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1.
Sci Rep ; 10(1): 2550, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054969

RESUMO

The intrauterine and early life environments have been linked to the etiology of breast cancer in prior studies. We prospectively examined whether maternal and newborn anthropometric factors as reported by the mother are related to an increased incidence of adult breast cancer in the daughter. We used data from 35,133 mother-daughter dyads of the Nurses' Health Study (NHS) II and the Nurses' Mothers' Cohort Study. In 2001, living mothers of NHS II participants who were free of cancer completed a questionnaire on their pregnancy with the nurse and their nurse daughter's early life experience. During 403,786 years of follow-up, 865 daughters developed incident cases of invasive breast cancer. Nurses with a birthweight of ≥4000 g had a 32% greater risk for breast cancer (multivariable-adjusted hazard ratio (HR) = 1.32, 95% confidence interval (CI) = 1.02-1.71, p-trend = 0.09) compared with those with birthweights of 3000-3499 g. Higher birth length tended to increase risk of premenopausal breast cancer (p for trend = 0.05). We further noted a modest U-shaped relation between maternal weight gain during pregnancy and premenopausal breast cancer incidence in the daughter. Fetal growth may contribute to shaping later life risk for breast cancer, especially prior to menopause.

2.
Int J Cancer ; 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32012248

RESUMO

Early-adulthood body size is strongly inversely associated with risk of premenopausal breast cancer. It is unclear whether subsequent changes in weight affect risk. We pooled individual-level data from 17 prospective studies to investigate the association of weight change with premenopausal breast cancer risk, considering strata of initial weight, timing of weight change, other breast cancer risk factors and breast cancer subtype. Hazard ratios (HR) and 95% confidence intervals (CI) were obtained using Cox regression. Among 628,463 women, 10,886 were diagnosed with breast cancer before menopause. Models adjusted for initial weight at ages 18-24 years and other breast cancer risk factors showed that weight gain from ages 18-24 to 35-44 or to 45-54 years was inversely associated with breast cancer overall (e.g., HR per 5 kg to ages 45-54: 0.96, 95% CI: 0.95-0.98) and with oestrogen-receptor(ER)-positive breast cancer (HR per 5 kg to ages 45-54: 0.96, 95% CI: 0.94-0.98). Weight gain from ages 25-34 was inversely associated with ER-positive breast cancer only and weight gain from ages 35-44 was not associated with risk. None of these weight gains were associated with ER-negative breast cancer. Weight loss was not consistently associated with overall or ER-specific risk after adjusting for initial weight. Weight increase from early-adulthood to ages 45-54 years is associated with a reduced premenopausal breast cancer risk independently of early-adulthood weight. Biological explanations are needed to account for these two separate factors.

3.
N Engl J Med ; 382(7): 644-654, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32053300
4.
Am J Clin Nutr ; 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31968071

RESUMO

BACKGROUND: Although a link between regular yogurt consumption and mortality appears plausible, data are sparse and have yielded inconsistent results. OBJECTIVES: We examined the association between regular yogurt consumption and risk of all-cause and cause-specific mortality among US women and men. METHODS: A total of 82,348 women in the Nurses' Health Study and 40,278 men in the Health Professionals Follow-Up Study without a history of cardiovascular disease (CVD) and cancer in 1980 (women) or 1986 (men) were followed up until 2012. Yogurt consumption was assessed by updated validated FFQs. RESULTS: During 3,354,957 person-years of follow-up, 20,831 women and 12,397 men died. Compared with no yogurt consumption, the multivariable-adjusted HRs (95% CIs) of mortality were 0.89 (0.86, 0.93), 0.85 (0.81, 0.89), 0.88 (0.84, 0.91), and 0.91 (0.85, 0.98) for ≤1-3 servings/mo, 1 serving/wk, 2-4 servings/wk, and >4 servings/wk in women (P-trend = 0.34), respectively. For men, the corresponding HRs (95% CIs) were 0.99 (0.94, 1.03), 0.98 (0.91, 1.05), 1.04 (0.98, 1.10), and 1.05 (0.95, 1.16), respectively. We further noted inverse associations for cancer mortality (multivariable-adjusted HR comparing extreme categories: 0.87; 95% CI: 0.78, 0.98; P-trend = 0.04) and CVD mortality (HR: 0.92; 95% CI: 0.79, 1.08; P-trend = 0.41) in women, although the latter was attenuated in the multivariable-adjusted model. Replacement of 1 serving/d of yogurt with 1 serving/d of nuts (women and men) or whole grains (women) was associated with a lower risk of all-cause mortality, whereas replacement of yogurt with red meat, processed meat (women and men), and milk or other dairy foods (women) was associated with a greater mortality. CONCLUSIONS: In our study, regular yogurt consumption was related to lower mortality risk among women. Given that no clear dose-response relation was apparent, this result must be interpreted with caution.

