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Dietary intake is one lifestyle factor shown to improve or maintain body composition. However, few studies have examined the Healthy Eating Index2015 (HEI2015), a measure of diet quality, and the association with body composition in adult men and women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participant data (<jats:italic>n<\/jats:italic>\u00a0=\u00a03017) from the Coronary Artery Risk Development in Young Adults (CARDIA) study were used to examine the associations of the HEI2015 with body composition measures at Year 25 (Y25), including (1) 25\u00a0year\u2010change in weight, body mass index (BMI), and waist circumference and (2) a computed tomography (CT) scan at Y25 measured muscle mass, muscle quality (better quality\u00a0=\u00a0less lipid within the muscle), and adipose tissue depots visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and adipose within skeletal muscle (intermuscular adipose tissue; IMAT). Dietary intake was assessed by a diet history three times over 20\u00a0years, at years 0, 7, and 20. HEI2015, averaged over three exams, was created and categorized into quintiles. Multiple regression analysis evaluated the associations of body composition stratified across quintiles of HEI2015 adjusted for demographic characteristics, energy intake, lifestyle factors, and baseline anthropometric measures as appropriate. Race\u2013sex interaction was tested (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u00a0&gt;\u00a00.30).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 25\u00a0years of follow\u2010up, averaged HEI2015 was significantly and inversely associated with weight gain (Quintile 1 (Q1) 37.3\u00a0lb vs. 32.9 in Q5; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0=\u00a00.01), change in BMI (Q1 5.8\u00a0kg\/m<jats:sup>2<\/jats:sup> vs. 5.0 in Q5; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0=\u00a00.005), and change in waist circumference (Q1 17.5\u00a0cm vs. 15.2\u00a0cm in Q5; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0&lt;\u00a00.001). By Y25, HEI2015 was inversely associated with VAT Q1 136.8\u00a0cm<jats:sup>3<\/jats:sup> vs. 116.6 in Q5; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0&lt;\u00a00.001) and IMAT volumes (Q1 9.52 vs. 8.12\u00a0cm<jats:sup>3<\/jats:sup> in Q5; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0&lt;\u00a00.001). Although total muscle volume declined (<jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0=\u00a00.03), lean muscle mass volume was similar across quintiles (<jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0=\u00a00.55). The IMAT\/total muscle mass ratio declined across HEI2015 quintiles (<jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0&lt;\u00a00.001). Finally, higher HEI2015 was associated with better muscle quality at Y25 (higher value\u00a0=\u00a0less lipid within the muscle; Q1 41.1 vs. 42.2 HU in Q5; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0=\u00a00.002). HEI2015 was nonlinearly, but inversely, associated with SAT (nonlinear <jats:italic>P<\/jats:italic>\u00a0=\u00a00.011).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Improving diet quality in young to middle\u2010aged adults is a recommended strategy to promote better measures of body composition. Our study findings suggest that healthier food choices may influence body composition.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.13399","type":"journal-article","created":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T03:59:00Z","timestamp":1702439940000},"page":"425-433","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Diet quality is associated with adipose tissue and muscle mass: the Coronary Artery Risk Development in Young Adults (CARDIA) study"],"prefix":"10.1002","volume":"15","author":[{"given":"Masoud","family":"Isanejad","sequence":"first","affiliation":[{"name":"Institute of Life Course and Medical Sciences University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4053-6729","authenticated-orcid":false,"given":"Lyn M.","family":"Steffen","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Terry","sequence":"additional","affiliation":[{"name":"Department of Radiology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Shikany","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Heersink School of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Zhou","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"So\u2010YunYi","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and 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