Alternative Healthy Eating Index-2010 and Incident Non-Communicable Diseases: Findings from a 15-Year Follow Up of Women from the 1973–78 Cohort of the Australian Longitudinal Study on Women’s Health

Abstract

Non-communicable diseases (NCDs) and multimorbidity (≥two chronic conditions), are increasing globally. Diet is a risk factor for some NCDs. We aimed to investigate the association between diet quality (DQ) and incident NCDs. Participants were from the Australian Longitudinal Study on Women’s Health 1973–78 cohort with no NCD and completed dietary data at survey 3 (2003, aged 25–30 years) who responded to at least one survey between survey 4 (2006) and survey 8 (2018). DQ was measured by the Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included coronary heart disease (CHD), hypertension (HT), asthma, cancer (excluding skin cancer), diabetes mellitus (DM), depression and/or anxiety, multimorbidity, and all-cause mortality. Repeated cross-sectional multivariate logistic regressions were performed to investigate the association between baseline DQ and NCDs over 15 years. The AHEI-2010 mean (±sd) for participants (n = 8017) was 51.6 ± 11.0 (range: 19–91). There was an inverse association between AHEI-2010 and incident asthma at survey 4 (ORQ5–Q1: 0.75, 95% CI: 0.57, 0.99). Baseline DQ did not predict the occurrence of any NCDs or multimorbidity between the ages of 25–45 years. Further well-planned, large prospective studies conducted in young women are needed to explore dietary risk factors before the establishment of NCDs.

Longitudinal analysis of the Alternative Healthy Eating Index-2010 and incident non-communicable diseases over 15 years in the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health

“…Reduced odds of asthma symptoms were documented in two French cohort studies (84,85) . In our repeated cross-sectional study, we found that women in the highest AHEI-2010 quintile had a 25 % reduction in the odds of asthma at 3 years after diet measurement (27) . By contrast, no association between the AHEI-2010 and adult-onset asthma had been reported (86,87) .…”

“…By contrast, no association between the AHEI-2010 and adult-onset asthma had been reported (86,87) . These mixed findings could be partly explained by the application of different measures for asthma (77) such as continuous scoring variable (84,85) or diagnosis status (12,27,86) or present asthma condition (87) , and for measures of diet such as FFQ (12,27,84,86) or 24-h recalls (85,87) . However, the evidence of DQ in adults could be expanded by longitudinal analysis using GEE approach, especially lagged model.…”

“…Of these, alcohol consumption was measured as a component in the AHEI-2010 (47) , and smoking was reported to be significantly associated with physical activity (56) . Regarding prescribed medication in the diet-NCD relationship, we have suggested that its potential involvement in the pathway depends on underlying disease condition (27) . BMI was deemed as a mediator, meaning that it can be altered by DQ (57) and can impact NCD outcomes (58)(59)(60)(61)(62)(63)(64) .…”

“…A number of studies have been conducted to measure the associations between DQ and incidence of NCD in a large population-based study setting, the Australian Longitudinal Study on Women's Health (ALSWH) (12,(19)(20)(21)(22)(23)(24)(25)(26)(27) . Analyses performed were cross-sectional (12,21,22,25,27) or longitudinal (19,20,23,24,26) .…”

“…Exploring the longitudinal relationship between DQ and NCD in childbearing women is of interest, because the findings from the ALSWH study suggest there is an increasing trend of NCD occurrence in women aged 25–47 years (34) . In our previous studies, we have investigated the association between baseline DQ and incident NCD of participants from the ALSWH 1946–1951 cohort (12) and 1973–1978 cohort (27) , using a repeated cross-sectional design. Based on the results of our systematic review (35) , we selected three dietary indices measuring various conceptual perspectives in our analysis of data from the ALSWH 1946–1951 cohort: (1) Healthy Eating Index for Australian Adults-2013 that assesses meeting Australian Dietary Guidelines-2013 (36) ; (2) Mediterranean Diet Score that assesses following a specific DP; and (3) Alternative Healthy Eating Index-2010 (AHEI-2010) that assesses adhering DP that highlights foods and nutrients for NCD prevention.…”