5.
J Periodontol ; 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31950502

RESUMO

BACKGROUND: The anti-inflammatory effect associated with flavonoids containing foods and beverages could potentially impact the risk of periodontal disease. We prospectively investigate the associations between habitual flavonoid intake and incidence of periodontitis. METHODS: The study population was 34,940 men from the Health Professionals Follow-Up Study, who were healthy and free of periodontal disease at baseline (1986). Participants in the study provided medical and dental history through mailed questionnaires biennially, and provided dietary data through semi-quantitative food frequency questionnaires every 4 years. We examined the associations between total flavonoids and six flavonoid subclasses (flavonoid polymers, anthocyanins, flavan-3-ols, flavanones, flavones, and flavonols) and incidence of periodontitis using Cox proportional hazard models. We adjusted for age, smoking, body mass index, physical activity, alcohol consumption, Alternative Healthy Eating Index, and diabetes. RESULTS: There was no association between total flavonoids and the risk of periodontitis. The hazard ratio comparing the highest quintile of total flavonoid to the lowest quintile was 0.97 (95% confidence interval: 0.87 to 1.08, P-value for trend = 0.61). Similar comparisons for flavonoids subclasses also did not show significant associations. CONCLUSION: No association was detected between habitual flavonoid intake and risk of periodontitis in the study population.

6.
BMJ ; 368: l6669, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915124

RESUMO

OBJECTIVE: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME: Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Estilo de Vida Saudável/fisiologia , Expectativa de Vida , Neoplasias , Comportamento de Redução do Risco , Adulto , Consumo de Bebidas Alcoólicas , Índice de Massa Corporal , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Neoplasias/psicologia , Pesquisa em Enfermagem , Estudos Prospectivos , Fumar
7.
Cancer Prev Res (Phila) ; 13(1): 65-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31699705

RESUMO

Branched-chain amino acids (BCAA) are essential amino acids, and emerging evidence suggests that BCAAs may mediate pathways related to cancer progression, possibly due to their involvement in insulin metabolism. We investigated the association between dietary intake of BCAAs with colorectal cancer risk in three prospective cohorts: the Nurses' Health Study I [(NHS), number of participants (n) at baseline = 77,017], NHS II (n = 92,984), and the Health Professionals Follow-up Study [(HPFS) n = 47,255]. Validated food frequency questionnaires were administered every 4 years and follow-up questionnaires on lifestyle biennially. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression models. Pooled HRs were obtained using random effect models. After up to 28 years of follow-up, 1,660 cases were observed in NHS, 306 in NHS II, and 1,343 in HPFS. In multivariable adjusted models, we observed a weak inverse association between BCAA intake and colorectal cancer [highest vs. lowest quintile, pooled HR including all three cohorts (95% CI): 0.89 (0.80-1.00), P trend = 0.06, HR per standard deviation (SD) increment 0.95 (0.92-0.99)]. However, after including dairy calcium to the models, BCAA intake was no longer associated with risk of colorectal cancer [HR 0.96 (0.85-1.08), P trend = 0.50, HR per SD increment 0.97 (0.93-1.01)]. We did not find evidence that higher dietary BCAA intake is associated with higher risk of colorectal cancer. As this is the first prospective study to examine the association between BCAA intake and colorectal cancer, our findings warrant investigation in other cohorts.

