TABLE 1.
Summary of main findings of observational studies investigating the relation between CVD and CVD risk factors and dietary scores1
| Study (reference) | Country | Dietary score | Main findings |
|---|---|---|---|
| USA | |||
| Aigner et al, 2018 (16) | USA | HEI, AHEI, DASH | All scores: low-quality diet associated with ↑ risk of stroke mortality (4.6-y follow-up); HEI-2010 was strongest predictor. Associations varied by ethnicity |
| Dijousse et al, 2018 (17) | USA | Modified DASH | ↑ Modified DASH score associated with ↓ CAD |
| Fung et al, 2018 (18) | USA | FGI, MDDS for women, PDQS | FGI not associated with total IHD in any cohort (26-y follow-up) |
| PDQS ↓ IHD in all 3 cohorts | |||
| MDDS ↓ IHD in 2 of 3 cohorts | |||
| Satija et al, 2017 (19) | USA | PDI, hPDI, uPDI | ↑ PDI independently associated with ↓ CAD |
| ↑ hPDI independently associated with ↓ CAD | |||
| ↑ uPDI associated with ↑ CAD | |||
| Shivappa et al, 2017 (20) | USA | DII | DII (proinflammatory diet tertile 3 vs. tertile 1) ↑ associations for CVD mortality |
| Fung et al, 2016 (21) | USA | FQS | Comparing top to bottom deciles, ↓ total CAD (26-y follow-up), independent of established risk factors (body weight, physical activity, smoking) |
| Li et al, 2016 (22) | USA | DASH, AHEI, AMD | AHEI, AMDS, DASH ↓ risk of hypertension (18.5-y follow-up). Comparing the extreme quartiles (highest and lowest) AMDS largest effect size |
| Mattei et al, 2016 (23) | USA | AHEI | ↓ MetS (modified by ethnic background), ↓ waist circumference, BP, and glucose (Mexicans and Puerto Ricans) and with ↓ TAG (Mexicans) ↑ HDL cholesterol (Puerto Ricans and Central Americans) |
| Frazier-Wood et al, 2015 (24) | USA | HEI | Women: HEI score not associated with any CVD risk factors |
| Men: HEI score associated with ↓ fasting insulin, ↓ HOMA-IR, ↓ HDL-C, ↓ TAG and ↓ CRP (not significant post adjustment for BMI) | |||
| Sotos-Prieto et al, 2015 (25) | USA | HEI, AHEI, modified MDS, DASH | Compared diet stability in each 4-y period, ↑ diet quality scores associated with ↓ CVD risk in the subsequent 4-y period |
| Tsivgoulis et al, 2015 (26) | USA | MDS | MDS ↓ incident ischemic stroke no association with incident hemorrhagic stroke (6.5-y follow-up) |
| Southern Europe | |||
| Shivappa et al, 2018 (27) | Italy | DII | DII (proinflammatory diet tertile 3 vs. 1) ↑ CVD mortality |
| Verde et al, 2018 (28) | Italy | MDS | ↑ MDS associated with ↓ hypertension |
| Vitale et al, 2018 (29) | Italy | Relative-MDS | ↑ R-MDS associated with ↓ plasma lipids, BP, and BMI |
| Bendinelli et al, 2018 (30) | Italy | HEI, DASH, MDS, IMI | IMI, DASH, and HEI were significantly and inversely associated with SBP and DBP. Strongest association between IMI and both SBP and DBP |
| Women: ↓ association between IMI, SBP, and DBP | |||
| Men: ↓ association between DASH and DBP | |||
| MDS not associated with SBP or DBP | |||
| Bonaccio et al, 2017 (31) | Italy | MDS, Diet Diversity Score | 2-point increase in MDS associated ↓ CVD risk (4.3-y follow-up). Stronger association in high income groups |
| Alvarez-Alvarez et al, 2018 (32) | Spain | MDS (4 versions), DASH | Compared with the lowest category of adherence to the 3 of the 4 MDS (MEDAS no significant association), higher adherence associated with ↓ CVD (10.4-y follow-up) |
| DASH: no significant associations across extreme score categories, ↓ linear trend | |||
| Aleman et al, 2016 (33) | Spain | MDS | Lower MSD associated with ↑ prevalence of hypertension |
| Eguaras et al, 2015 (34) | Spain | MDS | ↑ Risk of CVD across categories of BMI with ↓ adherence to MDS |
| Garcia-Arellano et al, 2015 (35) | Spain | DII | Risk ↑ across the quartiles (increasing inflammatory potential) incidence CVD (4.8-y follow-up) |
| Ramallal et al, 2015 (36) | Spain | DII | DII (proinflammatory diet highest vs. lowest quartile) ↑ CVD event (8.9-y follow-up) |
