OBJECTIVE -The aim of this article was to assess the association between the Alternate Healthy Eating Index (AHEI) and risk of type 2 diabetes in women.RESEARCH DESIGN AND METHODS -A total of 80,029 women aged 38 -63 years in the Nurses' Health Study were followed from 1984 to 2002. The AHEI score was computed from dietary information collected from five repeated food frequency questionnaires administered between 1984 and 1998. Relative risks (RRs) for type 2 diabetes were calculated using Cox proportional hazards models and adjusted for known diabetes risk factors. We also examined how changes in score in 4, 6 -8, and 10 -12 years are associated with diabetes risk.RESULTS -We ascertained 5,183 incident cases of type 2 diabetes during 18 years of follow-up. Women who scored high on the AHEI had a lower risk (RR comparing top to bottom score quintile 0.64 [95% CI 0.58 -0.71], P trend Ͻ 0.0001) for diabetes. Women with consistently high AHEI scores throughout follow-up, compared with those with consistently low scores, had the lowest risk for diabetes. In addition, women whose AHEI scores improved during follow-up, even during recent years, had a lower risk of diabetes than did women whose (low) score did not change.CONCLUSIONS -A higher AHEI score is associated with a lower risk of type 2 diabetes in women. Therefore, the AHEI score may be a useful clinical tool to assess diet quality and to recommend for the prevention of diabetes.
Diabetes Care 30:1753-1757, 2007T he prevalence of diabetes in the U.S. in 2005 was estimated to be 9.6% among adults aged 20 years and 20.9% among those aged Ն60 years (1). The vast majority of these cases are type 2 diabetes. Although obesity (2-4) and lack of physical activity (5,6) are the major risk factors, certain dietary factors may also modify the risk of developing type 2 diabetes. In particular, intake of whole grains and fiber (7), nuts (8,9), and magnesium (10,11) and moderate intake of alcohol (12,13) may reduce risk. On the other hand, intake of red and processed meats (14,15) and saturated fats (16) may increase risk. Therefore, dietary modifications may play an important role in the prevention of type 2 diabetes.The Alternate Healthy Eating Index (AHEI) was modified from the Healthy Eating Index developed by the U.S. Department of Agriculture (17). It measures diet quality using nine dietary components and can be used for providing dietary guidance for healthy eating. Several of the foods and nutrients included in the index have shown to be associated with risk of type 2 diabetes. The AHEI was previously shown to be inversely associated with risk of cardiovascular disease (18) and estrogen receptornegative breast cancer (19). However, it has not been evaluated in relation to type 2 diabetes. Therefore, we prospectively assessed the association between the AHEI and risk of type 2 diabetes in an ongoing cohort of U.S. women. Using repeated dietary measurement, we also examined the time period (i.e., recent versus distant diet) in which diet may have the greatest impact ...