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Dietary Surveys and Nutritional Epidemiology
Abbreviations: DGA, Dietary Guidelines for Americans; DGAI, Dietary Guidelines Adherence Index; FMD, flow-mediated dilation; PWV, pulse wave velocity
Endothelial dysfunction and arterial stiffness are early predictors of atherosclerosis, hypertension and CVD(1,2). There is strong evidence that diet is related to endothelial dysfunction(3,4)and, to a lesser degree, arterial stiffness(5,6). However, there is a significant variation in the methods used to quantify diet in previous studies, with the majority examining the intake of specific foods or nutrients rather than overall diet. Studies of chronic disease morbidity and mortality have indicated that the use of dietary indices, or diet quality scores, is a comprehensive approach that can provide a valuable insight into the relationship between diet and health(7,8).
The Dietary Guidelines for Americans (DGA) are evidence-based recommendations that provide guidance for choosing an eating pattern that promotes health and prevents disease. The 2010 Guidelines emphasise greater intake of fruits, vegetables, low-fat dairy products, whole grains, and a variety of lean meats while maintaining appropriate weight through energy balance and physical activity(9). The Dietary Guidelines Adherence Index (DGAI) is a tool that quantifies the degree to which key DGA recommendations are met. Developed in reference to the 2005 DGA(10)and updated for the 2010 DGA(11), the DGAI provides an objective index of diet quality that is useful for standardising dietary assessments across studies. To our knowledge, no studies have evaluated whether overall diet quality is associated with measures of vascular function, particularly in a large community-based sample.
Vascular health declines with age despite the control of traditional risk factors. It is unclear whether age-related decline in vascular function is part of a normal physiological ageing process or a consequence of repeated exposure to lifestyle-related risk factors. Physiological changes with age probably interact with lifestyle risk factors to exacerbate arterial stiffness and endothelial dysfunction(12). Given the burden of CVD on the USA's ageing population, there is a need for improved understanding of the interaction between age and lifestyle...