BACKGROUND Diets of the highest quality have been associated with a significantly lower risk of noncommunicable diseases. OBJECTIVE It was the aim of this study to update a previous systematic review investigating the associations of diet quality as assessed by the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), and Dietary Approaches to Stop Hypertension (DASH) score and multiple health outcomes. As an additional topic, the associations of these diet quality indices with all-cause mortality and cancer mortality among cancer survivors were also investigated. DESIGN A literature search for prospective cohort studies that were published up to May 15, 2017 was performed using the electronic databases PubMed, Scopus, and Embase. Summary risk ratios (RRs) and 95% CIs were estimated using a random effects model for high vs low adherence categories. RESULTS The updated review process showed 34 new reports (total number of reports evaluated=68; including 1,670,179 participants). Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction for all-cause mortality (RR 0.78, 95% CI 0.77 to 0.80; I2=59%; n=13), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.76 to 0.80; I2=49%; n=28), cancer (incidence or mortality) (RR 0.84, 95% CI 0.82 to 0.87; I2=66%; n=31), type 2 diabetes (RR 0.82, 95% CI 0.78 to 0.85; I2=72%; n=10), and neurodegenerative diseases (RR 0.85, 95% CI 0.74 to 0.98; I2=51%; n=5). Among cancer survivors, the association between diets for the highest quality resulted in a significant reduction in all-cause mortality (RR 0.88, 95% CI 0.81 to 0.95; I2=38%; n=7) and cancer mortality (RR 0.90, 95% CI 0.83 to 0.98; I2=0%; n=7). CONCLUSIONS In the updated meta-analyses, diets that score highly on the HEI, AHEI, and DASH were associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative disease by 22%, 22%, 16%, 18%, and 15%, respectively. Moreover, high-quality diets were inversely associated with overall mortality and cancer mortality among cancer survivors.

中文翻译：

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由健康饮食指数、替代健康饮食指数、停止高血压评分的饮食方法和健康结果评估的饮食质量：队列研究的更新系统回顾和荟萃分析

背景 最高质量的饮食与显着降低非传染性疾病的风险相关。目的 本研究的目的是更新之前的系统评价，调查饮食质量与健康饮食指数 (HEI)、替代健康饮食指数 (AHEI) 和停止高血压饮食方法 (DASH) 评分和多种健康结果。作为另一个主题，还研究了这些饮食质量指数与癌症幸存者的全因死亡率和癌症死亡率之间的关联。设计 使用电子数据库 PubMed、Scopus 和 Embase 对截至 2017 年 5 月 15 日发表的前瞻性队列研究进行文献检索。使用随机效应模型估计高与低依从性类别的汇总风险比 (RR) 和 95% CI。结果 更新的审查过程显示了 34 份新报告（评估的报告总数 = 68；包括 1,670,179 名参与者）。根据 HEI、AHEI 和 DASH 评分评估的最高质量饮食显着降低了全因死亡率（RR 0.78，95% CI 0.77 至 0.80；I2=59%；n=13），心血管疾病（发生率或死亡率）（RR 0.78，95% CI 0.76 至 0.80；I2=49%；n=28），癌症（发生率或死亡率）（RR 0.84，95% CI 0.82 至 0.87；I2=66%； n=31)、2 型糖尿病（RR 0.82，95% CI 0.78 至 0.85；I2=72%；n=10）和神经退行性疾病（RR 0.85，95% CI 0.74 至 0.98；I2=51%；n= 5）。在癌症幸存者中，最高质量饮食之间的关联导致全因死亡率（RR 0.88，95% CI 0.81 至 0.95；I2=38%；n=7）和癌症死亡率（RR 0.90，95% CI 0.83 至 0.83 至0.98；I2=0%；n=7）。结论 在更新的荟萃分析中，在 HEI、AHEI 和 DASH 上得分高的饮食与全因死亡率、心血管疾病、癌症、2 型糖尿病和神经退行性疾病的风险显着降低 22% 相关、22%、16%、18% 和 15%。此外，高质量饮食与癌症幸存者的总体死亡率和癌症死亡率呈负相关。AHEI 和 DASH 与全因死亡率、心血管疾病、癌症、2 型糖尿病和神经退行性疾病的风险分别显着降低 22%、22%、16%、18% 和 15% 相关。此外，高质量饮食与癌症幸存者的总体死亡率和癌症死亡率呈负相关。AHEI 和 DASH 与全因死亡率、心血管疾病、癌症、2 型糖尿病和神经退行性疾病的风险分别显着降低 22%、22%、16%、18% 和 15% 相关。此外，高质量饮食与癌症幸存者的总体死亡率和癌症死亡率呈负相关。