Adherence to the Healthy Eating Index and Alternative Healthy Eating Index dietary patterns and mortality from all causes, cardiovascular disease and cancer: a meta-analysis of observational studies

J Hum Nutr Diet. 2017 Apr;30(2):216-226. doi: 10.1111/jhn.12415. Epub 2016 Sep 13.


Background: This meta-analysis investigated the association of diet quality indices, as assessed by HEI and AHEI, and the risk of all-cause, cardiovascular and cancer mortality.

Methods: We used PubMed, ISI Web of Science and Google Scholar to search for eligible articles published before July 2015. A total of 12 cohort studies (38 reports) and one cross-sectional study (three reports) met the inclusion criteria and were included in our meta-analysis.

Results: The highest level of adherence to the Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) was significantly associated with a reduced risk of all-cause mortality [relative risk (RR) = 0.77, 95% confidence intterval (CI) = 0.76-0.78], cardiovascular mortality (RR = 0.77, 95% CI = 0.74-0.80) and cancer mortality (RR = 0.83, 95% CI = 0.81-0.86). Egger regression tests provided no evidence of publication bias.

Conclusions: The present study indicates that high adherence to HEI and AHEI dietary patterns, indicating high diet quality, are associated with reduced risk of all-cause mortality (as well as cardiovascular mortality and cancer mortality).

Keywords: Alternative Healthy Eating Index; Healthy Eating Index; cancer; cardiovascular; mortality.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Cardiovascular Diseases / mortality*
  • Cardiovascular Diseases / prevention & control*
  • Databases, Factual
  • Diet, Healthy*
  • Food Quality
  • Humans
  • Incidence
  • Neoplasms / mortality*
  • Neoplasms / prevention & control*
  • Observational Studies as Topic
  • Patient Compliance*