TABLE 2.
RR (95% CI) of chronic disease by quintile of the HEI-2005 among women in the Nurses’ Health Study (1984–2008) and men in the Health Professionals Follow-Up Study (1986–2008)1
| HEI-2005 |
||||||
| Q1 | Q2 | Q3 | Q4 | Q5 | P-linear trend2 | |
| Major chronic disease | ||||||
| Women | ||||||
| Range | <53.5 | 53.5–60.0 | 60.1–65.3 | 65.4–71.3 | >71.3 | |
| Median | 48.6 | 57.1 | 62.7 | 68.2 | 75.4 | |
| Cases, n | 5901 | 5287 | 5224 | 5166 | 5181 | |
| Age-adjusted | 1.0 (ref) | 0.84 (0.81, 0.88) | 0.80 (0.77, 0.83) | 0.75 (0.72, 0.78) | 0.68 (0.66, 0.71) | <0.001 |
| Multivariate-adjusted3 | 1.0 (ref) | 0.91 (0.88, 0.95) | 0.90 (0.87, 0.94) | 0.88 (0.84, 0.91) | 0.84 (0.80, 0.87) | <0.001 |
| Men | ||||||
| Range | <53.6 | 52.6–60.0 | 60.0–66.3 | 66.3–73.2 | >73.2 | |
| Median | 47.0 | 56.6 | 63.1 | 69.5 | 77.7 | |
| Cases, n | 3373 | 3178 | 3052 | 2990 | 2965 | |
| Age-adjusted | 1.0 (ref) | 0.90 (0.85, 0.94) | 0.83 (0.79, 0.87) | 0.80 (0.76, 0.84) | 0.74 (0.70, 0.78) | <0.001 |
| Multivariate-adjusted | 1.0 (ref) | 0.95 (0.90,1.00) | 0.90 (0.85, 0.95) | 0.89 (0.85, 0.94) | 0.84 (0.80, 0.89) | <0.001 |
| Pooled | ||||||
| Multivariate-adjusted | 1.0 (ref) | 0.93 (0.89, 0.96) | 0.90 (0.87, 0.93) | 0.88 (0.85, 0.91) | 0.84 (0.81, 0.87) | <0.001 |
| Cardiovascular disease | ||||||
| Women | ||||||
| Cases, n | 1168 | 980 | 932 | 896 | 892 | |
| Multivariate-adjusted | 1.0 (ref) | 0.89 (0.82, 0.97) | 0.87 (0.79, 0.95) | 0.81 (0.74, 0.89) | 0.75 (0.68, 0.82) | <0.001 |
| Men | ||||||
| Cases, n | 1082 | 1057 | 1019 | 982 | 962 | |
| Multivariate-adjusted | 1.0 (ref) | 0.97 (0.89, 1.06) | 0.91 (0.83, 1.00) | 0.89 (0.81, 0.98) | 0.84 (0.76, 0.92) | <0.001 |
| Pooled | ||||||
| Multivariate-adjusted | 1.0 (ref) | 0.93 (0.85, 1.02) | 0.89 (0.84, 0.95) | 0.85 (0.78, 0.93) | 0.79 (0.71, 0.88) | <0.0014 |
| Coronary heart disease | ||||||
| Women | ||||||
| Cases, n | 469 | 376 | 375 | 337 | 329 | |
| Multivariate-adjusted | 1.0 (ref) | 0.88 (0.77, 1.02) | 0.92 (0.80, 1.06) | 0.81 (0.70, 0.94) | 0.75 (0.64, 0.87) | <0.001 |
| Men | ||||||
| Cases, n | 548 | 495 | 472 | 475 | 433 | |
| Multivariate-adjusted | 1.0 (ref) | 0.93 (0.82, 1.05) | 0.86 (0.75, 0.98) | 0.90 (0.79, 1.03) | 0.77 (0.67, 0.89) | 0.02 |
| Pooled | ||||||
| Multivariate-adjusted | 1.0 (ref) | 0.91 (0.83, 0.99) | 0.89 (0.81, 0.98) | 0.86 (0.78, 0.95) | 0.76 (0.68, 0.84) | <0.001 |
| Stroke | ||||||
| Women | ||||||
