The Dietary Patterns Methods Project is a multi-institutional effort to standardize dietary pattern research through consistency of methods that could be used as a basis for future dietary recommendations. Four dietary quality indices including the Healthy Eating Index 2010, Alternative Healthy Eating Index 2010, alternate Mediterranean Diet, and the Dietary Approaches to Stop Hypertension diet were found to be consistently associated with reduced risk of death due to all-cause, cardiovascular disease, and cancer in 3 large cohorts. However, several questions related to the nature of the high-quality diet remain unanswered. For example, it is currently unknown if distinct dietary patterns exist within high-quality dietary intake that are associated with healthy benefits.

To explore this further, Angela Liese (University of South Carolina) and colleagues conducted a study, published in The Journal of Nutrition, to identify specific dietary patterns and groups therein and their associations with all- cause mortality, cardiovascular disease, and cancer mortality. Published in The Journal of Nutrition, researchers conducted sex-specific cluster analyses within Healthy Eating Index 2015 in 3 US cohorts. Associations of quintile 5 with all-cause, cardiovascular disease, and cancer mortality were evaluated relative to quintile 1.

In each cohort sex-specific sample, 3 identified clusters provide evidence for variation within high-quality dietary intake. Clusters revealed commonalities in total fruits and whole fruits intakes that exceeded goals and high sodium intake. Dietary whole grain intakes oftentimes fell below goals. Some clusters characterized by intakes of total vegetables, greens and beans, and seafood and plant protein exceeded goals. All high-quality dietary patterns were associated with lower risk of all-cause death than diet intake in quintile 1 (except for cluster 2 in the Women’s Health Initiative Observational Study) and with lower risk of cardiovascular disease mortality in the National Institutes of Health-American Association of Retired Persons Diet and Health Study and the Multiethnic Cohort. In contrast to the all-cause death patterns, cancer mortality results were inconsistent.

This exploration of the multidimensional nature of high-quality diets confirmed variation in eating types within the high-quality intake spectrum. The findings highlight differences in consumption patterns in people with very high-quality diets, by identifying intakes significantly greater than recommendations for select food groups such as total and whole fruits. Yet, areas still in need of improvement include sodium, dairy, and refined grains. More research is needed to understand whether exceeding recommendations on 1 dietary component can offset suboptimal adherence on another component. In conclusion, this cluster analysis-based study identified multiple ways to achieve a healthy diet.

In a companion commentary, Cara Frankenfeld (University of Puget Sound) commends the research team for analyzing dietary patterns within a high-quality diet, noting that this work provides an important foundation towards a more comprehensive understanding of how dietary patterns can influence population health.  Analyzing dietary patterns also provides information that can be utilized to improve dietary recommendations.


Angela D Liese, Edwina Wambogo, Jennifer L Lerman, Carol J Boushey, Marian L Neuhouser, Song Wang, Brook E Harmon, Lesley F Tinker, Variations in Dietary Patterns Defined by the Healthy Eating Index 2015 and Associations with Mortality: Findings from the Dietary Patterns Methods Project, The Journal of Nutrition, Volume 152, Issue 3, March 2022, Pages 796–804,

Cara L Frankenfeld, Probing Beyond: Looking into the Patterns within a High-Quality Diet, The Journal of Nutrition, Volume 152, Issue 3, March 2022, Pages 653–654,

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