Diet quality, change in diet quality and risk of incident CVD and diabetes

Zhe Xu, Lyn M. Steffen, Elizabeth Selvin, Casey Rebholz

Research output: Contribution to journalArticle


Objective:The objective of this study was to assess the prospective association between diet quality, as well as a 6-year change in diet quality, and risk of incident CVD and diabetes in a community-based population.Design:We used Cox regression models to estimate the prospective association between diet quality, assessed using the Healthy Eating Index (HEI)-2015 and the Alternative HEI (AHEI)-2010 scores, as well as change in diet quality, and incident CVD and diabetes.Setting:The ARIC Study recruited 15 792 black and white men and women (45-64 years) from four US communities.Participants:We included 10 808 study participants who reported usual dietary intake via FFQ at visit 1 (1987-1989) and who had not developed CVD, diabetes, or cancer at baseline.Results:Overall, 3070 participants developed CVD (median follow-up of 26 years) and 3452 developed diabetes (median follow-up of 22 years) after visit 1. Higher diet score at the initial visit was associated with a significantly lower risk of CVD (HR per 10 % higher HEI-2015 diet quality score: 0·90 (95 % CI: 0·86, 0·95) and HR per 10 % higher AHEI-2010 diet quality score: 0·96 (95 % CI: 0·93, 0·99)). We did not observe a significant association between initial diet score and incident diabetes. There were no significant associations between change in diet score and CVD or diabetes risk in the overall study population.Conclusions:Higher diet quality assessed using HEI-2015 and AHEI-2010 was strongly associated with lower CVD risk but not diabetes risk within a middle-aged, community-based US population.

Original languageEnglish (US)
JournalPublic Health Nutrition
StateAccepted/In press - Jan 1 2019



  • AHEI-2010
  • CVD
  • Diabetes
  • Diet quality
  • HEI-2015

ASJC Scopus subject areas

  • Astronomy and Astrophysics
  • Space and Planetary Science

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