8.
Int J Cancer ; 146(5): 1241-1249, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31116416

RESUMO

Although increasing dairy product intake has been associated with risk of several cancers, epidemiological studies on hepatocellular carcinoma are sparse and have yielded inconsistent results. We prospectively assessed the associations of dairy products (total, milk, butter, cheese and yogurt) and their major components (calcium, vitamin D, fats and protein) with the risk of hepatocellular carcinoma development among 51,418 men and 93,427 women in the Health Professionals Follow-Up Study and the Nurses' Health Study. Diets were collected at baseline and updated every 4 years using validated food frequency questionnaires. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression model. During up to 32 years of follow-up, a total of 164 hepatocellular carcinoma cases were documented. After adjustment for most known hepatocellular carcinoma risk factors, higher total dairy product intake was associated with an increased risk of hepatocellular carcinoma (highest vs. lowest tertile, HR = 1.85, 95% CI: 1.19-2.88; ptrend = 0.009). For the same comparison, we observed significant positive associations of high-fat dairy (HR = 1.81, 95% CI: 1.19-2.76; ptrend = 0.008) and butter (HR = 1.58, 95% CI: 1.06-2.36; ptrend = 0.04) with hepatocellular carcinoma risk. There was a nonsignificant inverse association between yogurt intake and hepatocellular carcinoma risk (HR = 0.72, 95% CI: 0.49-1.05; ptrend = 0.26). Our data suggest that higher intake of high-fat dairy foods was associated with higher, whereas higher yogurt consumption might be associated with lower risk of developing hepatocellular carcinoma among U.S. men and women.

9.
J Natl Cancer Inst ; 2019 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-31845728

RESUMO

BACKGROUND: Excess body weight is an established cause of postmenopausal breast cancer, but it is unknown if weight loss reduces risk. METHODS: Associations between weight change and risk of breast cancer were examined among women aged ≥50 years in the Pooling Project of Prospective Studies of Diet and Cancer. In 10 cohorts, weight assessed on three surveys was used to examine weight change patterns over approximately 10 years (Interval 1 median= 5.2 years; Interval 2 median = 4.0 years). Sustained weight loss was defined as ≥ 2kg lost in Interval 1 that was not regained in Interval 2. Among 180,885 women, 6,930 invasive breast cancers were identified during follow-up. RESULTS: Compared with women with stable weight (± 2kg), women with sustained weight loss had a lower risk of breast cancer. This risk reduction was linear and specific to women not using postmenopausal hormones (>2-4.5kg lost: Hazard Ratio (HR)= 0.82, 95% confidence interval (CI): 0.70-0.96; >4.5-<9kg lost: HR = 0.75, 95% CI: 0.63-0.90; ≥9kg lost: HR = 0.68, 95% CI: 0.50-0.93). Women who lost ≥9kg and gained some (but not all) of it back were also at a lower risk of breast cancer. Other patterns of weight loss and gain over the two intervals had a similar risk of breast cancer to women with stable weight. CONCLUSIONS: These results suggest that sustained weight loss, even modest amounts, is associated with lower breast cancer risk for women aged ≥50 years. Breast cancer prevention may be a strong weight loss motivator for the two-thirds of American women who are overweight or obese.

