Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project

Am J Clin Nutr. 2015 Mar;101(3):587-97. doi: 10.3945/ajcn.114.090688. Epub 2015 Jan 7.


Background: Healthy dietary patterns have been linked positively with health and longevity. However, prospective studies in diverse populations in the United States addressing dietary patterns and mortality are limited.

Objective: We assessed the ability of the following 4 diet-quality indexes [the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension (DASH)] to predict the reduction in risk of mortality from all causes, cardiovascular disease (CVD), and cancer.

Design: White, African American, Native Hawaiian, Japanese American, and Latino adults (n = 215,782) from the Multiethnic Cohort completed a quantitative food-frequency questionnaire. Scores for each dietary index were computed and divided into quintiles for men and women. Mortality was documented over 13-18 y of follow-up. HRs and 95% CIs were computed by using adjusted Cox models.

Results: High HEI-2010, AHEI-2010, aMED, and DASH scores were all inversely associated with risk of mortality from all causes, CVD, and cancer in both men and women (P-trend < 0.0001 for all models). For men, the HEI-2010 was consistently associated with a reduction in risk of mortality for all causes (HR: 0.75; 95% CI: 0.71, 0.79), CVD (HR: 0.74; 95% CI: 0.69, 0.81), and cancer (HR: 0.76; 95% CI: 0.70, 0.83) when lowest and highest quintiles were compared. In women, the AHEI and aMED showed large reductions for all-cause mortality (HR: 0.78; 95% CI: 0.74, 0.82), the AHEI showed large reductions for CVD (HR: 0.76; 95% CI: 0.69, 0.83), and the aMED showed large reductions for cancer (HR: 0.84; 95% CI: 0.76, 0. 92).

Conclusion: These results, in a US multiethnic population, suggest that consuming a dietary pattern that achieves a high diet-quality index score is associated with lower risk of mortality from all causes, CVD, and cancer in adult men and women.

Keywords: dietary indexes; epidemiology; multiethnic; risk factors; survival.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans
  • Aged
  • Asian Americans
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Cohort Studies
  • Diet / adverse effects*
  • Diet / ethnology
  • Female
  • Follow-Up Studies
  • Guidelines as Topic*
  • Hawaii / epidemiology
  • Health Promotion*
  • Hispanic or Latino
  • Humans
  • Japan / ethnology
  • Los Angeles / epidemiology
  • Male
  • Middle Aged
  • Mortality
  • Native Hawaiian or Other Pacific Islander
  • Neoplasms / ethnology
  • Neoplasms / mortality
  • Neoplasms / prevention & control*
  • Patient Compliance*
  • Prospective Studies
  • Whites