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Title: Adherence index based on the AHA 2006 diet and lifestyle recommendations is associated with select cardiovascular disease risk factors in older Puerto Ricans

Author
item BHUPATHIRAJU, SHILPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item TUCKER, KATHERINE - Northeastern University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/3/2011
Publication Date: 3/1/2011
Citation: Bhupathiraju, S., Lichtenstein, A.H., Dawson-Hughes, B., Tucker, K.L. 2011. Adherence index based on the AHA 2006 diet and lifestyle recommendations is associated with select cardiovascular disease risk factors in older Puerto Ricans. American Journal of Clinical Nutrition. 141(3):460-469.

Interpretive Summary: The American Heart Association (AHA) periodically issues diet and lifestyle recommendations to decrease heart disease risk, most recently the AHA 2006 Diet and Lifestyle recommendations. It is difficult to evaluate the effect of these recommendations because of our inability to efficiently determine food intake patterns in large groups of individuals. The aim of this study was to develop a unique diet and lifestyle score based on the AHA 2006 Diet and Lifestyle recommendations (AHA-DLS) that would allow us to evaluate the recommendations. We evaluated this score in relation to available heart disease risk factors in a population of older Puerto Ricans. In a cross-sectional study of Puerto Rican adults, aged 45-75 years, living in the greater Boston area, information was available for the following variables; diet (assessed using a semi-quantitative food frequency questionnaire), systolic and diastolic blood pressure, waist circumference, ten-year risk of coronary heart disease (CHD) (estimated using the Framingham risk score), fasting blood lipids, serum glucose, insulin, and C-reactive protein (CRP) concentrations. The AHA-DLS was tested and adjusted for both internal consistency and content validity. The AHA-DLS was significantly associated with high-density lipoprotein cholesterol (HDL-cholesterol) HDL-cholesterol, serum insulin and serum CRP concentrations, waist circumference, and ten-year risk of CHD. Women and men who had the highest (best) AHA-DLS had significantly lower serum insulin and CRP concentrations, and waist circumference, both risk factors for heart disease. Women, but not men, who had the highest AHA-DLS, had lower 10-year risk of CHD. These data suggest that the AHA-DLS is a useful tool to measure adherence to the AHA DL recommendations and may be used to examine associations between diet and lifestyle behaviors and heart disease risk in additional populations and over time.

Technical Abstract: Background: The effect of adherence to the American Heart Association (AHA) 2006 Diet and Lifestyle recommendations is unknown. Objective: To develop a unique diet and lifestyle score based on the AHA 2006 Diet and Lifestyle (AHA DL) recommendations. We evaluated this score in relation to available cardiovascular disease risk factors in a population of older Puerto Ricans. Design: In a cross-sectional study of Puerto Rican adults, aged 45-75 years, living in the greater Boston area, information was available for the following variables: diet (assessed using a semi-quantitative food frequency questionnaire), systolic and diastolic blood pressure, waist circumference, ten-year risk of coronary heart disease (CHD) (estimated using the Framingham risk score), fasting blood lipids, serum glucose, insulin, and C-reactive protein (CRP) concentrations. We developed a unique diet and lifestyle score (AHA-DLS) based on the AHA 2006 Diet and Lifestyle recommendations. Results: The AHA-DLS had both internal consistency and content validity. The AHA-DLS was significantly associated with high-density lipoprotein cholesterol (HDL-cholesterol), serum insulin and serum CRP concentrations, waist circumference, and ten-year risk of CHD. Women and men in the highest quartile of the AHA-DLS had significantly lower serum insulin and CRP (P for trend=0.008) concentrations (P for trend=0.001), and waist circumference (P for trend=0.0001). Women, but not men, in the highest quartile had lower 10-year risk of CHD (P for trend=0.03). Conclusions: The AHA-DLS is a useful tool to measure adherence to the AHA DL recommendations and may be used to examine associations between diet and lifestyle behaviors and cardiovascular disease risk.