Abstract
<title>Abstract</title> <p>Background Carotid intima-media thickness (cIMT) is a well-established marker of subclinical atherosclerosis, while overall diet quality has emerged as an important modifiable determinant of cardiovascular health. Therefore, this study aimed to investigate the association between adherence to the Healthy Eating Index-2020 (HEI-2020) and cIMT among overweight and obese children and adolescents. Methods This cross-sectional study included 353 overweight or obese children and adolescents aged 6–13 years residing in Tehran, Iran. Dietary intake was assessed using a validated 147-item semi-quantitative food frequency questionnaire, and HEI-2020 scores were calculated to evaluate overall diet quality. Carotid intima-media thickness was measured using high-resolution ultrasonography and an automated edge-tracking technique. Multivariable linear and logistic regression analyses were performed to examine the association between HEI-2020 and cIMT after adjustment for demographic, anthropometric, lifestyle, and metabolic variables. Results Mean cIMT values decreased significantly across increasing tertiles of HEI-2020, from 0.41 mm in the lowest tertile to 0.37 mm in the highest tertile (P < 0.01). In fully adjusted models, each one-standard deviation increase in HEI-2020 score was associated with a 0.020-mm lower cIMT. Furthermore, each one-standard deviation increase in HEI-2020 was associated with a 27% lower odds of elevated cIMT (OR = 0.73, 95% CI: 0.56–0.94). Compared with participants in the lowest tertile, those in the second and third tertiles had 55% and 50% lower odds of elevated cIMT, respectively (P-trend = 0.03). Conclusions Greater adherence to HEI-2020 was independently associated with lower carotid intima-media thickness and reduced odds of elevated cIMT among overweight and obese children and adolescents.</p>