The Healthy Beverage Index Is Associated with Reduced Cardiometabolic Risk in US Adults: A Preliminary Analysis

Background and objective Beverage recommendations exist, but few evaluate overall beverage intake quality. Our objective was to develop a scoring algorithm for assessing beverage intake quality among US adults (aged ≥19 years), and to examine the association between overall beverage quality and cardiometabolic risk. Design We developed a scoring algorithm, similar to the Healthy Eating Index-2010, using recommendations for total beverage energy, meeting fluid requirements, and consuming within recommended limits for beverage subgroups (eg, low-fat milk, fruit juice). Multiple scoring systems were evaluated. The final scoring system, which consisted of 10 components, was applied to the average of 2 days of 24-hour dietary intake data for adults (aged ≥19 years) from the National Health and Nutrition Examination Survey (NHANES), 2005-2010. Statistical analyses performed Poisson regression models stratified by sex and body mass index multivariables were used to examine the cross-sectional association between the Healthy Beverage Index (HBI) score and cardiometabolic outcomes. Results The 10-item index had a mean±standard deviation score of 63±16 from a possible 100 points. Each 10-point higher HBI score was associated with lower odds ratios for hypertension (men and women); high fasting insulin level, high fasting glucose level, and high low-density lipoprotein cholesterol level (women and overweight/obese men), low high-density lipoprotein cholesterol level (women), and high C-reactive protein level (men). Conclusions We found positive associations between higher HBI scores and more favorable lipid profiles; hypertension risk; and, among men, C-reactive protein levels. These preliminary results suggest that the HBI could be a valuable tool to evaluate overall beverage intake quality in adults. More research is needed to understand whether improvements in beverage quality and, thus, HBI score, are associated with beneficial changes in health.