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

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.