| Cases, n | 380 | 345 | 353 | 332 | 351 | |
| Multivariate-adjusted | 1.0 (ref) | 0.93 (0.80, 1.08) | 0.96 (0.82, 1.11) | 0.86 (0.74, 1.01) | 0.82 (0.70, 0.96) | 0.01 |
| Men | ||||||
| Cases, n | 218 | 218 | 200 | 186 | 189 | |
| Multivariate-adjusted | 1.0 (ref) | 1.02 (0.84, 1.24) | 0.91 (0.74, 1.04) | 0.84 (0.68, 1.04) | 0.82 (0.66, 1.02) | 0.02 |
| Pooled | ||||||
| Multivariate-adjusted | 1.0 (ref) | 0.96 (0.86, 1.09) | 0.94 (0.83, 1.06) | 0.86 (0.75, 0.97) | 0.82 (0.72, 0.93) | <0.001 |
| Diabetes | ||||||
| Women | ||||||
| Cases, n | 1367 | 1302 | 1171 | 1064 | 976 | |
| Multivariate-adjusted | 1.0 (ref) | 0.97 (0.90, 1.05) | 0.91 (0.84, 0.99) | 0.84 (0.77, 0.92) | 0.83 (0.76, 0.90) | <0.001 |
| Men | ||||||
| Cases, n | 573 | 540 | 494 | 462 | 388 | |
| Multivariate-adjusted | 1.0 (ref) | 0.96 (0.85, 1.08) | 0.91 (0.80, 1.03) | 0.89 (0.78, 1.01) | 0.82 (0.71, 0.94) | 0.003 |
| Pooled | ||||||
| Multivariate-adjusted | 1.0 (ref) | 0.97 (0.91, 1.03) | 0.91 (0.85, 0.98) | 0.86 (0.80, 0.92) | 0.82 (0.76, 0.89) | <0.001 |
| Cancer | ||||||
| Women | ||||||
| Cases, n | 2510 | 2352 | 2387 | 2530 | 2590 | |
| Multivariate-adjusted | 1.0 (ref) | 0.93 (0.88, 0.99) | 0.93 (0.88, 0.98) | 0.95 (0.90, 1.01) | 0.93 (0.87, 0.98) | 0.04 |
| Men | ||||||
| Cases, n | 1204 | 1067 | 1063 | 1113 | 1136 | |
| Multivariate-adjusted | 1.0 (ref) | 0.87 (0.80, 0.95) | 0.86 (0.79, 0.93) | 0.89 (0.81, 0.97) | 0.86 (0.79, 0.94) | 0.003 |
| Pooled | ||||||
| Multivariate-adjusted | 1.0 (ref) | 0.91 (0.85, 0.97) | 0.90 (0.83, 0.97) | 0.93 (0.86, 0.99) | 0.90 (0.84, 0.96) | 0.001 |
HEI, Healthy Eating Index; Q, quintile; ref, reference.
Test for linear trend calculated by assigning the median value of diet score in each quintile and modeling this as a continuous variable in regression models.
Multivariate Cox proportional hazards models adjusted for age (in mo), energy (kcal/d, continuous), smoking status (5 categories), BMI (8 categories), aspirin (0, 1–6, ≥7 d/wk), physical activity (5 categories), vitamin E supplementation, family history of myocardial infarction, and family history of colon cancer; in the analysis in women, models adjusted for family history of breast cancer, menopausal status, and use of hormone therapy. All models were adjusted for history of hypertension and history of hypercholesterolemia, except where cancer was the only outcome.
-heterogeneity between studies <0.05 based on the Cochran Q statistic.