10.
BMJ ; 367: l6204, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31776125

RESUMO

OBJECTIVE: To examine the association of consumption of dairy foods with risk of total and cause specific mortality in women and men. DESIGN: Three prospective cohort studies with repeated measures of diet and lifestyle factors. SETTING: Nurses' Health Study, Nurses' Health Study II, and the Health Professionals Follow-up Study, in the United States. PARTICIPANTS: 168 153 women and 49 602 men without cardiovascular disease or cancer at baseline. MAIN OUTCOME MEASURE: Death confirmed by state vital records, the national death index, or reported by families and the postal system. During up to 32 years of follow-up, 51 438 deaths were documented, including 12 143 cardiovascular deaths and 15 120 cancer deaths. Multivariable analysis further adjusted for family history of cardiovascular disease and cancer, physical activity, overall dietary pattern (alternate healthy eating index 2010), total energy intake, smoking status, alcohol consumption, menopausal status (women only), and postmenopausal hormone use (women only). RESULTS: Compared to the lowest category of total dairy consumption (average 0.8 servings/day), the multivariate pooled hazard ratio for total mortality was 0.98 (95% confidence interval 0.96 to 1.01) for the second category of dairy consumption (average 1.5 servings/day), 1.00 (0.97 to 1.03) for the third (average 2.0 servings/day), 1.02 (0.99 to 1.05) for the fourth (average 2.8 servings/day), and 1.07 (1.04 to 1.10) for highest category (average 4.2 servings/day; P for trend <0.001). For the highest compared to the lowest category of total dairy consumption, the hazard ratio was 1.02 (0.95 to 1.08) for cardiovascular mortality and 1.05 (0.99 to 1.11) for cancer mortality. For subtypes of dairy products, whole milk intake was significantly associated with higher risks of total mortality (hazard ratio per 0.5 additional serving/day 1.11, 1.09 to 1.14), cardiovascular mortality (1.09, 1.03 to 1.15), and cancer mortality (1.11, 1.06 to 1.17). In food substitution analyses, consumption of nuts, legumes, or whole grains instead of dairy foods was associated with a lower mortality, whereas consumption of red and processed meat instead of dairy foods was associated with higher mortality. CONCLUSION: These data from large cohorts do not support an inverse association between high amount of total dairy consumption and risk of mortality. The health effects of dairy could depend on the comparison foods used to replace dairy. Slightly higher cancer mortality was non-significantly associated with dairy consumption, but warrants further investigation.


Assuntos
Laticínios/efeitos adversos , Dieta/mortalidade , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Estados Unidos
11.
EClinicalMedicine ; 14: 88-95, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31709406

RESUMO

Background: Processed meat intake may increase the risk of chronic obstructive pulmonary disease (COPD). However, the magnitude of this association may depend on smoking and unhealthy diet. Our aims were to determine whether processed meat intake increased the risk of COPD among middle-aged women, and to estimate the combined impact of high processed meat intake, smoking and unhealthy diet on the risk of COPD. Methods: Analyses included 87,032 registered nurses from the Nurses' Health Study II (baseline mean age 36.8 years). Over 2,296,894 person-years (1991-2017), we documented 634 incident cases of COPD. Cumulative average of processed meat intake (every 4 years) was divided into never/almost never, < 1 or ≥ 1 servings/week. A score was created to study the impact of 3-risk lifestyle factors. Findings: In multivariable-adjusted Cox proportional hazards models, after careful adjustment for smoking and unhealthy diet, we observed a positive association between processed meat intake and the risk of COPD: Hazard Ratio (HR, 95%CI) for ≥ 1 servings/week vs. never/almost never = 1.29 (1.00-1.65). In analyses stratified according to smoking or unhealthy diet, processed meat intake was associated with increased risk of COPD only among ever smokers (HR 1.37 [1.01-1.86]), and among women with unhealthy diet (HR 1.39 [1.04-1.85]). The multivariable-adjusted HR for COPD in participants with all 3 high-risk lifestyle factors compared with none was 6.32 (3.67-10.87). Interpretation: Processed meat intake was associated with elevated risk of developing COPD in middle-aged women, especially in presence of other high-risk lifestyle factors (smoking, unhealthy diet). Fundings: US CDC and NIH.

