Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study

Abstract

A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis centers. Dietary data (using three independent 24-hour dietary records), clinical and laboratory parameters were collected. The construct and criterion validity of original AHEI-2010 with 11 items and the AHEI-HD with 16 items were examined. Both scales showed reasonable item-scale correlations and satisfactory discriminant validity. The AHEI-HD demonstrated a weaker correlation with energy intake compared with AHEI-2010. Principle component analysis yielded the plateau scree plot line in AHEI-HD but not in AHEI-2010. In comparison with patients in lowest diet quality (tertile 1), those in highest diet quality (tertile 3) had significantly lower risk for death, with a hazard ratio (HR) and 95% confidence intervals (95%CI) of HR: 0.40; 95%CI: 0.18 – 0.90; p = 0.028, as measured by AHEI-2010, and HR: 0.37; 95%CI: 0.17–0.82; p = 0.014 as measured by AHEI-HD, respectively. In conclusion, AHEI-HD was shown to have greater advantages than AHEI-2010. AHEI-HD was suggested for assessments of diet quality in hemodialysis patients.

Application of a Modified Healthy Eating Index (HEI-Flex) to Compare the Diet Quality of Flexitarians, Vegans and Omnivores in Germany

“…These HEI-flex results confirm previous studies observing the higher diet quality in plant-based diets compared to OMN, based on various diet quality indices. However, many of these diet quality indices (e.g., diet quality index, Mediterranean diet score, plant-based index) often differ in terms of their research aim (e.g., associations between dietary intake and health outcomes) or scoring methodology (e.g., allocation of foods only according to positive and negative) [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Therefore, only studies based on the original HEI versions are included in the discussion below.…”

Evaluation of Diet Quality Using the Healthy Eating Index in College Athletes

“…Adequate and balanced nutrition does not only affect exercise capacity and performance, but also protects the immune function and health of the athletes (1,2). In recent years, the Healthy Eating Index (HEI) has been used in the evaluation of the diet quality in the general population (3)(4)(5)(6)(7). The HEI score has been originally designed to help individuals to consume a healthful and nutritionally adequate diet.…”

Targeted Nutrition in Chronic Disease

“…The present Special Issue on “Targeted Nutrition in Chronic Disease” includes three reviews [ 2 , 3 , 4 ] and seven original research articles [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. A meta-analysis on coffee intake and obesity suggested that higher coffee intake was associated with modestly lower body mass index (BMI) and waist circumference in men but not in women [ 2 ].…”

“…The alternative healthy eating index (AHEI) is a score that can be used to evaluate the risk and mortality of chronic diseases including kidney failure [ 18 ]. To improve the assessment of diet quality among hemodialysis (HD) patients, Van Duong and colleagues adapted and validated the AHEI by adding a group of eating variables to enhance the sensitivity of the score [ 8 ]. The inclusion of additional dietary information enhanced the performance of the AHEI–HD index [ 8 ], which could be used to provide dietary recommendations to hemodialysis patients and to obtain a better prediction of the mortality outcome in patients with a low AHEI–HD compared to patients with a high AHEI–HD.…”

“…To improve the assessment of diet quality among hemodialysis (HD) patients, Van Duong and colleagues adapted and validated the AHEI by adding a group of eating variables to enhance the sensitivity of the score [ 8 ]. The inclusion of additional dietary information enhanced the performance of the AHEI–HD index [ 8 ], which could be used to provide dietary recommendations to hemodialysis patients and to obtain a better prediction of the mortality outcome in patients with a low AHEI–HD compared to patients with a high AHEI–HD. In another study on chronic kidney disease, the weekly consumption of 14 food intake markers was mapped in 839 Brazilian individuals with a self-declared diagnosis who were undergoing different treatment modalities [ 9 ].…”