Abstract
Background/objectives
Previous studies consistently report that diet quality is inversely associated with risk of cardiovascular disease (CVD) and type 2 diabetes. However, few studies have assessed the association of diet quality with serum lipoproteins, an intermediate marker of cardio-metabolic health, or assessed whether type 2 diabetes modifies these associations. This study assessed associations of diet quality (evaluated using the Alternative Healthy Eating Index (AHEI)), and the interaction of diet quality with diabetes, on total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), apolipoprotein A (apoA1), and apolipoprotein B (apoB) among American Indians (AIs).
Subjects/methods
Participants comprised AIs who participated in the Strong Heart Family Study (SHFS)—a study of CVD and its risk factors in 12 AI communities. Generalized estimated equations (GEEs) were used to examine the following associations: (1) the cross-sectional associations of diet quality (as determined by AHEI) with serum lipoproteins (n = 2200); and (2) the prospective associations of the AHEI measured at baseline with serum lipoproteins (n = 1899).
Results
In cross-sectional analyses, associations of AHEI with TC (p < 0.0001) LDL-C (p = 0.005), and ApoB (p = 0.002) differed according to diabetes status. In prospective analysis, AHEI was associated with more favorable levels of TC (p = 0.029) and LDL-C (p = 0.008) among participants with diabetes independent of other demographic, behavioral, and health factors; associations of diet quality with TC, LDL-C, and ApoB were much weaker among participants without diabetes. There was no association of diet quality with TG, HDL-C, or ApoA.
Conclusions
The associations of diet quality with TC, LDL-C, and ApoB differ according to diabetes status.
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Acknowledgements
The authors would like to thank the SHFS participants, the Indian Health Services facilities, and participating tribal communities for their extraordinary cooperation and involvement. The opinions expressed in this paper are those of the author(s) and do not necessarily reflect the views of the Indian Health Service.
Funding
The Strong Heart Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institute of Health, Department of Health and Human Services, under contract numbers 75N92019D00027, 75N92019D00028, 75N92019D00029, and 75N92019D00030. The study was previously supported by research grants: R01HL109315, R01HL109301, R01HL109284, R01HL109282, and R01HL109319 and by cooperative agreements: U01HL41642, U01HL41652, U01HL41654, U01HL65520, and U01HL65521. AMF is also supported by 5KL2TR000421.
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SAEK, MMA, JACD, and AMF designed the research question. SAEK and AMF analyzed the data. BVH provided essential material. SAEK and AMF wrote the paper. MMF, JACD, RNL, and BVH provided content expertize, and edited and revised drafts of the manuscript. AMF had primary responsibility for the final content.
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Kauffman, S.A.E., Averill, M.M., Delaney, J.A.C. et al. Associations of diet quality and blood serum lipoprotein levels in a population at high risk for diabetes: the Strong Heart Family Study. Eur J Clin Nutr 74, 1084–1090 (2020). https://doi.org/10.1038/s41430-019-0539-1
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DOI: https://doi.org/10.1038/s41430-019-0539-1
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