Nutritional epidemiology has traditionally focused on the effects of single nutrients or foods on disease outcomes. However, because nutrients and foods are consumed in combination, their joint effects may be best investigated by considering the entire eating pattern. Analyzing food consumption in the form of dietary patterns offers a perspective different from the traditional single-nutrient focus and may provide a comprehensive approach to disease prevention or treatment, which has been used in several settings, including Dietary Approach to Stop Hypertension and the Lyon Diet Heart Study.
In previous studies of men, the researchers identified two major dietary patterns: One is labeled the "prudent pattern" characterized by a higher intake of fruits, vegetables, fish, whole grains, and legumes; the second is labeled the "Western pattern," characterized by a higher intake of red and processed meat, high-fat dairy products, sweets, and desserts. These two patterns significantly predicted the risk of coronary heart disease (CHD) during 8 years of follow-up among 44,875 men. However, such associations have not been examined in women. Therefore, the present study examined prospectively the associations between dietary patterns and the risk of CHD among women in the Nurses' Health Study.
Women were included in the present analysis if they completed the 1984 semiquantitative food frequency questionnaire (FFQ) with less than 70 missing items, and a total caloric range as calculated by the FFQ between 500 and 3500 kcal/d. There were 69,017 women included in this study. The endpoint of the study included fatal CHD and nonfatal MI that occurred between the return of the 1984 questionnaire, and June 1, 1996. Ascertainment of death records was 98% complete.
There were two major dietary patterns identified, and they were labeled as the "prudent" pattern and the "Western" pattern, as they were in the previous study. The prudent pattern was characterized by a high intake of fruits, vegetables, whole grains, legumes, poultry, and fish. The Western pattern was characterized by refined grains, processed and red meats, desserts, high-fat dairy products, and french fries.
Individuals with high prudent-pattern scores tended to smoke less; use more vitamin supplements; drink more alcohol; consume more folate, fiber, and protein; and consume less saturated and monounsaturated fats. A higher prudent pattern score was associated with a lower risk of total CHD. After adjusting for body mass index, smoking, caloric intake, supplemental vitamin use, hormone replacement therapy, and other coronary risk factors, the prudent pattern remained significantly and inversely associated with the risk of CHD. The positive associations between the Western pattern and CHD persisted in all subgroups.
This study indicates that a diet high in fruits, vegetables, legumes, whole grains, poultry, and fish and low in red and processed meats and refined grains may lower risk of CHD in women.
T. Fung, W. Willett, M. Stampfer, J. Manson, F. Hu. Dietary Patterns and the Risk of Coronary Heart Disease in Women. Arch Intern Med 161(15):1857-1862 (August 2001) [Correspondence: Teresa T. Fung, ScD, RD, Programs in Nutrition, Simmons College, 300 The Fenway, Boston, MA 02115. E-mail: firstname.lastname@example.org].
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