Diet Quality, Change in diet quality and Risk of Incident Cardiovascular Disease and Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Dietary intake is a modifiable risk factor for cardiovascular disease (CVD) and diabetes. There is limited evidence on diet quality and diet quality change in the general population and their potential prospective associations with cardiovascular disease and diabetes. Objective: To assess the association between diet quality and diet quality change with subsequent risk for incident CVD and diabetes in the Atherosclerosis Risk in Communities (ARIC) Study. Design: We included 11,079 ARIC study participants who reported usual dietary intake via food frequency questionnaire at visit 1 (1987-1989) and who had not developed CVD, diabetes, or cancer at baseline. Diet quality was assessed using the Healthy Eating Index (HEI)-2015 and the Alternative HEI (AHEI)-2010 scores. We used Cox regression models with multiple adjustment to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident CVD and diabetes. Associations between change in diet quality scores from visit 1 to visit 3 (6 years) and incident CVD and diabetes were also examined. Results: Overall, there were 3,138 participants who developed CVD (median follow-up of 26 years) and 3,542 developed diabetes after visit 1 (median follow-up of 22 years). Higher diet score at the initial visit was associated with a significantly lower risk of CVD: HR, 0.90 (95% CI, 0.86 to 0.95) per 10% increase in initial diet score in HEI-2015 and HR, 0.96 (95% CI, 0.93 to 0.99) per 10% increase in AHEI-2010. We did not observe a significant association between initial diet score and incident diabetes (p-values >0.05). 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 was strongly associated with a lower CVD risk but not diabetes risk within a middle-aged, community-based U.S. population. Adherence to current dietary guidelines could potentially confer benefits for CVD prevention