Saturday, June 9, 2012

Scoring Your Diet

This blog entry is related to the one on the Alternative Healthy Eating Index - 2010 that was posted here yesterday.
The information provided is taken from this publication in the Journal Nutrition
 Chiuve, S. E., Fung, T. T., Rimm, E. B., Hu, F. B., McCullough, M. L., Wang, M., Willett, W. C. (2012). Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease. The Journal of Nutrition, 142(6), 1009-1018.

The AHEI-2010 comes with 11 items and for each item a persons food frequency information can be used to give them a score of 0 to 10.  It is better to have dietary recall over some period of time.  The intake for that period of time should be considered usual or normal.  Yesterday I told you the 11 items and today I give you the criteria.  When the HSPH put this together, they were using a real sample of dietary information from a study - so they based it on actual food intakes.  The creators of the index encourage researchers to use it in their own work and I encourage you to consider each of these evidence based rationales for your personal dietary choices.  To reiterate, for each item, the authors provided citations to the previous research that associated the item with increased or decreased risk of disease.  The health statements below are not their opinion but science based conclusions. 

Remember you can get a score between 0 and 10, I am giving you the extremes in these examples.
  1. Vegetables (not counting potatoes)  You get ten points for having at least 5 servings a day.  A serving is a half cup or one cup if it is a green leafy vegetable (1 c = 236 .59 g).  If you consume no veggies or just potatoes, you get a score of zero.  Vegetables are associated with decrease risk of  CVD and some cancers.  Green leafy veggies are associated with decreased risk of diabetes.  Potatoes are not associated with either and may increase the risk of diabetes.
  2. Whole Fruits (only) Ten points for 4 or more servings a day (NOT fruit juice) and a serving is one medium fruit or a half cup berries.  If you do not eat fruit on any day you get a 0.  Fruits decrease the risk of CVD and some cancers.  Fruit juice does not and can increase the risk of diabetes.
  3. Whole Grains This is calculated in grams - you may eat a food, like oat meal that has 15g of whole grains in it.  To get a ten, women need 75g and men 90g per day.  Read your labels - only whole grains count, so looking at total grains can be confusing. Whole grains reduce the risk of CVD, colorectal cancer and diabetes.  Refined grains (the white stuff) increases these risks - avoid them.
  4. Sugar Sweetened Beverages & Fruit Juice - (you know this includes soda and fruit drinks/ades).  You have to not drink any of this stuff to get your 10 points.  IF you drink one or more a day you get zero.  A serving is 8 ounces (226 g). The drinks are associated with weight gain and obesity, CVD, and diabetes.  See the note above re fruit juice.
  5. Nuts, Beans (legumes), Vegetable Protein (tofu)  The constituents or make-up of these foods is very healthful - monounsaturated fats, micronutrients, etc. These lean proteins decrease the risk of CVD (esp when eating them instead of read meat).  Nuts reduce diabetes and weight gain (but watch them for calories).  To get 10 points consume one or more servings a day (serving size is small- 1 oz (28.35g) or 1 TBSP of peanut butter (not the crappy kind).  One serving a day will get you your 10 points.  Only go for 3 or 4 servings if it is in place of bad calories - like lunch meat.
  6. Red and Processed Meats  Best scenario - 10 pts for less than one serving a MONTH.  If you have greater than or equal to 1.5 servings per day, you get 0 points.  A serving is 4 ounces of meat (steak, etc) or 1.5 ounces of processed meats (lunch meat, bacon).  Why?  Consuming red and processed meats increases the risk of CVD, CVA, diabetes, colorectol and other cancers. 
  7. Trans fats -They increase the risk of CHD and diabetes and the scores are calculated as a % of total energy intake.  The best (10 points) is .5 or less a day -  if you consume 4 or greater - 0 points.  This is the equivalent of about ten calories in a 1800 calorie diet per day.  Trans fats have no health promoting properties, but do occur naturally in small amounts - making total elimination impossible.  Certainly it is better to choose prepared foods that are 100% trans free.
  8. Fish - or long chain fatty acids (EPA+DHA)  Fish is associated with a decreased risk of cardiac arrhythmia - or irregular heartbeat and sudden cardiac death.  My father died from this. The goal is 250mg/d or two 4 ounce servings of fish per week (10 points). If you do not eat any fish you get 0 points.
  9. PUFA  Instead of having a saturated fat item as the original HEI does, this index encourages poly unsaturated fat intake in place of saturated fats.  This is very important and ties into the concern that people misunderstand the fat problem and consume an overall low fat diet.  That is not healthy! Please read more here. (esp paragraph 3) Healthy oils are associated with decreased CHD and diabetes.  We should get 10 % of our total calories from these fats (10 points).  You cannot count your fish twice though.  You can count mono unsaturated fats, like olive oil.  This would be 180 calories in a 1800 calorie day.
  10. Sodium/Salt  Too much sodium increases blood pressure, CVD, stomach cancer and all death.  The recommendations of 1500mg a day - no more - should get you your 10 points.
  11. Alcohol  No alcohol = 2.5 points, Too much (greater than or equal to 2.5/d (women) 3.5/d men), = 0 points and Moderate = 10 points.  To get your ten points women have one half to one and a half drinks per day and men have 1.5 to 2 drinks a day.  Remember these few things - 1) alcohol HAS calories, 2) not everyone should drink - no matter what this says - and 3) a drink is 4 ounces of wine, or 12 ounces of beer or 1.5 ounces of booze.  So two drinks a day = 8 ounces of wine (possibly one glass at some bars!).  I drink two measured drinks a week, sometimes 3 so I guess I would get 5 to 8 points.
Some abbreviations used:
CVD - cardiovascular disease (includes all types of heart disease)
CHD - coronary heart disease (one type of heart disease)
CVA  - cerebrovascular accident (stroke)

This was a long post both in preparation and in actual length.  It is also very important.  I will leave it for two days and take a break tomorrow!  Hmmm - I also need to consider my diet.... I think I might score over 90 :)

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