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

  • Stephanie E. Chiuve
    Correspondence
    Address correspondence to: Stephanie E. Chiuve, ScD, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston MA 02115
    Affiliations
    Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts

    Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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  • Laura Sampson
    Affiliations
    Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
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  • Walter C. Willett
    Affiliations
    Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts

    Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

    Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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      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.
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      References

        • Drewnowski A.
        Concept of a nutritious food: toward a nutrient density score.
        Am J Clin Nutr. 2005; 82: 721-732
        • Garsetti M.
        • de Vries J.
        • Smith M.
        • Amosse A.
        • Rolf-Pedersen N.
        Nutrient profiling schemes: overview and comparative analysis.
        Eur J Nutr. 2007; 46: 15-28
        • Drewnowski A.
        • Fulgoni 3rd, V.
        Nutrient profiling of foods: creating a nutrient-rich food index.
        Nutr Rev. 2008; 66: 23-39
        • Lytton T.D.
        Signs of change or clash of symbols?.
        Health Matrix Level. 2010; 20: 93-144
        • Kraft Foods
        The sensible solutions.
      1. Co. HB. Guiding Stars program.
        • American Heart Association
        Food certification program.
        • NuVal
        How it works.
        • Food Standards Agency
        Traffic-light labelling.
        • Townsend M.S.
        Where is the science?.
        Am J Clin Nutr. 2010; 91: 1109S-1115S
        • Azais-Braesco V.
        • Goffi C.
        • Labouze E.
        Nutrient profiling: comparison and critical analysis of existing systems.
        Public Health Nutr. 2006; 9: 613-622
        • Scarborough P.
        • Boxer A.
        • Rayner M.
        • Stockley L.
        Testing nutrient profile models using data from a survey of nutrition professionals.
        Public Health Nutr. 2007; 10: 337-345
        • Katz D.L.
        • Njike V.Y.
        • Faridi Z.
        • et al.
        The stratification of foods on the basis of overall nutritional quality: the overall nutritional quality index.
        Am J Health Promot. 2009; 24: 133-143
        • Schneeman B.
        • Office of Nutrition Labeling and Dietary Supplements, Center for Food Safety and Applied Nutrition, Food and Drug Administration
        Guidance for industry: letter regarding point of purchase food labeling.
        • Willett W.C.
        • Green A.
        • Stampfer M.J.
        • et al.
        Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes.
        N Engl J Med. 1987; 317: 1303-1309
        • Colditz G.A.
        • Rimm E.B.
        • Giovannucci E.
        • Stampfer M.J.
        • Rosner B.A.
        • Willett W.C.
        A prospective study of parental history of myocardial infarction and coronary artery disease in men.
        Am J Cardiol. 1991; 67: 933-938
        • Katz D.L.
        • Njike V.Y.
        • Rhee L.Q.
        • Reingold A.
        • Ayoob K.T.
        Performance characteristics of NuVal and the Overall Nutritional Quality Index (ONQI).
        Am J Clin Nutr. 2010; 91: 1102S-1108S
        • Katz D.L.
        • Njike V.Y.
        • Kennedy D.
        • Faridi Z.
        • Treu J.
        • Rhee L.Q.
        Overall Nutrition Quality Index Reference Manual.
        • Rimm E.B.
        • Giovannucci E.L.
        • Stampfer M.J.
        • Colditz G.A.
        • Litin L.B.
        • Willett W.C.
        Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals.
        Am J Epidemiol. 1992; 135: 1114-1126
        • Feskanich D.
        • Rimm E.B.
        • Giovannucci E.L.
        • et al.
        Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire.
        J Am Diet Assoc. 1993; 93: 790-796
        • Giovannucci E.
        • Colditz G.
        • Stampfer M.J.
        • et al.
        The assessment of alcohol consumption by a simple self-administered questionnaire.
        Am J Epidemiol. 1991; 133: 810-817
        • Alpert J.S.
        • Thygesen K.
        • Antman E.
        • Bassand J.P.
        Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction.
        J Am Coll Cardiol. 2000; 36: 959-969
        • Walker A.E.
        • Robins M.
        • Weinfeld F.D.
        The National Survey of Stroke.
        Stroke. 1981; 12: I13-I44
        • Manson J.E.
        • Colditz G.A.
        • Stampfer M.J.
        • et al.
        A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women.
        Arch Intern Med. 1991; 151: 1141-1147
        • National Diabetes Data Group
        Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance.
        Diabetes. 1979; 28: 1039-1057
        • Stampfer M.J.
        • Willett W.C.
        • Speizer F.E.
        • et al.
        Test of the National Death Index.
        Am J Epidemiol. 1984; 119: 837-839
        • Willett W.C.
        Issues in analysis and presentation of dietary data.
        (Chapter 13)in: Willett W.C. Nutritional epidemiology. 2nd ed. Oxford University Press, New York1998
        • Lupton J.R.
        • Balentine D.A.
        • Black R.M.
        • et al.
        The Smart Choices front-of-package nutrition labeling program: rationale and development of the nutrition criteria.
        Am J Clin Nutr. 2010; 91: 1078S-1089S
      2. Letter from Rep. Rosa DeLauro to Margaret Hamburg, MD, Comm. FDA Sept. 21, 2009.www.house.gov/delauro/.

        • Silverglade B.
        • Heller I.R.
        Food labeling. Chaos: the case for reform.
        Center for the Science in the Public Interest, Washington DC2009
        • Food and Drug Administration
        Guidance for industry: dear manufacturer letter regarding front-of-package symbols.
        • Food and Drug Administration
        Guidance for industry: letter regarding point of purchase food labeling.
        • Hamburg M.A.
        FDA response to Representative DeLauro.
        • Nestle M.
        • Ludwig D.S.
        Front-of-package food labels: public health or propaganda?.
        JAMA. 2010; 303: 771-772
        • Lobstein T.
        • Davies S.
        Defining and labelling “healthy” and “unhealthy” food.
        Public Health Nutr. 2009; 12: 331-340

      Linked Article

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        American Journal of Preventive MedicineVol. 40Issue 5
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          In this issue of the American Journal of Preventive Medicine, Chiuve and colleagues1 present findings from the Nurses' Health Study showing that the Overall Nutritional Quality Index (ONQI), a measure of healthfulness of dietary intake, was inversely associated with total chronic disease, diabetes, and all-cause mortality. This measure uses an algorithm based on a nutritional profiling scheme that incorporates numerous dietary components. Although the results of this study are promising with regard to the association between the ONQI score and chronic disease, this also raises a question with regard to the use of this score, when the algorithm used to derive the score is proprietary and, therefore, not available to the scientific or clinical community.
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      • The Use of Proprietary Nutrient Profiling Tools in Nutrition Science and Policy: A Commentary
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        American Journal of Preventive MedicineVol. 41Issue 3
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