Marjorie L
- Venue
- Public Health Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2006-02
- Volume
- 9
- Issue
- 1a
- Pages
- 152-157
- ISSN
- 1368-9800 (ISSN-L)
- 1475-2727
- OpenAlex
- W2148852305
- Cited by
- 267
- References
- 36
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 12 · 2023: 18 · 2022: 12 · 2021: 25 · 2020: 17 · 2019: 16 · 2018: 12 · 2017: 11 · 2016: 13 · 2015: 13 · 2014: 13 · 2013: 17 · 2012: 17
- FWCI
- 9.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Public Health Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- Alternative Healthy Eating Index, Healthy Eating Index, dietary adherence, diet quality, cardiovascular risk, cancer risk, mortality prediction, Dietary Guidelines for Americans, unsaturated fat, Nurses' Health Study, Health Professionals Follow-up Study, prospective cohort
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Chronic Disease, Diet, Diet Surveys, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Predictive Value of Tests, Prospective Studies, Surveys and Questionnaires, Risk Factors, Sex Factors, Cohort Studies, Nutrition Policy
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