12.
Nutrients ; 11(10)2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31635313

RESUMO

OBJECTIVE: We aimed to assess the day-to-day variation in twelve one-day diet records over one year from 131 residents of urban and rural areas in the western region of Japan. METHODS: Between 2014 and 2015, the participants provided repeated one-day diet records once a month. We estimated the intraclass correlation coefficient (ICCs) for intakes for energy and 39 crude and energy-adjusted nutrients using linear mixed models. RESULTS: Among the unadjusted nutrients, ICCs ranged from 0.05 (95 percent confidence interval = 0.03-0.09) for vitamin A retinol equivalent (RE) to 0.55 (95% CI = 0.48-0.62) for potassium. After energy adjustment, the ICCs were 0.02 (95 percent confidence interval = 0.03-0.09) for vitamin A (RE) and 0.52 (95 percent confidence interval = 0.45-0.59) for potassium. Intakes of energy-adjusted macronutrients tended to have moderate degrees of day-to-day coefficients of variation (CVw, range = 0.13-0.23, mean = 0.18), while the coefficients of variation for intakes of micronutrients varied dramatically (CVw, range = 0.17-2.59, mean = 0.54). CONCLUSION: There were large day-to-day variations in nutrient intake assessed by diet records among urban and rural residents in the western region of Japan. This study provided information on the reproducibility of crude and energy-adjusted nutrients that may be useful for other dietary studies in Japanese populations.

13.
Alzheimers Dement ; 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31628050

RESUMO

INTRODUCTION: We investigated the relation between self-reported hearing loss and risk of subjective cognitive function (SCF) decline among women. METHODS: We conducted a longitudinal study of 20,193 women in the Nurses' Health Study aged ≥66 years who reported their hearing status and had no subjective cognitive concerns in 2012. SCF scores were assessed by a 7-item questionnaire in 2012 and 2014. SCF decline was defined as a new report of at least one cognitive concern during follow-up. RESULTS: Self-reported hearing loss was associated with higher risk of SCF decline. Compared with women with no hearing loss, the multivariable-adjusted odds ratios (95% confidence interval) for incident SCF score ≥1 were 1.35 (1.25, 1.47), 1.39 (1.24, 1.56), and 1.40 (1.21, 1.75) among women with mild, moderate, and severe hearing loss, respectively. Recent progression of hearing loss was associated with even higher risk. DISCUSSION: Self-reported hearing loss was associated with higher risk of incident subjective cognitive function decline in women.

14.
Diabetes Care ; 42(12): 2181-2189, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31582428

RESUMO

OBJECTIVE: We evaluated the associations of long-term changes in consumption of sugary beverages (including sugar-sweetened beverages and 100% fruit juices) and artificially sweetened beverages (ASBs) with subsequent risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: We followed up 76,531 women in the Nurses' Health Study (1986-2012), 81,597 women in the Nurses' Health Study II (1991-2013), and 34,224 men in the Health Professionals' Follow-up Study (1986-2012). Changes in beverage consumption (in 8-ounce servings/day) were calculated from food frequency questionnaires administered every 4 years. Multivariable Cox proportional regression models were used to calculate hazard ratios for diabetes associated with changes in beverage consumption. Results of the three cohorts were pooled using an inverse variance-weighted, fixed-effect meta-analysis. RESULTS: During 2,783,210 person-years of follow-up, we documented 11,906 incident cases of type 2 diabetes. After adjustment for BMI and initial and changes in diet and lifestyle covariates, increasing total sugary beverage intake (including both sugar-sweetened beverages and 100% fruit juices) by >0.50 serving/day over a 4-year period was associated with a 16% (95% CI 1%, 34%) higher diabetes risk in the subsequent 4 years. Increasing ASB consumption by >0.50 serving/day was associated with 18% (2%, 36%) higher diabetes risk. Replacing one daily serving of sugary beverage with water, coffee, or tea, but not ASB, was associated with a 2-10% lower diabetes risk. CONCLUSIONS: Increasing consumption of sugary beverages or ASBs was associated with a higher risk of type 2 diabetes, albeit the latter association may be affected by reverse causation and surveillance bias.

