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Aspects of Dietary Diversity Differ in Their Association with Atherosclerotic Cardiovascular Risk in a Racially Diverse US Adult Population

University of Delaware, Department of Behavioral Health and Nutrition, 206C McDowell Hall, Newark, DE 19716, USA
University of Delaware, College of Health Sciences, STAR, Newark, DE 19716, USA
University of Delaware, Department of Medical Laboratory Sciences, 206C McDowell Hall, Newark, DE 19716, USA
Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, 251 Bayview Blvd, Baltimore, MD 21224, USA
Author to whom correspondence should be addressed.
Nutrients 2019, 11(5), 1034;
Received: 11 April 2019 / Revised: 29 April 2019 / Accepted: 1 May 2019 / Published: 8 May 2019
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
PDF [662 KB, uploaded 8 May 2019]


The study objectives were to measure dietary diversity (DD) of an urban US population and to determine if associations of 10 year atherosclerotic cardiovascular (ASCVD) risk with DD were independent of dietary quality. Participants were drawn from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, wave 4 (n = 2066, 1259 African Americans (AA), 807 Whites (W). Three DD measures were derived from 2 days of 24 h recall data collected with the USDA automated-multiple-pass-method. Count was based on consumption of at least half an equivalent of food from 21 subgroups. Evenness was calculated using Berry Index (BI) and BI-adjusted by food health values. Dissimilarity was calculated by Mahalanobis Distance. Diet quality was assessed by Mean Nutrient Adequacy (MAR) and DASH scores. Associations of DD and quality with ASCVD risk, calculated using 2013 American College of Cardiology and American Heart Association guidelines, were assessed with multivariable regression. Covariates included income, education, food security, and energy/kg weight. Count and MAR were positively associated whereas dissimilarity was negatively associated with ASCVD risk. There was no evidence that evenness contributed to cardiovascular health. The findings suggest more diversity in food attributes and diets rich in micronutrients rather than increased count support cardiovascular health. View Full-Text
Keywords: diet diversity; diet quality; cardiovascular disease risk; MAR; DASH diet diversity; diet quality; cardiovascular disease risk; MAR; DASH

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Fanelli Kuczmarski, M.; Brewer, B.C.; Rawal, R.; Pohlig, R.T.; Zonderman, A.B.; Evans, M.K. Aspects of Dietary Diversity Differ in Their Association with Atherosclerotic Cardiovascular Risk in a Racially Diverse US Adult Population. Nutrients 2019, 11, 1034.

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