Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study

Tuyen Van Duong, I. Hsin Tseng, Te Chih Wong, Hsi Hsien Chen, Tso Hsiao Chen, Yung Ho Hsu, Sheng Jeng Peng, Ko Lin Kuo, Hsiang Chung Liu, En Tzu Lin, Yi Wei Feng, Shwu Huey Yang

Research output: Contribution to journalArticle


A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis centers. Dietary data (using three independent 24-hour dietary records), clinical and laboratory parameters were collected. The construct and criterion validity of original AHEI-2010 with 11 items and the AHEI-HD with 16 items were examined. Both scales showed reasonable item-scale correlations and satisfactory discriminant validity. The AHEI-HD demonstrated a weaker correlation with energy intake compared with AHEI-2010. Principle component analysis yielded the plateau scree plot line in AHEI-HD but not in AHEI-2010. In comparison with patients in lowest diet quality (tertile 1), those in highest diet quality (tertile 3) had significantly lower risk for death, with a hazard ratio (HR) and 95% confidence intervals (95%CI) of HR: 0.40; 95%CI: 0.18 - 0.90; p = 0.028, as measured by AHEI-2010, and HR: 0.37; 95%CI: 0.17-0.82; p = 0.014 as measured by AHEI-HD, respectively. In conclusion, AHEI-HD was shown to have greater advantages than AHEI-2010. AHEI-HD was suggested for assessments of diet quality in hemodialysis patients.

Original languageEnglish
Issue number6
Publication statusPublished - Jun 21 2019



  • all-cause mortality
  • alternative healthy eating index
  • complex and multidimensional
  • diet quality
  • diet quantity
  • end-stage renal disease
  • hemodialysis
  • principal component analysis
  • prospective cohort
  • validation

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics

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