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Higher Adherence to the Mediterranean Diet Score, but not other Diet Quality Scores, is Associated with a Favorable Longitudinal Cardiometabolic Profile in the Boston Puerto Rican Health Study

Diet quality scores have been used to evaluate adherence to specific dietary recommendations or to consumption of healthful foods and nutrients. Few studies have assessed the strength of the associations between several diet quality scores and longitudinal cardiometabolic profile, and it remains unknown which score can best predict cardiometabolic risk factors in at‐risk ethnic minority populations. We aimed to contrast longitudinal associations of four diet quality scores (American Heart Association Diet Score (AHA‐DS), Dietary Approaches to Stop Hypertension score (DASH), the Healthy Eating Index‐2005 (HEI), and a Mediterranean Diet Score (MeDS)) calculated from baseline dietary data obtained from a validated food frequency questionnaire and 2‐y follow‐up measures of 14 individual cardiometabolic risk factors in the Boston Puerto Rican Health Study (n=1,251, ages 45–75y at baseline). Multivariable‐adjusted repeated‐subjects mixed‐effects models were used to determine the association between z‐scores of each diet quality score and cardiometabolic risk factors over 2 years. The MeDS was significantly associated with decreased waist circumference (β‐coefficient (standard error) =−0.539 (0.268), p=0.044); body mass index (−0.236 (0.082), p=0.004); log‐insulin (−0.047 (0.022), p=0.027); log‐Homeostatic Model Assessment of Insulin Resistance (HOMA‐IR, −0.053 (0.025), p=0.034) and log‐C‐reactive protein (−0.091 (0.036), p=0.011), and marginally significant with waist‐to‐hip ratio (−0.004 (0.002), p=0.05). The HEI was positively associated with LDL‐cholesterol (2.00 (0.924), p=0.031), and neither AHA‐DS nor DASH were associated with any longitudinal value. In conclusion, higher adherence to the MeDS at baseline is associated with a favorable cardiometabolic profile in the subsequent 2 years. The results could help nutrition researchers and health professionals select suitable measures of diet quality in epidemiological studies, as well as craft effective nutritional messages and programs that focus on meaningful dietary recommendations for this at‐risk minority group.