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Research

Alternate Healthy Eating Index 2010 and risk of chronic obstructive pulmonary disease among US women and men: prospective study

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h286 (Published 03 February 2015) Cite this as: BMJ 2015;350:h286
  1. Raphaëlle Varraso, researcher12,
  2. Stephanie E Chiuve, assistant professor of medicine3, research associate4,
  3. Teresa T Fung, adjunct professor4, professor5,
  4. R Graham Barr, assistant professor of medicine and epidemiology6,
  5. Frank B Hu, professor478,
  6. Walter C Willett, professor478,
  7. Carlos A Camargo, professor789
  1. 1INSERM U1168, VIMA (Aging and chronic diseases. Epidemiological and public health approaches), 16 avenue Paul Vaillant Couturier, 94 807 Villejuif, France
  2. 2UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
  3. 3Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
  4. 4Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
  5. 5Department of Nutrition, Simmons College, Boston, MA 02115, USA
  6. 6Division of General Medicine, Department of Medicine, and Department of Epidemiology, Columbia University Medical Center, New York, NY 10032, USA
  7. 7Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
  8. 8Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
  9. 9Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
  1. Correspondence to: R Varraso raphaelle.varraso{at}inserm.fr
  • Accepted 10 December 2014

Abstract

Objective To investigate the association between the Alternate Healthy Eating Index 2010 (AHEI-2010)—a measure of diet quality—and the risk of chronic obstructive pulmonary disease (COPD).

Design Prospective cohort study.

Setting Participants in the Nurses’ Health Study and the Health Professionals Follow-up Study, United States.

Participants 73 228 female nurses from 1984 to 2000 and 47 026 men from 1986 to 1998, who completed biennial questionnaires.

Main outcome measures The primary outcome was the self report of newly diagnosed COPD. Multivariable Cox proportional hazards models were adjusted for age, physical activity, body mass index, total energy intake, smoking, second hand tobacco exposure (only in the Nurses’ Health Study), race/ethnicity, physician visits, US region, spouse’s highest educational attainment (only in the Nurses’ Health Study), and menopausal status (only in the Nurses’ Health Study).

Results Over the study period, 723 cases of newly diagnosed COPD occurred in women and 167 in men. In the pooled analysis, a significant negative association was seen between the risk of newly diagnosed COPD and fifths of the AHEI-2010: hazard ratios were 0.81 (95% confidence interval 0.51 to 1.29) for the second fifth, 0.98 (0.80 to 1.18) for the third fifth, 0.74 (0.59 to 0.92) for the fourth fifth, and 0.67 (0.53 to 0.85) for participants who ate the healthiest diet according to the AHEI-2010 (that is, were in the highest fifth), compared with those who ate the less healthy diet (participants in the lowest fifth). Similar findings were observed among ex-smokers and current smokers.

Conclusions A higher AHEI-2010 diet score (reflecting high intakes of whole grains, polyunsaturated fatty acids, nuts, and long chain omega-3 fats and low intakes of red/processed meats, refined grains, and sugar sweetened drinks) was associated with a lower risk of COPD in both women and men. These findings support the importance of a healthy diet in multi-interventional programs to prevent COPD.

Footnotes

  • We thank Gary Chase and Karen Corsano for invaluable assistance with the implementation of the study. We also thank Marjory McCullough, Rong Chen, and Rui Jiang for their help with the dataset.

  • Contributors: RV conceived the study, collected the data, planned and performed the statistical analysis, and drafted and critically revised the manuscript. SEC and TTF conceived the study, planned the analysis, and critically revised the manuscript. RGB, FBH, WCW, and CAC conceived the study, collected the data, obtained funding, planned the analysis, and critically revised the manuscript. All authors approved the final version for publication. RV and CAC are the guarantors.

  • Funding: This study was supported by grants CA-87969, CA-167552, HL-63841, and AI-52338 from the National Institutes of Health (Bethesda, MD, USA). The design, conduct, and reporting were entirely the responsibility of the authors, independent from funders.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The institutional review board approved the Nurses’ Health Study and the Health Professionals Follow-up Study protocols, and all participants gave written consent. The study was conducted according to the ethical guidelines of Brigham and Women’s Hospital (Boston, USA).

  • Transparency declaration: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: Requests for access to data, statistical code, questionnaires, and technical processes may be made by contacting the corresponding author at raphaelle.varraso{at}inserm.fr.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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