title: Healthy Eating and Risks of Total and Cause-Specific Death among Low-Income Populations of African-Americans and Other Adults in the Southeastern United States: A Prospective Cohort Study.
abstract: BACKGROUND
  A healthy diet, as defined by the US Dietary Guidelines for Americans (DGA), has been associated with lower morbidity and mortality from major chronic diseases in studies conducted in predominantly non-Hispanic white individuals. It is unknown whether this association can be extrapolated to African-Americans and low-income populations.
  
  
  RESULTS
  We examined the associations of adherence to the DGA with total and cause-specific mortality in the Southern Community Cohort Study, a prospective study that recruited 84,735 American adults, aged 40-79 y, from 12 southeastern US states during 2002-2009, mostly through community health centers that serve low-income populations. The present analysis included 50,434 African-Americans, 24,054 white individuals, and 3,084 individuals of other racial/ethnic groups, among whom 42,759 participants had an annual household income less than US$15,000. Usual dietary intakes were assessed using a validated food frequency questionnaire at baseline. Adherence to the DGA was measured by the Healthy Eating Index (HEI), 2010 and 2005 editions (HEI-2010 and HEI-2005, respectively). During a mean follow-up of 6.2 y, 6,906 deaths were identified, including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases. A higher HEI-2010 score was associated with lower risks of disease death, with adjusted hazard ratios (HRs) of 0.80 (95% CI, 0.73-0.86) for all-disease mortality, 0.81 (95% CI, 0.70-0.94) for cardiovascular disease mortality, 0.81 (95% CI, 0.69-0.95) for cancer mortality, and 0.77 (95% CI, 0.67-0.88) for other disease mortality, when comparing the highest quintile with the lowest (all p-values for trend < 0.05). Similar inverse associations between HEI-2010 score and mortality were observed regardless of sex, race, and income (all p-values for interaction > 0.50). Several component scores in the HEI-2010, including whole grains, dairy, seafood and plant proteins, and ratio of unsaturated to saturated fatty acids, showed significant inverse associations with total mortality. HEI-2005 score was also associated with lower disease mortality, with a HR of 0.86 (95% CI, 0.79-0.93) when comparing extreme quintiles. Given the observational study design, however, residual confounding cannot be completely ruled out. In addition, future studies are needed to evaluate the generalizability of these findings to African-Americans of other socioeconomic status.
  
  
  CONCLUSIONS
  Our results showed, to our knowledge for the first time, that adherence to the DGA was associated with lower total and cause-specific mortality in a low-income population, including a large proportion of African-Americans, living in the southeastern US.
authors.affiliation: Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Danxia
authors.initials: D
authors.lastname: Yu
authors.affiliation: International Epidemiology Institute, Rockville, Maryland, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sonderman
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Maciej S
authors.initials: MS
authors.lastname: Buchowski
authors.affiliation: International Epidemiology Institute, Rockville, Maryland, United States of America; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: McLaughlin
authors.affiliation: Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
authors.affiliation: International Epidemiology Institute, Rockville, Maryland, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Steinwandel
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Signorello
authors.affiliation: Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Xianglan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, United States of America.
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Hargreaves
authors.affiliation: International Epidemiology Institute, Rockville, Maryland, United States of America; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: William J
authors.initials: WJ
authors.lastname: Blot
authors.affiliation: Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D002423:Cause of Death; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D011446:Prospective Studies; D064890:Social Determinants of Health; D015144:Southeastern United States