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Peer-reviewedCC BY 4.0Nutrients

Baseline Food Supply-Based Dietary Scores and Ischemic Heart Disease Mortality: A Longitudinal Cross-Country Study

  • Saya Nosaka1,2
  • Fumiya Kawase3,4
  • Tomoko Imai4,5
  • Ayako Sezaki4,6
  • Keiko Miyamoto4,7
  • Chisato Abe4,8
  • Masayo Sanada4,9
  • Norie Sugihara10
  • Toshie Honda4,7
  • Yuta Sumikama1,11
  • Ayaka Inden4,12
  • Takayoshi Tsukahara1,4
1 more authors
  • Hiroshi Shimokata4,13
13 affiliations
  1. 1Graduate School of Nutritional Science, Nagoya University of Arts and Sciences, Aichi 470-0196, Japan
  2. 2Department of Nutrition, Osaka Metropolitan University, Osaka 536-8525, Japan
  3. 3Department of Sports and Health Sciences, Graduate School of Biomedical Engineering, Tohoku University, Sendai 980-8575, Japan
  4. 4Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Nisshin 470-0196, Japan
  5. 5Department of Food Science and Nutrition, Doshisha Women’s College of Liberal Arts, Kyoto 602-0893, Japan
  6. 6Center for Nutritional Epidemiology and Policy Research, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu 566-0002, Japan
  7. 7Department of Nursing, Nagoya University of Arts and Sciences, Nagoya 460-0001, Japan
  8. 8Department of Food and Nutrition, Tsu City College, Tsu 514-0112, Japan
  9. 9Department of Nursing, Heisei College of Health Sciences, Gifu 501-1131, Japan
  10. 10Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka 238-8522, Japan
  11. 11Department of Nutrition, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan
  12. 12Clinical Nutrition Unit, Hamamatsu University Hospital, Hamamatsu 431-3192, Japan
  13. 13Department of Nutritional Science, Nagoya University of Arts and Sciences, Nisshin 470-0196, Japan
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Abstract

Background/Objectives: National food environments may be associated with cardiovascular risk, but how their association with country-level ischemic heart disease (IHD) mortality differs across diet-quality indices remains unclear. We compared six food supply-based dietary scores calculated using 2010 food data in relation to annual IHD mortality from 2010 to 2021. Methods: We conducted a longitudinal study of 148 countries with populations ≥ 1 million. Using 2010 FAOSTAT Food Balance Sheet data, we calculated the Dietary Approaches to Stop Hypertension (DASH) score, the Alternative Healthy Eating Index (AHEI), Mediterranean Diet Score (MDS), Traditional Japanese Diet Score (TJDS), Planetary Health Diet Index (PHDI), and Quantitative Index for Dietary Diversity (QUANTIDD). The outcome was age-standardized IHD mortality during 2010–2021. Associations between time-invariant baseline dietary scores and annual IHD mortality were assessed using multivariable-adjusted linear mixed-effects models. Effect sizes were expressed as mortality rate ratios (MRRs) per 1-standard deviation (SD) higher score; model fit was compared using Akaike information criterion (AIC) weights and marginal R2, and effect estimates were compared pairwise. Results: Higher DASH and AHEI scores were associated with lower IHD mortality. MRRs per 1-SD higher score were 0.914 (95% confidence interval, 0.849–0.983) for DASH and 0.908 (95% confidence interval, 0.838–0.985) for AHEI. No significant associations were observed for MDS, TJDS, PHDI, or QUANTIDD. DASH had the highest AIC weight (0.434), followed by AHEI (0.341), with a slightly higher marginal R2 for DASH. Pairwise comparisons showed no statistically significant differences in effect estimates between DASH and AHEI or between either of these scores and the other dietary scores. Conclusions: Higher baseline DASH and AHEI scores were associated with lower IHD mortality during 2010–2021, with similar effect estimates per 1-SD higher score and broadly comparable model fit. However, direct pairwise comparisons revealed no statistically significant differences in standardized effect sizes between these scores (DASH and AHEI) and the other dietary scores. These findings suggest that the relevance of dietary scores may depend on the outcome and analytic context rather than the superiority of a single index. Because this was an ecological study, these findings should not be interpreted as individual-level causal effects.

