Couple Eating Meal

Alternative Food Pyramid Could Reduce Risk of Death

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Couple Eating MealYou are what you eat. How long have we all heard this adage? And how many diet books and nutritional pyramids have been created to address this topic?

According to Harvard researchers, not the right ones. In 2008, faculty in the Department of Nutrition at Harvard University’s School of Public Health devised a response to the USDA’s Food Pyramid. They dubbed it the Healthy Eating Pyramid (HEP).[1]

Unlike the USDA’s version, the HEP has exercise and weight control as its foundation. Next come fruits and vegetables, healthy fats/oils and whole grains. After those are fish, poultry and eggs, as well as nuts, seeds, beans and tofu. Then comes dairy OR vitamin D/calcium supplements.

Lastly, are red meat, refined grains, sugar and salt. They also make note of taking a daily multivitamin and consuming up to one alcoholic drink a day. Plus, the HEP focuses less on numbers and servings from each category and more on quality.

Healthy Eating Pyramid Source: Harvard School of Public Health

The Battle of the Indexes

To see how well Americans were following the USDA’s guidelines, the agency created the Healthy Eating Index to score adherence. A score of 100 meant total adherence, while a score of 0 meant completely disregarding the guidelines.

They found that men with the highest scores reduced their risk of heart disease, cancer and other chronic diseases by 11 percent. Women with the highest scores reduced their risk by 3 percent.

Harvard decided to follow suit and created the Alternative Healthy Eating Index based on their Healthy Eating Pyramid. They found that men with the highest scores reduced their risk of heart disease, cancer and other chronic diseases by 20 percent. Women with the highest scores reduced their risk by 11 percent. And when it came to cardiovascular disease in particular, men with high scores reduced their risk by 40 percent, while women saw a 30 percent risk reduction.

Given these fantastic results, researchers from England decided to see how participants in the Whitehall II study fared. This study involved a group of more than 7,300 London-based office staff between the ages of 35 and 55, who have been followed for 18 years, monitoring diet, exercise, etc.[2]

The Diet/Death Connection

Several studies have examined adherence to the AHEI and cause of death. One study found that high scores were associated with lower risk of cardiovascular disease.[3] Another study found that high scores were correlated with reduced risk of type 2 diabetes.[4] And yet another study (also with the Whitehall II group) found that sticking to the AHEI resulted in nearly double the odds of reversing metabolic syndrome.[5]

Yet, current study researchers didn’t feel that these or other previous studies adequately examined the effect of the AHEI on overall, as well as cause-specific mortality. Additionally, they wanted to know which specific components of the AHEI were most closely related to a decrease in mortality rates.[6]

Researchers looked at participants’ semiquantitative food-frequency questionnaires. Each questionnaire had 127 food items on it. Researchers converted daily intake of these foods into daily intake numbers. Multivitamin use was also noted.

They then determined AHEI scores based on intake levels in nine areas:

  • Vegetables
  • Fruits
  • Nuts and soy
  • Ratio of white meat (seafood and poultry) to red meat
  • Cereal fiber (which was recorded with total fiber)
  • Trans fat
  • Ratio of polyunsaturated fats to saturated fats
  • Long-term multivitamin use (less than five years or five years or longer)
  • Alcohol consumption

Based on this, total AHEI scores ranged from 2.5 to 87.5 points.

Researcher went on to note health behaviors such as smoking, total caloric intake and physical activity levels. They also determined baseline health status, including coronary heart disease, diabetes, high blood pressure, high cholesterol, BMI, metabolic syndrome and chronic inflammation, marked by high interleukin-6 and C-reactive protein.

After controlling for sex, age, ethnicity, marital status, occupation, smoking, exercise habits and total caloric intake, researchers found that those people who scored higher on the AHEI had a decreased risk of all-cause mortality, as well as death, from cardiovascular disease.

Specifically, those in the highest third of the AHEI had a nearly 25 percent reduced risk of all-cause mortality and a 40 percent lower risk of death from cardiovascular disease, as compared with those people in the lower third.

Interestingly, when it came to all-cause mortality, four of the nine components of the AHEI score were significantly linked to reduced risk. These included nuts and soy, ratio of white to red meat, total fiber and alcohol consumption.

On the cardiovascular front, nuts and soy, as well as moderate alcohol consumption were significantly associated with reduced risk.

While researchers acknowledge that a pre-determined food questionnaire with just over 100 food items is not as ideal as a food diary, they believe the results support adherence to the Healthy Eating Pyramid and AHEI. They suggest, “Encouragement of the consumption of nuts and soy products and white meat instead of red meat, a high fiber intake, and moderate alcohol consumption may have a significant benefit in terms of a decrease in all-cause and cardiovascular mortality.”

Go Nuts … and Wine a Little

Nuts and WineNow who can’t get behind recommendations like nuts and wine! On the nut front, your best bets are almonds, walnuts and pistachios. But remember, moderation is the key.

Because they can be high in fat, limit your nut consumption to a handful at most. And think unsalted and raw versus roasted. Also, as an FYI, peanuts are not nuts. They are legumes, like beans or peas. Plus, they are one of the most common food allergens in the United States. So keep your nutty intake to actual nuts.

On the wine front, less is more. A “serving” of alcohol for liquor is 1–2 ounces. For wine, it’s four ounces, and for beer it’s 10-12 ounces. Best options include red wine (due to resveratrol) or clear liquors such as vodka or gin (because they’re lower in calories and carbohydrates than other liquors). Be sure to mix with water or club soda rather than tonic water or fruit juice to keep sugar levels low.


[2] Akbaraly, TN et al. Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort. Am J Clin Nutr. 2011 May 25. [Epub ahead of print.]

[3] McCullough ML et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002;76:1261-7.

[4] Fung, TT et al. A prospective study of overall diet quality and risk of type 2 diabetes in women. Diabetes Care. 2007;30:1753-7.

[5] Akbaraly, TN et al. Overall diet history and reversibility of the metabolic syndrome over 5 years: the Whitehall II prospective cohort study. Diabetes Care. 2010;33:2339-41.

[6] Akbaraly, TN et al. Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort. Am J Clin Nutr. 2011 May 25. [Epub ahead of print.]

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