|Van Horn, Linda|
Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/30/2011
Publication Date: 2/1/2012
Citation: Van Horn, L., Tian, L., Neuhouser, M., Howard, B., Eaton, C., Snetselaar, L., Matthan, N., Lichtenstein, A. 2012. Dietary patterns are associated with disease risk among participants in the women's health initiative observational study. Journal of Nutrition. 142:284-291. Interpretive Summary: Heart disease is the leading cause of death in women. Focusing on women who participated in the women’s Health Initiative we compared the diets of women who developed heart disease over a 5-year period with those who did not develop heart disease. The two groups of women were matched for age, study enrollment date, and race/ethnicity. Three dietary patterns or clusters were identified among all the women. Diet cluster 1 was rich in carbohydrate, vegetable protein, fiber, dietary vitamin K, folate, carotenoids, unsaturated fatty acids found in vegetable oils, and supplemental calcium and vitamin D. Diet cluster 2 was rich in total and animal protein, omega-3 fatty acids, vitamin D, and calcium. Diet cluster 3 was rich in energy (calories), total fat, and trans fatty acids. It was more likely that women who reported consuming diets similar to diet cluster 1 were at lower risk of developing heart disease than those women who reported consuming diets similar to diet cluster 2 after adjusting for smoking, level of education, and level of physical activity. However, this difference in heart disease risk between the women consuming two different types of diet was not significant after adjusting for a body weight relative to height index and systolic blood pressure. Women consuming diets similar to diet cluster 3 were at higher risk of developing heart disease than those women who reported consuming diets similar to diet cluster 2, although this difference did not remain significant after adjustment for smoking, level of education, and level of physical activity. These data suggest that certain dietary patterns are associated with elevated risk for heart disease in postmenopausal women. However, this association is modified by other lifestyle variables.
Technical Abstract: Coronary heart disease (CHD) is the leading cause of death in women. A nested case-control study tested whether dietary patterns predicted CHD events among 1224 participants in the Women’s Health Initiative-Observational Study (WHI-OS) with centrally confirmed CHD, fatal or nonfatal myocardial infarct compared to 1224 WHI-OS controls matched for age, enrollment date, race/ethnicity, and absence of CHD at baseline or follow-up. The first six principal components explained >75% of variation in dietary intakes and K-mean analysis based on these six components produced three clusters. Diet cluster 1 was rich in carbohydrate, vegetable protein, fiber, dietary vitamin K, folate, carotenoids, a-linolenic acid [18:3(n-3)], linoleic acid [18:2(n-6)], and supplemental calcium and vitamin D. Diet cluster 2 was rich in total and animal protein, arachidonic acid [20:4(n-6)], DHA [22:6(n-3)], vitamin D, and calcium. Diet cluster 3 was rich in energy, total fat, and trans fatty acids (all P < 0.01). Conditional logistic regression analysis demonstrated diet cluster 1 was associated with lower CHD risk than diet cluster 2 (reference group) adjusted for smoking, education, and physical activity [OR = 0.79 (95% CI = 0.64, 0.99); P = 0.038]. This difference was not significant after adjustment for BMI and systolic blood pressure. Diet cluster 3 was associated with higher CHD risk than diet cluster 2 [OR = 1.28 (95% CI = 1.04, 1.57); P = 0.019], but this difference did not remain significant after adjustment for smoking, education, and physical activity. Within this WHI-OS cohort, distinct dietary patterns may be associated with subsequent CHD outcomes.