Although AHEI-2010 validated its disease-predictive value in the United States 9, 18, 26, this study was the first to recruit Tianjin community population using AHEI-2010 as a measure of dietary quality in Asia. The mean AHEI-2010 score of all participants recruited in this study was 58.49. The total score is 110 points. Although AHEI-2010 has no cutoff point, the average obtained is far from optimal. The study concluded that the diet quality of the Tianjin population is flawed and needs to be improved.
According to the 2014 Dietary Reference Intakes (China DRIS), the actual intake of fruits was significantly lower than the recommended intake, and the intake of sodium was higher than the recommended intake 27. This study also found that, the lowest scoring component of the AHEI-2010 was fruit (a lower score means lower intake). Fruits provide the body with essential nutrients such as vitamins, minerals, dietary fiber, plant compounds. It is an important part of a healthy diet. Insufficient fruit intake is associated with increased morbidity and mortality from chronic diseases such as hypertension 28, 29, cardiovascular disease30, cancer31 and stroke 32, 33. Tianjin population needs to further increase fruit intake. Although sodium is not the lowest-scoring ingredient, the actual intake of Tianjin residents is 10.5 grams on average, about double the recommended intake. The reason for considering high sodium intake is that Tianjin is close to the ocean and belongs to a high-salt area. High sodium intake is associated with hypertension, higher risk of stroke 34, 35 and overall mortality36. Furthermore, in clinical trials, low-sodium diets significantly reduced blood pressure 37 and cardiovascular disease risk 38. A low-salt diet is one of the keys to staying healthy.
The two highest-scoring components were trans fats and PUFA. Trans fatty acids enter the diet mainly through partially hydrogenated oils used in baked goods, sourdough bread, fried foods, chips, crackers, and margarine 39. Ingestion of trans fatty acids leads to adverse physiological changes, including lowering of HDL cholesterol levels, and elevation of LDL cholesterol, triglycerides, markers of systemic inflammation (C-reactive protein, interleukin-6, and tumor necrosis factor α) levels, causing endothelial cell dysfunction 40, 41, and many metabolic and epidemiological studies have confirmed the impact of trans fats on human health 42, 43 which means that reducing the intake of trans fatty acids is imminent. Intake of PUFA is strongly associated with lower risk of cardiovascular disease 44, diabetes 45, and colorectal cancer 46. This ingredient scored the second highest, thanks to Tianjin's preference for seafood. The main source of over-the-counter omega-3 PUFA supplements is fish oil, which is mainly composed of triglycerides. However, given post hoc analysis, small number of events, unadjusted borderline statistical significance for multiple trials, and study limitations mentioned elsewhere 47, 48. The relationship between PUFA and stroke requires further study.
For the sociodemographic variables analyzed in our study, education and marital status were also associated with diet quality, with less educated people having lower overall diet quality, possibly due in part to a lack of nutritional knowledge, cooking skills, or the use of prophylaxis. information capacity 49, 50. A study found that compared with highly educated women, less educated women have less knowledge of diet-disease relationships, less control over household food choices, and lower social support for healthy eating. As a result, less educated women have fewer economic and psychosocial resources to protect them from harsher environments 51–53. Getting married often brings health benefits, compared to unmarried people, married people have fewer premature all-cause mortality and chronic health conditions 54. The presence of an intimate partner is often associated with a reduced risk of coronary heart disease, improved outcomes, more effective health behavior changes, and patient management 55.
Few studies have investigated the relationship between dietary patterns and physical health indicators. A better understanding of the biological basis of diet-related health markers could better explain metabolic differences in individuals with and without chronic disease 56. This study found that AHEI-2010 quartiles were significantly different among some health indicators (BMI, TG, FBS, HCY). Among them, BMI was an independent risk factor for AHEI-2010. These findings are clinically important because these health markers are susceptible to negative effects from poor diet. In clinical practice, individuals are often advised to make dietary changes, and adherence to healthy eating patterns can lead to improvements in anthropometric and laboratory parameters (ie, blood glucose, lipids, and HCY). The relationship between laboratory markers and diet is complex because changes in markers are often triggered by the cumulative effects of diet and other factors. Diet is a complex exposure variable, there are many factors that affect diet, which in turn affects the development of disease