Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort

Tasnime N Akbaraly; Jane E Ferrie; Claudine Berr; Eric J Brunner; Jenny Head; Michael G Marmot; Archana Singh-Manoux; Karen Ritchie; Martin J Shipley; Mika Kivimaki

doi:10.3945/ajcn.111.013128

© 2011 American Society for Nutrition

Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort¹,²,³

¹From the Department of Epidemiology and Public Health, University College London, London, United Kingdom (TNA, JEF, EJB, JH, MGM, AS-M, MJS, and MK); INSERM U 1061, Montpellier, France (TNA and CB); University Montpellier I, Montpellier, France (TNA and CB); Centre Memoire de Ressource et de Recherche, Languedoc Roussillon, Montpellier, France (TNA and CB); Centre for Research in Epidemiology and Population Health, INSERM U1018, France (AS-M); Centre de Gérontologie, Hôpital Ste Périne, Assistance Publique-Hopitaux de Paris, Paris, France (AS-M); and Faculty of Medicine, Imperial College, London, United Kingdom (KR).

↵2 Supported by grants from the British Medical Research Council (MRC) G8802774; the British Heart Foundation; the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute (R01HL036310); the National Institute on Aging, NIH (R01AG013196 and R01AG034454); and the Agency for Health Care Policy and Research (grant HS06516). Also supported by the British United Provident Association Foundation, United Kingdom (TNA and MK); the Medical Research Council (grant G8802774 to JEF); the British Heart Foundation (MSK); the Academy of Finland and the New European Union New and Emerging Risks in Occupational Safety and Health research programme (MK); a European Young Investigator Award from the European Science Foundation (AS-M); and the National Institute on Aging (R01AG013196 to JH).
↵3 Address correspondence to T Akbaraly, INSERM U 1061, Hôpital La Colombière, 39 avenue Charles Flahault, BP 34493, 34093 Montpellier cedex 05, France. E-mail: tasnime.akbaraly{at}inserm.fr.

Abstract

Background: Indexes of diet quality have been shown to be associated with decreased risk of mortality in several countries. It remains unclear if the Alternative Healthy Eating Index (AHEI), designed to provide dietary guidelines to combat major chronic diseases, is related to mortality risk.

Objective: We aimed to examine the association between adherence to the AHEI and cause-specific mortality over 18 y of follow-up in a British working population.

Design: Analyses are based on 7319 participants (mean age: 49.5 y; range: 39–63 y; 30.3% women) from the Whitehall II Study. Cox proportional hazards regression models were performed to analyze associations of the AHEI (scored on the basis of intake of 9 components: vegetables, fruit, nuts and soy, white or red meat, trans fat, polyunsaturated or saturated fat, fiber, multivitamin use, and alcohol) with mortality risk.

Results: After potential confounders were controlled for, participants in the top compared with the bottom third of the AHEI score showed 25% lower all-cause mortality [hazard ratio (HR): 0.76; 95% CI: 0.61, 0.95] and >40% lower mortality from cardiovascular disease (CVD; HR: 0.58; 95% CI: 0.37, 0.91). Consumption of nuts and soy and moderate alcohol intake appeared to be the most important independent contributors to decreased mortality risk. The AHEI was not associated with cancer mortality or noncancer/non-CVD mortality.

Conclusion: Our findings suggest that the encouragement of adherence to the AHEI dietary recommendations constitutes a valid and clear public health recommendation that would decrease the risk of premature death from CVD.

Received January 28, 2011.
Accepted April 26, 2011.

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