Greater adherence to the 2019 Canada’s Food Guide recommendations on healthy food choices reduces the risk of cardiovascular disease in adults: a prospective analysis of UK Biobank data

Abstract

Background The Canada's Food Guide (CFG) was profoundly revised in 2019, but the extent to which adherence to recommendations on healthy food choices reduces the risk of cardiovascular disease (CVD) is unknown Objectives The aim of this study was to examine how greater adherence to the 2019 CFG's recommendations on healthy food choices influences the risk of incident CVD. Design Participants were a sample of adults without history of CVD, diabetes or cancer from the UK Biobank prospective cohort study. Usual dietary intakes were estimated by modeling data from repeated web-based 24-h dietary recalls using the National Cancer Institute multivariate method. Adherence to key CFG's recommendations on healthy food choices was assessed using the Healthy Eating Food Index (HEFI)-2019. The CVD outcome was a composite of fatal and non-fatal myocardial infarction and ischemic stroke. Cox regression models adjusted via inverse probability weighting were used to estimate CVD risks. Counterfactual models were used to interpret risks of hypothetical changes in the HEFI-2019 score. Results A total of 136,698 participants met the eligibility criteria (55% females, mean age of 57.2 years, range 40–75 years). During the 11-year follow-up, there were 2,843 cases of incident CVD. Compared with no change in the HEFI-2019 score, increasing the HEFI-2019 score of all participants to the 90th percentile of the score distribution (58.1 points) would hypothetically reduce the risk of CVD by 24% (relative risk, 0.76; 95%CI: 0.58, 0.94; absolute risk difference, -0.58%). Conclusions These results suggest that greater adherence to the 2019 CFG recommendations on healthy food choices reduces the 11-year risk of CVD in middle-aged and older adults.

Associations of Diet with Health Outcomes in the UK Biobank: A Systematic Review

“…Dietary indices are often the parameter used to measure diet and CVD incidence in UK Biobank studies ( Figure 2 ). Dietary pattern observations, as opposed to data on a single food group, tend to offer more conclusive findings across the studies, in which a healthy diet is found to be associated with a decrease in CVD incidence and mortality [ 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 ]. There are several definitions of a healthy diet used in these studies.…”

“…There are several definitions of a healthy diet used in these studies. These studies emphasise a high consumption of plant-based foods, a moderate intake of animal-based foods, and a limited intake of refined grains, processed meats, sugar-sweetened beverages, and foods high in sodium, saturated fat, and added sugars as the most used characteristics [ 12 , 16 , 17 , 18 ]. Others focused on a plant-based diet [ 11 , 15 ].…”

Relationship between Adherence to the 2019 Canada’s Food Guide Recommendations on Healthy Food Choices and Nutrient Intakes in Older Adults

“…Notably, the variability of the HEFI-2019 score was sufficient, the HEFI-2019 score was correlated with the Healthy Eating Index (HEI)-2015 (r=0.79) and differences of HEFI-2019 score were found among subgroups with known diet quality differences based on sex, age, and smoking status (18). Finally, a prospective analysis of UK Biobank data suggested that a hypothetical increase in HEFI-2019 score reduces the 11-year risk of cardiovascular disease in middle-aged and older adults (6).…”

“…The CFG-2007 recommended daily servings based on comprehensive diet simulations, thus ensuring that Dietary Reference Intakes (DRI) were met (2). The latest CFG (2019) adopted a different approach and primarily aims at chronic disease risk reduction (3)(4)(5)(6). In addition, recommendations in CFG-2019 (e.g., "eat more often …") are more flexible than those of CFG-2007 and rely on proportions of food categories to constitute a healthy plate, without recommended quantitative daily servings.…”

Relationship between adherence to the 2019 Canada’s Food Guide recommendations on healthy food choices and nutrient intakes in older adults

“…The CFG-2007 recommended daily servings based on comprehensive diet simulations, thus ensuring that Dietary Reference Intake (DRI) were met (2). The latest CFG (2019) adopted a different approach and primarily aims at chronic disease risk reduction (3)(4)(5)(6). In addition, recommendations in CFG-2019 (e.g., "eat more often …") are more flexible than those of CFG-2007 and rely on proportions of food categories to constitute a healthy plate, without recommended quantitative daily servings.…”