title: Changes in Diet Quality Scores and Risk of Cardiovascular Disease Among US Men and Women.
abstract: BACKGROUND
  Adherence to several diet quality scores, including the Alternative Healthy Eating Index, Alternative Mediterranean Diet score, and Dietary Approach to Stop Hypertension, has been associated with lower risk of cardiovascular disease (CVD), but little is known about how changes in these scores over time influence subsequent CVD risk.
  
  
  RESULTS
  We analyzed the association between 4-year changes in the 3 diet quality scores (Alternative Healthy Eating Index, Alternative Mediterranean Diet score, and Dietary Approach to Stop Hypertension) and subsequent cardiovascular disease (CVD) risk among 29 343 men in the Health Professionals Follow-up Study and 51 195 women in the Nurses' Health Study (1986-2010). During 1 394 702 person-years of follow-up, we documented 11 793 CVD cases. Compared with participants whose diet quality remained relatively stable in each 4-year period, those with the greatest improvement in diet quality scores had a 7% to 8% lower CVD risk in the subsequent 4-year period (pooled hazard ratio, 0.92 [95% confidence interval (CI), 0.87-0.99] for the Alternative Healthy Eating Index; 0.93 [95% CI, 0.85-1.02] for the Alternative Mediterranean Diet score; and 0.93 [95% CI, 0.87-0.99] for the Dietary Approach to Stop Hypertension; all P for trend <0.05). In the long term, increasing the diet scores from baseline to the first 4-year follow-up was associated with lower CVD risk during the next 20 years (7% [95% CI, 1-12] for the Alternative Healthy Eating Index, and 9% [95% CI, 3-14] for the Alternative Mediterranean Diet score). A decrease in diet quality scores was associated with significantly elevated risk of CVD in subsequent time periods.
  
  
  CONCLUSIONS
  Improving adherence to diet quality scores over time is associated with significantly lower CVD risk in both the short term and long term.
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sotos-Prieto
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: Shilpa N
authors.initials: SN
authors.lastname: Bhupathiraju
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: Josiemer
authors.initials: J
authors.lastname: Mattei
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: Teresa T
authors.initials: TT
authors.lastname: Fung
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: Yanping
authors.initials: Y
authors.lastname: Li
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.).
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Simmons College, Boston, MA (T.T.F.); Department of Epidemiology and Biostatistics and MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R., F.B.H.). nhbfh@channing.harvard.edu.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: cardiovascular diseases; cohort studies; diet; longitudinal studies