15.
J Nutr ; 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31618417

RESUMO

BACKGROUND: Very-long-chain SFAs (VLCSFAs), such as arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0), have demonstrated inverse associations with cardiometabolic conditions, although more evidence is needed to characterize their relation with risk of type 2 diabetes (T2D). In addition, little is known regarding their potential dietary and lifestyle predictors. OBJECTIVE: We aimed to examine the association of plasma and erythrocyte concentrations of VLCSFAs with incident T2D risk. METHODS: We used existing measurements of fatty acid concentrations in plasma and erythrocytes among 2854 and 2831 participants in the Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS), respectively. VLCSFAs were measured using GLC, and individual fatty acid concentrations were expressed as a percentage of total fatty acids. Incident T2D cases were identified by self-reports and confirmed by a validated supplementary questionnaire. Cox proportional hazards regression was used to evaluate the association between VLCSFAs and T2D, adjusting for demographic, lifestyle, and dietary variables. RESULTS: During 39,941 person-years of follow-up, we documented 243 cases of T2D. Intakes of peanuts, peanut butter, vegetable fat, dairy fat, and palmitic/stearic (16:0-18:0) fatty acids were significantly, albeit weakly, correlated with plasma and erythrocyte VLCSFA concentrations (|rs| ≤ 0.19). Comparing the highest with the lowest quartiles of plasma concentrations, pooled HRs (95% CIs) were 0.51 (0.35, 0.75) for arachidic acid, 0.43 (0.28, 0.64) for behenic acid, 0.40 (0.27, 0.61) for lignoceric acid, and 0.41 (0.27, 0.61) for the sum of VLCSFAs, after multivariate adjustments for demographic, lifestyle, and dietary factors. For erythrocyte VLCSFAs, only arachidic acid and behenic acid concentrations were inversely associated with T2D risk. CONCLUSIONS: Our findings suggest that, in US men and women, higher plasma concentrations of VLCSFAs are associated with lower risk of T2D. More research is needed to understand the mechanistic pathways underlying these associations.

16.
Bull World Health Organ ; 97(5): 349-357, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31551631

RESUMO

National dietary surveillance systems are necessary for monitoring people's intake of foods and nutrients associated with health and disease, and for implementing national and global dietary goals. However, these systems do not exist in many low- and middle-income countries. The development of a model of dietary surveillance for Bosnia and Herzegovina, described here, provides insights into the feasibility and sustainability of dietary surveillance systems in resource-constrained settings and illustrates the challenges involved. In 2016, a year-long dietary survey was initiated in collaboration with the country's Institute for Statistics using a subsample of households that participated in the 2015 national Household Budget Survey. Interviewers collected lifestyle, anthropometric and health data and participants answered two 24-hour dietary recall questionnaires. The survey included a representative sample of 853 participants and was performed efficiently by a small team of highly motivated, well-trained staff. Conducting a high-quality dietary survey was found to be feasible despite constrained resources. In addition, the ability to link dietary intake and regular household survey data provided an effective way of associating dietary variables with socioeconomic determinants of health. This dietary survey, the first conducted by an official institution in Bosnia and Herzegovina, represents an important starting point for building a sustainable nutritional surveillance system for the country. The cost-effective, low-burden approach to dietary surveillance described here could be applied in other low- and middle-income countries, many of which already carry out regular economic surveys.

