# Associations Between the Cardiovascular Health Diet Index (CHDI) and Cardiometabolic Risk Factors in Brazilian Workers: A Cross‐Sectional Study

## TL;DR

This study shows that better heart-healthy diets, measured by the CHDI, are linked to lower risks of obesity, high blood pressure, and insulin resistance in Brazilian workers.

## Contribution

This is one of the first studies to apply the CHDI in a working population, highlighting its potential as a novel dietary assessment tool for cardiovascular health.

## Key findings

- Higher CHDI scores were associated with lower likelihood of excess body weight, abdominal obesity, and elevated diastolic blood pressure.
- The CHDI showed stronger associations with cardiometabolic risk factors than the BHEI-R, likely due to its focus on ultra-processed foods and protein sources.
- Better adherence to CHDI dietary patterns was linked to reduced insulin resistance and systemic inflammation markers.

## Abstract

The Cardiovascular Health Diet Index (CHDI) was recently developed to assess compliance with dietary recommendations aimed at preventing cardiovascular disease and promoting cardiovascular health on a population level, based on guidance from the American Heart Association (AHA) and adapted to Brazilian dietary culture. The purpose of this study was to assess dietary quality among workers at a public university in Brazil using the CHDI and determine its association with cardiometabolic risk factors and sociodemographic data.

This cross‐sectional study included 557 workers aged 20–59 years from a Brazilian public university. Dietary quality was assessed using the CHDI (score from 0 to 100 points) and the Brazilian Healthy Eating Index‐Revised (BHEI‐R) (score from 0 to 100 points), both based on data from one 24‐h dietary recall (24HR) obtained in a phone interview by a registered dietitian using the multiple‐pass method. Clinical parameters included body mass index (BMI), waist circumference, blood pressure, lipids (LDL‐c and triglycerides), fasting glucose, HbA1c, fasting insulin (used to calculate HOMA2‐IR for insulin resistance), and C‐reactive protein (CRP). Sociodemographic variables included age, sex, education level, and race/ethnicity. Associations were analyzed using modified Poisson regression models with robust variance for dichotomous outcomes and multiple linear regression models for continuous outcomes.

Better adherence to a heart‐healthy dietary pattern, as measured by the CHDI, was consistently associated with lower chances of having key cardiometabolic risk factors. Specifically, Poisson regression analyses showed that each additional point in the CHDI score corresponded to about a 1% lower likelihood of having excess body weight (BMI > 25 kg/m²; β: 0.99; p = 0.0102), being classified as at increased cardiovascular risk due to abdominal obesity (waist circumference; β: 0.99; p = 0.0145), or presenting elevated diastolic blood pressure (> 80 mmHg; β: 0.99; p = 0.0370). Higher scores were also associated with about a 1% lower probability of having insulin resistance (β: 0.99; p < 0.0001) and elevated C‐reactive protein levels, a marker of systemic inflammation (β: 0.99; p = 0.0207).

The CHDI showed stronger associations with cardiometabolic risk factors than the BHEI‐R, indicating its potential as a sensitive tool for assessing diet quality in research and surveillance. Further studies in diverse populations are needed to confirm its applicability in other contexts.

Graphical abstract showing a cross‐sectional study of 557 workers aged 20–59, assessing dietary quality via the Cardiovascular Health Diet Index (CDHI) and its association with cardiometabolic risk factors.

This study is among the first to apply the Cardiovascular Health Diet Index (CHDI) to assess dietary quality in a working population, reinforcing its potential as an innovative and underutilized tool in cardiovascular health research.The dietary quality assessed by the CHDI showed a stronger association with cardiometabolic risk factors than the BHEI‐R, likely due to its updated approach that considers the consumption of ultra‐processed foods and distinguishes between plant and animal‐based protein sources.The promising results of the CHDI in assessing dietary quality suggest that it could be a valuable tool for identifying key areas requiring dietary interventions, particularly in strategies aimed at promoting cardiovascular health and preventing cardiovascular diseases.

This study is among the first to apply the Cardiovascular Health Diet Index (CHDI) to assess dietary quality in a working population, reinforcing its potential as an innovative and underutilized tool in cardiovascular health research.

The dietary quality assessed by the CHDI showed a stronger association with cardiometabolic risk factors than the BHEI‐R, likely due to its updated approach that considers the consumption of ultra‐processed foods and distinguishes between plant and animal‐based protein sources.

The promising results of the CHDI in assessing dietary quality suggest that it could be a valuable tool for identifying key areas requiring dietary interventions, particularly in strategies aimed at promoting cardiovascular health and preventing cardiovascular diseases.