Cited by 1,191Nutritional Studies and DietNutrition, Health, and Society StudiesNutrition, Genetics, and Disease

Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance

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McCullough, Marjorie L, Feskanich, Diane, Stampfer, Meir J, Giovannucci, Edward L, Rimm, Eric B, Hu, Frank B, Spiegelman, Donna, Hunter, David J +2 more·2002·The American Journal of Clinical Nutrition

Abstract

Background Adherence to the Dietary Guidelines for Americans, measured with the US Department of Agriculture Healthy Eating Index (HEI), was associated with only a small reduction in major chronic disease risk. Research suggests that greater reductions in risk are possible with more specific guidance.Objective We evaluated whether 2 alternate measures of diet quality, the Alternate Healthy Eating Index (AHEI) and the Recommended Food Score (RFS), would predict chronic disease risk reduction more effectively than did the HEI.Design A total of 38 615 men from the Health Professional's Follow-up Study and 67 271 women from the Nurses' Health Study completed dietary questionnaires. Major chronic disease was defined as the initial occurrence of cardiovascular disease (CVD), cancer, or nontraumatic death during 8-12 y of follow-up.Results High AHEI scores were associated with significant reductions in risk of major chronic disease in men [multivariate relative risk (RR): 0.80; 95% CI: 0.71, 0.91] and in women (RR: 0.89; 95% CI: 0.82, 0.96) when comparing the highest and lowest quintiles. Reductions in risk were particularly strong for CVD in men (RR: 0.61; 95% CI: 0.49, 0.75) and in women (RR: 0.72; 95% CI: 0.60, 0.86). In men but not in women, the RFS predicted risk of major chronic disease (RR: 0.93; 95% CI: 0.83, 1.04) and CVD (RR: 0.77; 95% CI: 0.64, 0.93).Conclusions The AHEI predicted chronic disease risk better than did the RFS (or the HEI, in our previous research) primarily because of a strong inverse association with CVD. Dietary guidelines can be improved by providing more specific and comprehensive advice.

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Crossref · 10.1093/ajcn/76.6.1261

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Authors
McCullough, M. L., Feskanich, D., Stampfer, M. J., Giovannucci, E. L., Rimm, E. B., Hu, F. B., Spiegelman, D., Hunter, D. J., Colditz, G. A., & Willett, W. C.
Affiliations
  • American Cancer Society (US)
  • Harvard University (US)
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2002-12
Volume
76
Issue
6
Pages
1261-1271
ISSN
0002-9165 (ISSN-L)
OpenAlex
W2108176440
Cited by
1,191
References
84
Citations by year
2026: 36 · 2025: 44 · 2024: 59 · 2023: 47 · 2022: 84 · 2021: 87 · 2020: 55 · 2019: 62 · 2018: 68 · 2017: 55 · 2016: 66 · 2015: 82 · 2014: 61 · 2013: 72 · 2012: 57
FWCI
17.08
Type
journal article
Language
en
Open access
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Heart, Lung, and Blood Institute (R01HL035464, HL35464)
  • National Cancer Institute (CA-87969, P01CA087969)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
Keywords
diet quality, Alternative Healthy Eating Index, Healthy Eating Index, chronic disease risk, cardiovascular disease, cancer, mortality, dietary guidelines, sex differences, Health Professionals Follow-up Study, Nurses' Health Study
MeSH terms
Adult, Aged, Cardiovascular Diseases, Chronic Disease, Diet, Female, Health Promotion, Humans, Male, Middle Aged, Neoplasms, Nurses, Nutritional Physiological Phenomena, Patient Education as Topic, Surveys and Questionnaires, Risk Factors, Nutrition Policy

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