| Georgousopoulou et al, 2016 (37) | Greece | DII | Higher DII (anti-inflammatory diet): borderline association with ↓ 10-y CVD incidence |
| Kastorini et al, 2016 (38) | Greece | MDS | Per 10% increase MDS ↓ CVD incidence (8.4-y follow-up) |
| Northern Europe | |||
| Adriouch et al, 2017 (39) | France | FSA-NPS | ↑ CVD risk with lower diet quality (12.4-y follow-up). Association stronger in overweight |
| Lelong et al, 2016 (40) | France | PNNS score, DASH, MDS | PNNS, DASH, and MDS ↓ associated with systolic BP (women only) |
| No significant association found in men | |||
| Neufcourt et al, 2016 (41) | France | DII | DII (proinflammatory diet highest vs. lowest quartile) ↑ MI (11.4-y follow-up) |
| Alkerwi et al, 2015 (42) | Luxembourg | DQI-I, DASH, MDS, DII | ↑ DASH score and MDS were associated with ↓ DBP |
| Sijtsma et al, 2015 (43) | Netherlands | DHNaFS, DUNaFS | Q5 vs. Q1 DHNaFS: 30% ↓ CVD risk |
| DUNaFS not related to CVD risk | |||
| Lemming et al, 2018 (44) | Sweden | Modified MDS, Healthy NFI | MDS (mMED) and NFI high-adherence categories vs. low-adherence categories ↓ mMED showed stronger association |
| Boden et al, 2017 (45) | Sweden | DII | Male participants with the most proinflammatory DII scores ↑ risk of MI (6.4-y follow-up). No association found between DII and MI in women |
| Roswall et al, 2015 (46) | Sweden | NFI | No association between the healthy NFI and overall CVD (21.3-y follow-up) |
| Tektonidis et al, 2015 (47) | Sweden | Modified-MDS | ↑ MDS associated with ↓ risk of MI |
| Galbete et al, 2018 (48) | Germany | NFI, MDS, | Nordic diet, MDS, and MedPyr not associated with incidence of MI |
| Waldeyer et al, 2018 (49) | Germany | MDS | ↑ MDS associated with ↓ SYNTAX score |
| Phillips et al, 2018 (50) | Ireland | DASH score | ↑ DASH score associated with ↓ BMI, tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) |
| Q4 of DASH score associated with lower obesity and metabolic syndrome, respectively, compared to Q1 | |||
| Arentoft et al, 2018 (51) | Denmark | Danish Dietary Guidelines Index | Lower score: ↓ LDL:HDL ratio, ↑ HDL-cholesterol; Men: ↓ BMI, trunk fat, high-sensitivity C-reactive protein, HbA1c; Women: ↑ systolic BP |
| Hansen et al, 2018 (52) | Denmark | Danish Dietary Guidelines Index | Higher Danish Dietary Guidelines Index score ↓ total incidence stroke in men but not in women. In women, ↓ total incidence ischemic stroke |
| Stefler et al, 2017 (53) | Czech Republic, Poland, and the Russian Federation | MDS | One SD increase in the MDS ↓ associated with CVD mortality but not with CAD |
| Eriksen et al, 2018 (54) | UK | FSA-NPS, UK DRV score | 2-point increase in NP score associated with ↓ total cholesterol and HbA1c |
| 2-point increase in DRV score associated with ↓ waist circumference, BMI, total cholesterol and HbA1c | |||
| Gibson et al, 2018 (55) | UK | DASH | Lower DASH (poor diet quality) ↑ cardiometabolic risk (metabolic syndrome) |
| Jones et al, 2018 (56) | UK | DASH | Compared with participants with the least DASH-accordant diets, those with the most DASH-accordant diets ↓ risk incident stroke and total incident CVD (12.4-y follow-up). No association with risk of CAD |
| Mytton et al, 2018 (57) | UK | FSA-NPS | No association between consumption of less-healthy food and incident CVD or CVD mortality (fully adjusted) |
| Maddock et al, 2018 (58) | UK | DASH | Across quintiles, higher DASH-type diet ↓ BP, TAG, PWV, ↑ HDL-cholesterol (30-y follow-up) |
| Tong et al, 2016 (59) | UK | MDS (4 versions: pyramid-based MDS, literature-based MDS, median MDS and tertile MDS) | All MDS ↓ incidence of the cardiovascular outcomes, MDS dietary pyramid showed strongest effect (17-y follow-up) |
