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Epidemiology

Associations of diet quality and blood serum lipoprotein levels in a population at high risk for diabetes: the Strong Heart Family Study

European Journal of Clinical Nutrition volume 74, pages 1084–1090 (2020)Cite this article

Subjects

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.

Author information

Authors and Affiliations

  1. From the Nutritional Sciences Program, University of Washington, Seattle, WA, USA

    Sophie A. E. Kauffman

  2. Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA

    Michelle M. Averill

  3. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Joseph A. C Delaney & Amanda M. Fretts

  4. Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA

    Joseph A. C Delaney, Rozenn N. Lemaitre & Amanda M. Fretts

  5. Department of Medicine, University of Washington, Seattle, WA, USA

    Rozenn N. Lemaitre

  6. MedStar Health Research Institute, Hyattsville, MD, USA

    Barbara V. Howard

  7. Georgetown and Howard Universities Center for Translational Science, Washington, DC, USA

    Barbara V. Howard

Authors
  1. Sophie A. E. Kauffman
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  5. Barbara V. Howard
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Contributions

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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Correspondence to Amanda M. Fretts.

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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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