International food group–based diet quality and risk of coronary heart disease in men and women
Open accessAbstract
Background Standard diet quality assessment tools, which measure micronutrient sufficiency and food consumption related to disease and applicable to different populations, are needed to track progress in meeting the Sustainable Development Goals related to hunger, food security, and nutrition. Diet quality scores have been constructed for high- and low-income countries, but none are simple to administer or applicable internationally.Objective We prospectively examined the association between the Food Group Index (FGI), the Minimal Diet Diversity Score for Women (MDDW), and a new Prime Diet Quality Score (PDQS), and the risk of ischemic heart disease (IHD) in 3 US cohorts.Design In total, 75,045 women (baseline age 43-63 y), 43,966 men (aged 40-75 y), and 93,131 younger women (aged 27-44 y) without a history of cardiovascular disease were followed up to 28 y. Diet was assessed multiple times using food frequency questionnaires and the 3 diet quality scores were computed for each individual. The association with IHD was modeled with Cox proportional hazard models, controlling for potential confounders.Results During follow-up, we ascertained 2908 incident IHD cases in the Nurses' Health Study, 3722 in the Health Professionals Follow-up Study, and 505 in the Nurses' Health Study II. The FGI was not associated with total IHD in any cohort. The PDQS was significantly associated with IHD in all 3 cohorts separately and the pooled RR for each SD increase was 0.89 (95% CI: 0.87, 0.91). This was significantly different than the pooled RR of 0.93 for MDDW (95% CI: 0.90, 0.96) and the RR of 0.98 for the FGI (95% CI: 0.95, 1.01). The association did not appear to differ by age.Conclusion We found that the PDQS with the most detailed differentiation of healthy and unhealthy foods was associated with a lower risk of IHD in a high-income country. On the other hand, diet quality scores that do not account for unhealthy foods had a limited association with IHD.
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The PDQS is a validated dietary quality index based on food consumption patterns.
“The PDQS is a validated dietary quality index (DQI) based on food consumption patterns [16].”
From The association between the Mediterranean Diet and the Prime Diet Quality Score and polycystic ovary syndrome: a case control study (2025) · cites this paper as [16]
The ‘Diet assessment and computation of diet quality scores’ section describes the PDQS as a diet-quality score based on consumption of 21 healthy and unhealthy food groups. The Discussion reports that it predicted ischemic heart disease risk in the studied cohorts, but says the results need confirmation in other populations; it calls the food-frequency questionnaire, not the PDQS, validated. Thus, ‘validated’ overstates the support for the PDQS itself (page numbers unavailable). (LLM, conf=0.85)
Experimental — accuracy not yet measuredAdherence to a high PDQS diet, rich in fiber and healthy fats, promotes better insulin sensitivity.
“It has been reported that adherence to a high PDQS diet, rich in fiber and healthy fats, promotes better insulin sensitivity.”
From The association between the Mediterranean Diet and the Prime Diet Quality Score and polycystic ovary syndrome: a case control study (2025) · cites this paper as [16]
The Diet assessment and computation of diet quality scores section includes whole grains, legumes, nuts, and liquid vegetable oils among foods that raise the PDQS, consistent with the diet description. But the Results and Discussion report an association with lower ischemic heart disease risk, not improved insulin sensitivity; the paper does not establish the claimed effect. (LLM, conf=0.83)
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- Authors
- Fung, T. T., Isanaka, S., Hu, F. B., & Willett, W. C.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Fung, Teresa T
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 107
- Issue
- 1
- Pages
- 120-129
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC5972643
- OpenAlex
- W2789711714
- Cited by
- 120
- References
- 21
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 19 · 2023: 16 · 2022: 17 · 2021: 24 · 2020: 6 · 2019: 12 · 2018: 5
- FWCI
- 11.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UM1-CA-176726, UM1-CA167552, CA176726, CA-167552)
- National Heart, Lung, and Blood Institute (R01HL035464, R01HL034594)
- National Cancer Institute (UM1CA176726, UM1CA186107)
- 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
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
- Keywords
- diet quality, coronary artery disease, ischemic heart disease, unhealthy food, diet quality index, women, men, Nurses' Health Study, Health Professionals Follow-up Study, Nurses' Health Study II
- MeSH terms
- Adult, Aged, Edible Grain, Coronary Disease, Diet, Female, Follow-Up Studies, Food Supply, Fruit, Humans, Fabaceae, Life Style, Male, Middle Aged, Nuts, Prospective Studies, Surveys and Questionnaires, Risk Factors, Vegetables, Exercise, Nutrition Assessment, Body Mass Index, Incidence
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