ABSTRACT
Despite the fact that existing dietary scores that capture the overall healthiness of the
diet have extensively been used to study associations with risk factors for cardiovascular
disease, it is questionable whether these scores are appropriate for the Hispanic/Latino U.S.
population, since these metrics may not accurately capture the diet habits of ethnic/racial
minority groups. In chapter 1, we adapted a traditional Mexican diet score (tMexS) based on an
existing non-validated score, and we assessed its reproducibility and validity among U.S. adults
of Mexican heritage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
The tMexS had satisfactory reproducibility and moderate validity correlations with nutrient
intakes and biomarkers.
Since the purpose of dietary scores is to assess and guide an individual’s dietary intake
for the prevention of disease, the utility of the tMexS needed to be evaluated with disease
endpoints. In chapter 2, we examined the association between the tMexS and risk of
hypertension and changes in blood pressure (BP) among participants of Mexican heritage in
HCHS/SOL. Greater adherence to a traditional Mexican diet was associated with a reduction of
0.21±0.11 mmHg in diastolic BP during a mean follow-up of 6 years, but not with the risk of
hypertension. However, for tMexS components, we found 18% higher hypertension risk for each
serving per day of red and processed meats, and 12% lower hypertension risk per serving per
day of corn tortilla and 29% lower hypertension risk for grains. Associations between tMexS and
BP were stronger among men and participants with overweight or obesity.
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To our knowledge, no studies have compared a diet score that measures adherence to a
traditional diet against prevailing diet quality scores. In chapter 3, we compared the tMexS
against three diet quality scores: the Mediterranean diet score (MeDS), the Alternate Healthy
Eating Index 2010 (AHEI-2010), and the Dietary Approaches to Stop Hypertension (DASH)
score in association with risk of hypertension and change in BP among U.S. adults of Mexican
heritage in HCHS/SOL. We found that higher scores on AHEI-2010, but not DASH, MeDS, or
tMexS, were associated with lower hypertension risk; however, tMexS reduced diastolic BP.