Background and objectives: Lipoprotein particle concentrations and size are associated with increased
risk for atherosclerosis and premature cardiovascular disease. Studies also suggest that certain dietary
behaviours may be cardioprotective. Limited comparative data regarding any dietary score/index-
lipoprotein particle subclass associations exist. Thus, our objective was to assess relationships between
the Dietary Approaches to Stop Hypertension (DASH), Health Eating Index-2015 (HEI-2015), Mediter-
ranean Diet (MD) and Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and plasma lipids
and lipoprotein profiles to test the hypothesis that healthier diet (better quality and more anti-
inflammatory) would be associated with a more favourable lipoprotein profile.
Materials and methods: This was a cross-sectional study of 1862 men and women aged 46e73 years,
randomly selected from a large primary care centre in Ireland. DASH, HEI-2015, MD and E-DII scores were
derived from food frequency questionnaires. Lipoprotein subclass particle concentrations and size were
determined using nuclear magnetic resonance spectroscopy. Correlation and multivariate-adjusted
linear regression analyses with correction for multiple testing were performed to examine dietary
score relationships with lipoprotein particle subclasses.
Results: In fully adjusted models, higher diet quality or a more anti-inflammatory diet was associated
with less large and medium very low-density lipoprotein (VLDL) (DASH and HEI-2015), intermediate-
density lipoprotein (IDL) (DASH, MD and E-DII) and small high-density lipoprotein (HDL) (DASH, HEI-
2015 and E-DII) particles. After accounting for multiple testing, relationships with large VLDL (DASH:
b ¼ -0.102, p ¼ .037), IDL (DASH: b ¼ -0.089, p ¼ .037) and small HDL (DASH: b ¼ -0.551, p ¼ .014 and E-
DII: b ¼ 0.483, p ¼ .019) concentrations persisted.
Conclusions: These findings provide evidence that better diet quality, determined by the DASH score,
may be more closely associated with a more favourable lipoprotein particle subclass profile in middle-to
older-aged adults than the HEI-2015, MD and E-DII scores. A less pro-atherogenic lipoprotein status may
be a potential mechanism underlying the cardioprotective effects of higher dietary quality.