Healthy eating index (HEI) as the predictor of asthma: Findings from NHANES

Clin Nutr ESPEN. 2023 Aug:56:158-165. doi: 10.1016/j.clnesp.2023.05.013. Epub 2023 May 25.


Background&aims: Previous studies have shown that the formation and development of asthma are closely related to diet. A proper diet can control asthma onset although the precise dietary components involved in preventing or delaying the onset of asthma remain unclear. The healthy eating index (HEI-2015) is a dietary score that measures the overall diet quality as well as the quality of several dietary components. We aimed to explore the relationship between HEI and asthma.

Methods: This is a cross-sectional study that used data from the 2005 to 2018 National Health and Nutritional Examination Survey (NHANES) in adults (n = 26,567). Our inclusion criteria were adults ≥18 years, completion of asthma-related questionnaires and availability of HEI data. Weighted logistic regression was performed to assess the association between asthma and HEI after adjusting for several covariates.

Results: Patients with asthma were more likely to be female, come from a poorer background, have a raised body mass index (BMI) and a lower HEI total score. Higher HEI total scores were associated with a lower risk of asthma in adults. In addition, eating more whole fruits, more greens and beans, more total protein foods, more seafood and plant proteins, and having a reduced dietary intake of added sugars reduces the risk of asthma. In asthmatic populations, higher HEI scores are associated with older age at onset of asthma.

Conclusion: There is an inverse association between the HEI and asthma. This underlines the importance of improving adherence to healthy dietary patterns in the prevention of asthma.

Keywords: Asthma; Cross-sectional study; Diet; Dietary pattern; HEI.

MeSH terms

  • Adult
  • Body Mass Index
  • Cross-Sectional Studies
  • Diet*
  • Diet, Healthy*
  • Humans
  • Nutrition Surveys