Table 2.
Pooled Results for the Association of Changes in Diet-Quality Scores during the 12-Year Period (1986–1998) with the Subsequent Risk of Death from Any Cause.*
| Variable | Quintile of Change | P Value for Trend | ||||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | ||
| Alternate Healthy Eating Index score† | ||||||
|
| ||||||
| Median change in the score in the NHS (%) | −10.4 (−9.5) | −2.8 (−2.6) | 2.2 (2.0) | 7.3 (6.6) | 14.8 (13.4) | |
|
| ||||||
| Median change in the score in the HPFS (%) | −9.4 (−8.5) | −1.7 (−1.5) | 3.4 (3.1) | 8.5 (7.7) | 16.2 (14.7) | |
|
| ||||||
| No. of deaths | 2452 | 2150 | 1914 | 1754 | 1676 | |
|
| ||||||
| Age-adjusted hazard ratio (95% CI) | 1.24 (1.16 to 1.32) | 1.10 (1.03 to 1.17) | 1.00 (ref) | 0.93 (0.87 to 0.99) | 0.88 (0.82 to 0.94) | <0.001 |
|
| ||||||
| Model 1: multivariable-adjusted hazard ratio (95% CI) | 1.11 (1.04 to 1.18) | 1.05 (0.99 to 1.12) | 1.00 (ref) | 0.95 (0.89 to 1.01) | 0.94 (0.88 to 1.00) | <0.001 |
|
| ||||||
| Model 2: multivariable-adjusted hazard ratio (95% CI) | 1.12 (1.05 to 1.19) | 1.06 (1.00 to 1.13) | 1.00 (ref) | 0.94 (0.88 to 1.01) | 0.91 (0.85 to 0.97) | <0.001 |
|
| ||||||
| Alternate Mediterranean Diet score‡ | ||||||
|
| ||||||
| Median change in the score in the NHS (%) | −2 (−22.2) | −1 (−11.1) | 0 | 1 (11.1) | 3 (33.3) | |
|
| ||||||
| Median change in the score in the HPFS (%) | −2 (−22.2) | −1 (−11.1) | 0 | 1 (11.1) | 2 (22.2) | |
|
| ||||||
| No. of deaths | 2325 | 1805 | 2114 | 2522 | 1180 | |
|
| ||||||
| Age-adjusted hazard ratio (95% CI) | 1.15 (1.08 to 1.22) | 1.00 (0.94 to 1.07) | 1.00 (ref) | 0.89 (0.84 to 0.95) | 0.77 (0.72 to 0.83) | <0.001 |
|
| ||||||
| Model 1: multivariable-adjusted hazard ratio (95% CI) | 1.05 (0.98 to 1.12) | 0.97 (0.91 to 1.03) | 1.00 (ref) | 0.93 (0.87 to 0.98) | 0.86 (0.79 to 0.92) | <0.001 |
|
| ||||||
| Model 2: multivariable-adjusted hazard ratio (95% CI) | 1.06 (0.99 to 1.13) | 0.97 (0.91 to 1.04) | 1.00 (ref) | 0.93 (0.87 to 0.98) | 0.84 (0.78 to 0.91) | <0.001 |
|
| ||||||
| DASH score§ | ||||||
|
| ||||||
| Median change in the score in the NHS (%) | −5 (−15.6) | −2 (−6.3) | 0 | 2 (6.3) | 5 (15.6) | |
|
| ||||||
| Median change in the score in the HPFS (%) | −5 (−15.6) | −2 (−6.3) | 0 | 2 (6.3) | 6 (18.8) | |
|
| ||||||
| No. of deaths | 2425 | 1605 | 2694 | 1390 | 1832 | |
|
| ||||||
| Age-adjusted hazard ratio (95% CI) | 1.16 (1.10 to 1.23) | 1.04 (0.97 to 1.10) | 1.00 (ref) | 0.91 (0.86 to 0.98) | 0.87 (0.82 to 0.93) | <0.001 |
|
| ||||||
| Model 1: multivariable-adjusted hazard ratio (95% CI) | 1.04 (0.98 to 1.10) | 0.99 (0.93 to 1.05) | 1.00 (ref) | 0.95 (0.88 to 1.01) | 0.93 (0.88 to 0.99) | 0.003 |
|
| ||||||
| Model 2: multivariable-adjusted hazard ratio (95% CI) | 1.06 (1.00 to 1.12) | 1.01 (0.94 to 1.07) | 1.00 (ref) | 0.93 (0.87 to 1.00) | 0.89 (0.84 to 0.95) | <0.001 |
The multivariable-adjusted model 1 was adjusted for age; initial diet-quality score (in quintiles); race (white vs. nonwhite); family history of myocardial infarction, diabetes, or cancer; use or nonuse of aspirin or multivitamins; initial BMI (<23.0, 23.0 to 24.9, 25.0 to 29.9, 30.0 to 34.9, and =35.0); initial smoking status and changes in smoking status; initial smoking pack-years and changes in smoking pack-years (continuous variable) among participants with any history of smoking (ever smokers); initial levels of physical activity and total energy intake and changes in these levels (all in quintiles); and menopausal status and use or nonuse of hormone-replacement therapy in women. The multivariable-adjusted model 2 had the same adjustments as model 1 plus history of hypertension, hypercholesterolemia, or type 2 diabetes (all yes vs. no); weight change (in quintiles); and use or nonuse of cholesterol-lowering and antihypertensive medications. The Dietary Approaches to Stop Hypertension (DASH) score models were also adjusted for initial intake of alcohol and change in this intake (in quintiles). Results from the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) were combined with the use of the fixed-effects model. CI denotes confidence interval.
Scores on the Alternate Healthy Eating Index–2010 range from 0 to 110, with higher scores indicating a healthier diet.
Scores on the Alternate Mediterranean Diet range from 0 to 9, with higher scores indicating a healthier diet.
Scores on the DASH range from 8 to 40, with higher scores indicating a healthier diet.