Research article
The Association Between a Nutritional Quality Index and Risk of Chronic Disease

https://doi.org/10.1016/j.amepre.2010.11.022Get rights and content

Background

The Overall Nutritional Quality Index (ONQI) algorithm is a nutrient profiling scheme that incorporates more than 30 dietary components, and it aims to rank foods by relative healthfulness.

Purpose

To assess whether diets with a higher ONQI score predict lower risk of major chronic disease risk.

Methods

A total of 62,284 healthy women from the Nurses' Health Study and 42,382 healthy men from Health Professionals Follow-Up Study were followed from 1986 to 2006. Dietary data were collected from questionnaires at baseline. Each food was scored by the ONQI algorithm and the average ONQI score for the diet consumed by each participant was computed. Total chronic disease was defined as cardiovascular disease (CVD); cancer; diabetes; and nontrauma death. Data analysis was conducted in 2010.

Results

A total of 20,004 and 13,520 chronic disease events were documented in women and men, respectively. The ONQI score was inversely associated with risk of total chronic disease, CVD, diabetes, and all-cause mortality (p-trend≤0.01), but not cancer, in both cohorts. Women in the highest compared to lowest quintile of the ONQI score had a relative risk (95% CI) of 0.91 (0.87, 0.95) for chronic disease; 0.79 (0.71, 0.88) for CVD; 0.86 (0.78, 0.96) for diabetes; and 0.90 (0.84, 0.97) for all-cause mortality. Men in the highest compared to lowest quintile of the ONQI score had a relative risk of 0.88 (0.83, 0.93) for chronic disease; 0.77 (0.70, 0.85) for CVD; 0.84 (0.73, 0.96) for diabetes; and 0.89 (0.83, 0.97) for all-cause mortality.

Conclusions

Consumption of foods that lead to a higher score for the ONQI scoring system is associated with modestly lower risk of chronic disease and all-cause mortality.

Section snippets

Background

Nutrient profiling is an effort to rank or classify foods based on nutrient composition.1 Dozens of nutrient profiling schemes have been developed,2, 3 and the potential applications of these profiles include consumer education and dietary guidance, regulation of health claims, and evaluation of the nutritional quality of food products. A rapidly growing application for these profiles is front-of-package food product labeling. Front-of-package labeling has emerged recently from many sources,4

Study Population

The Nurses' Health Study was established in 1976, when 121,700 female registered nurses aged 30–55 years were enrolled.15 The Health Professionals Follow-up Study (HPFS) is a prospective cohort of 51,529 U.S. men, aged 40–75 years, who returned a mailed questionnaire about diet and medical history in 1986.16 In both cohorts, detailed information on lifestyle habits, medical history and newly diagnosed disease is updated biennially. Dietary data were collected with a 138- and 135-item food

Results

The median (10th–90th percentile) of the ONQI-f score was 32.2 (23.1, 42.4) in the women and 30.1 (21.4, 40.9) in the men. The baseline characteristics and mean values for the nutrients included in the ONQI algorithm are presented by quintiles of ONQI-f score in Table 2. As expected, the intake of nutrients in the numerator was higher, and nutrients in the denominator were lower, with greater ONQI-f scores. Women and men who consumed a diet with a higher average ONQI-f score were less likely to

Discussion

In these two prospective cohorts, consumption of foods with higher ratings based on the ONQI algorithm was associated with lower risk of chronic disease and total mortality over 20 years of follow-up. Higher ONQI-f scores were associated with a 9%–12% lower risk of chronic disease and a 10%–11% lower risk of all-cause mortality. These associations were driven by strong associations with risk of CVD and diabetes. The ONQI-f score was not significantly associated with risk of cancer. The ONQI

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