Everything in Moderation - Dietary Diversity and Quality, @entity1144 and Risk of XXXX .

@entity2175 @entity1 @entity6 @entity1144 @entity731
UNASSIGNED: Diet guidelines recommend increasing dietary diversity. Yet, metrics for dietary diversity have neither been well-defined nor evaluated for impact on metabolic health. Also, whether diversity has effects independent of diet quality is unknown. We characterized and evaluated associations of diet diversity and quality with @entity1144 and @entity2175 ( @entity2175 ) in the Multi-Ethnic Study of @entity731 . At baseline (2000-02), diet was assessed among 5,160 Whites, Hispanic, Blacks, and Chinese age 45-84 y and free of @entity2175 , using a validated questionnaire. Three different aspects of diet diversity were characterized including count (number of different food items eaten more than once/week, a broad measure of diversity), evenness (Berry index, a measure of the spread of the diversity), and dissimilarity (Jaccard distance, a measure of the diversity of the attributes of the foods consumed). Diet quality was characterized using aHEI, DASH, and a priori pattern. Count and evenness were weakly positively correlated with diet quality (r with AHEI: 0.20, 0.04), while dissimilarity was moderately inversely correlated (r = -0.34). In multivariate models, neither count nor evenness was associated with change in waist circumference (WC) or incident @entity2175 . Greater food dissimilarity was associated with higher gain in WC (p-trend<0.01), with 120% higher gain in @entity1 in the highest quintile of dissimilarity scores. Diet diversity was not associated with incident @entity2175 . Also, none of the diversity metrics were associated with change in WC or incident @entity2175 when restricted to only healthier or less healthy foods. Higher diet quality was associated with lower risk of @entity2175 . Our findings provide little evidence for benefits of diet diversity for either @entity1144 or @entity6 . Greater dissimilarity among foods was actually associated with gain in WC. These results do not support the notion that "eating everything in moderation" leads to greater diet quality or better metabolic health.