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Cite

BibTeXRIS
BibTeX
@article{nosaka2026baseline,
  title = {{Baseline Food Supply-Based Dietary Scores and Ischemic Heart Disease Mortality: A Longitudinal Cross-Country Study}},
  author = {Saya Nosaka and Fumiya Kawase and Tomoko Imai and Ayako Sezaki and Keiko Miyamoto and Chisato Abe and Masayo Sanada and Norie Sugihara and Toshie Honda and Yuta Sumikama and Ayaka Inden and Takayoshi Tsukahara and Hiroshi Shimokata},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18203456},
  url = {https://www.mdpi.com/2072-6643/18/20/3456},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Baseline Food Supply-Based Dietary Scores and Ischemic Heart Disease Mortality: A Longitudinal Cross-Country Study
AU  - Saya Nosaka
AU  - Fumiya Kawase
AU  - Tomoko Imai
AU  - Ayako Sezaki
AU  - Keiko Miyamoto
AU  - Chisato Abe
AU  - Masayo Sanada
AU  - Norie Sugihara
AU  - Toshie Honda
AU  - Yuta Sumikama
AU  - Ayaka Inden
AU  - Takayoshi Tsukahara
AU  - Hiroshi Shimokata
PY  - 2026
DA  - 2026/10/01
JO  - Nutrients
DO  - 10.3390/nu18203456
UR  - https://www.mdpi.com/2072-6643/18/20/3456
AB  - Background/Objectives: National food environments may be associated with cardiovascular risk, but how their association with country-level ischemic heart disease (IHD) mortality differs across diet-quality indices remains unclear. We compared six food supply-based dietary scores calculated using 2010 food data in relation to annual IHD mortality from 2010 to 2021. Methods: We conducted a longitudinal study of 148 countries with populations ≥ 1 million. Using 2010 FAOSTAT Food Balance Sheet data, we calculated the Dietary Approaches to Stop Hypertension (DASH) score, the Alternative Healthy Eating Index (AHEI), Mediterranean Diet Score (MDS), Traditional Japanese Diet Score (TJDS), Planetary Health Diet Index (PHDI), and Quantitative Index for Dietary Diversity (QUANTIDD). The outcome was age-standardized IHD mortality during 2010–2021. Associations between time-invariant baseline dietary scores and annual IHD mortality were assessed using multivariable-adjusted linear mixed-effects models. Effect sizes were expressed as mortality rate ratios (MRRs) per 1-standard deviation (SD) higher score; model fit was compared using Akaike information criterion (AIC) weights and marginal R2, and effect estimates were compared pairwise. Results: Higher DASH and AHEI scores were associated with lower IHD mortality. MRRs per 1-SD higher score were 0.914 (95% confidence interval, 0.849–0.983) for DASH and 0.908 (95% confidence interval, 0.838–0.985) for AHEI. No significant associations were observed for MDS, TJDS, PHDI, or QUANTIDD. DASH had the highest AIC weight (0.434), followed by AHEI (0.341), with a slightly higher marginal R2 for DASH. Pairwise comparisons showed no statistically significant differences in effect estimates between DASH and AHEI or between either of these scores and the other dietary scores. Conclusions: Higher baseline DASH and AHEI scores were associated with lower IHD mortality during 2010–2021, with similar effect estimates per 1-SD higher score and broadly comparable model fit. However, direct pairwise comparisons revealed no statistically significant differences in standardized effect sizes between these scores (DASH and AHEI) and the other dietary scores. These findings suggest that the relevance of dietary scores may depend on the outcome and analytic context rather than the superiority of a single index. Because this was an ecological study, these findings should not be interpreted as individual-level causal effects.
SN  - 2072-6643
ER  -