| Lassale et al, 2016 (60) | Pan-Europe (10 countries) | NFI, MDS (3 versions), HLI, WHO HDI, DASH, DQI | All dietary scores: ↓ associations CVD mortality (12.8-y follow-up), stratified results by country showed differential associations between scores and CVD mortality) |
| Asia | |||
| Bai et al, 2017 (61) | China | DASH | Stratified results reported: normal BMI, DASH-style diet and physical activity: ↓ incidence hypertension (11-y follow-up) |
| Lau et al, 2015 (62) | China | MDS | ↑ MDS was an independent predictor for ↓ systolic BPV |
| Murakami et al, 2018 (63) | Japan | JFG score, MDS, DASH | JFG and mJFG scores ↑ LDL-cholesterol, |
| MDS ↓ HDL cholesterol | |||
| No associations of DASH score with BP | |||
| Kim et al, 2018 (64) | Korea | CQI | Highest quintile CQI ↓ prevalence of obesity and hypertension |
| Tiong et al, 2018 (65) | Philippines and Malaysia | Modified DASH score | Modified DASH score not significantly associated with CVD risk in the Malaysian cohort |
| ↑ Modified DASH score associated with ↓ SBP, ↓ DBP, ↓ total cholesterol, ↓ LDL, and ↓ triglyceride in the Philippines cohort | |||
| Neelakantan et al, 2018 (66) | Singapore | AHEI, Modified-MDS, DASH, HDI | ↑ diet index scores associated with a ↓ risk of CVD mortality |
| Australia | |||
| Hodge et al, 2018 (67) | Australia | DII, MDS | MDS and DII (less inflammatory) diets ↓ total, CVD, and CAD mortality. No difference in effect size between DII and MDS with CVD mortality |
| Livingstone et al, 2018 (68) | Australia | DGI | DGI associated with ↓ glucose, BMI, waist circumference |
| Livingstone et al, 2016 (69) | Australia | DGI, RFS | DGI and RFS (highest vs. lowest tertile) ↓ hypertension (DGI stronger effect size, and stronger in obese) in men not women |
| Vissers et al, 2016 (70) | Australia | DII | DII (proinflammatory diet) ↑ risk of myocardial infarction (no association fully adjusted models), no association found for total CVD, IHD, or cerebrovascular disease |
| Middle East | |||
| Daneshzad et al, 2018 (71) | Iran | Modified-NFI | ↑ modified-NFI associated with ↓ LDL, ↓ SBP, ↓ risk of obesity |
| Sakhaei et al, 2018 (72) | Iran | DASH, MDS | ↑ DASH diet associated with ↓ serum CRP concentrations but not with IL-17A concentrations; ↑ MDS associated with ↓ circulating IL-17A concentrations but not with hs-CRP concentrations |
| Saraf-Bank et al, 2017 (73) | Iran | HEI | HEI (highest vs. lowest quartile) ↓ risk of MetS and individual risk factors |
| Golzarand et al, 2015 (74) | Iran | DPI | No association with systolic and diastolic blood pressure across Q categories of DPI |
1
Direction of associations based on headline results reported in the study between dietary score exposure and cardiovascular outcomes. ↑ denotes increase/direct and ↓ decrease/inverse. AHEI, alternative HEI; AMDS, alternative MDS; BMI, body mass index; BP, blood pressure; CAD, coronary artery disease; CQI, carbohydrate quality index; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension Trial; DBP, diastolic blood pressure; DGI, Dietary Guideline Index; DII, Dietary Inflammation Index; DPI, Dietary Phytochemical Index; DQI-I, Diet Quality Index-International; DRV, dietary reference value; DHNaFS, Dutch Healthy Nutrient and Food Score; DUNaFS, Dutch Undesirable Nutrient and Food Score; FSA-NPS, Food Standards Agency nutrient profile score; hPDI, healthful PDI; HbA1c, glycated hemoglobin; HEI, Healthy Eating Index; IHD, ischemic heart disease; IMI, Italian Mediterranean Index; JFG, Japanese Food Guide; MDDS, minimal diet diversity score; MEDAS, Mediterranean Diet Adherence Screener; MDS, Mediterranean Diet Score; MetS, metabolic syndrome; NFI, Nordic Food Index; mMED, modified Mediterranean Diet score; PDQS, prime diet quality score; PNNS, Program National Nutrition Santé; Q, quartile of score; RFS, Recommended Food Score; SBP, systolic blood pressure; TAG, triacylglycerol; uPDI, unhealthful Plant-based Diet Index.