The association between a nutritional quality index and risk of chronic disease

Am J Prev Med. 2011 May;40(5):505-13. doi: 10.1016/j.amepre.2010.11.022.


Background: The Overall Nutritional Quality Index (ONQI) algorithm is a nutrient profiling scheme that incorporates more than 30 dietary components, and it aims to rank foods by relative healthfulness.

Purpose: To assess whether diets with a higher ONQI score predict lower risk of major chronic disease risk.

Methods: A total of 62,284 healthy women from the Nurses' Health Study and 42,382 healthy men from Health Professionals Follow-Up Study were followed from 1986 to 2006. Dietary data were collected from questionnaires at baseline. Each food was scored by the ONQI algorithm and the average ONQI score for the diet consumed by each participant was computed. Total chronic disease was defined as cardiovascular disease (CVD); cancer; diabetes; and nontrauma death. Data analysis was conducted in 2010.

Results: A total of 20,004 and 13,520 chronic disease events were documented in women and men, respectively. The ONQI score was inversely associated with risk of total chronic disease, CVD, diabetes, and all-cause mortality (p-trend≤0.01), but not cancer, in both cohorts. Women in the highest compared to lowest quintile of the ONQI score had a relative risk (95% CI) of 0.91 (0.87, 0.95) for chronic disease; 0.79 (0.71, 0.88) for CVD; 0.86 (0.78, 0.96) for diabetes; and 0.90 (0.84, 0.97) for all-cause mortality. Men in the highest compared to lowest quintile of the ONQI score had a relative risk of 0.88 (0.83, 0.93) for chronic disease; 0.77 (0.70, 0.85) for CVD; 0.84 (0.73, 0.96) for diabetes; and 0.89 (0.83, 0.97) for all-cause mortality.

Conclusions: Consumption of foods that lead to a higher score for the ONQI scoring system is associated with modestly lower risk of chronic disease and all-cause mortality.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Chronic Disease / epidemiology*
  • Chronic Disease / mortality
  • Consumer Health Information*
  • Diet / standards*
  • Diet / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Nutrition Assessment*
  • Nutrition Surveys
  • Prospective Studies
  • Risk Assessment*
  • Risk Factors
  • Sex Factors
  • Surveys and Questionnaires