17.
Am J Clin Nutr ; 110(5): 1201-1212, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504094

RESUMO

BACKGROUND: Whether changes in dairy product consumption are related to subsequent risk of type 2 diabetes (T2D) remains unknown. OBJECTIVE: We evaluated the association of long-term changes in dairy product consumption with subsequent risk of T2D among US men and women. METHODS: We followed up 34,224 men in the Health Professionals Follow-Up Study (1986-2012), 76,531 women in the Nurses' Health Study (1986-2012), and 81,597 women in the Nurses' Health Study II (1991-2013). Changes in dairy consumption were calculated from consecutive quadrennial FFQs. Multivariable Cox proportional regression models were used to calculate HRs for T2D associated with changes in dairy product consumption. Results of the 3 cohorts were pooled using an inverse variance-weighted, fixed-effect meta-analysis. RESULTS: During 2,783,210 person-years, we documented 11,906 incident T2D cases. After adjustment for initial and changes in diet and lifestyle covariates, decreasing total dairy intake by >1.0 serving/d over a 4-y period was associated with an 11% (95% CI: 3%, 19%) higher risk of T2D in the subsequent 4 y compared with maintaining a relatively stable consumption (i.e., change in intake of ±1.0 serving/wk). Increasing yogurt consumption by >0.5 serving/d was associated with an 11% (95% CI: 4%, 18%) lower T2D risk, whereas increasing cheese consumption by >0.5 serving/d was associated with a 9% (95% CI: 2%, 16%) higher risk compared with maintaining stable intakes. Substituting 1 serving/d of yogurt or reduced-fat milk for cheese was associated with a 16% (95% CI: 10%, 22%) or 12% (95% CI: 8%, 16%) lower T2D risk, respectively. CONCLUSIONS: Increasing yogurt consumption was associated with a moderately lower risk of T2D, whereas increasing cheese consumption was associated with a moderately higher risk among US men and women. Our study suggests that substituting yogurt or reduced-fat milk for cheese is associated with a lower risk of T2D.

18.
Am J Clin Nutr ; 110(4): 803-804, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504123
19.
Circulation ; 140(12): 979-991, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31401846

RESUMO

BACKGROUND: Plant-based diets have been associated with lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits. However, the association between changes in plant-based diet quality and mortality remains unclear. METHODS: We investigated the associations between 12-year changes (from 1986 to 1998) in plant-based diet quality assessed by 3 plant-based diet indices (score range, 18-90)-an overall plant-based diet index (PDI), a healthful PDI, and an unhealthful PDI-and subsequent total and cause-specific mortality (1998-2014). Participants were 49 407 women in the Nurses' Health Study (NHS) and 25 907 men in the Health Professionals Follow-Up Study (HPFS) who were free from CVD and cancer in 1998. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS: We documented 10 686 deaths including 2046 CVD deaths and 3091 cancer deaths in the NHS over 725 316 person-years of follow-up and 6490 deaths including 1872 CVD deaths and 1772 cancer deaths in the HPFS over 371 322 person-years of follow-up. Compared with participants whose indices remained stable, among those with the greatest increases in diet scores (highest quintile), the pooled multivariable-adjusted HRs for total mortality were 0.95 (95% CI, 0.90-1.00) for PDI, 0.90 (95% CI, 0.85-0.95) for healthful PDI, and 1.12 (95% CI, 1.07-1.18) for unhealthful PDI. Among participants with the greatest decrease (lowest quintile), the multivariable-adjusted HRs were 1.09 (95% CI, 1.04-1.15) for PDI, 1.10 (95% CI, 1.05-1.15) for healthful PDI, and 0.93 (95% CI, 0.88-0.98) for unhealthful PDI. For CVD mortality, the risk associated with a 10-point increase in each PDI was 7% lower (95% CI, 1-12%) for PDI, 9% lower (95% CI, 4-14%) for healthful PDI, and 8% higher (95% CI, 2-14%) for unhealthful PDI. There were no consistent associations between changes in plant-based diet indices and cancer mortality. CONCLUSIONS: Improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of an unhealthful plant-based diet was associated with a higher risk of total and CVD mortality.

20.
Am J Clin Nutr ; 110(5): 1192-1200, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414137

RESUMO

BACKGROUND: Previous studies have examined dairy products with various fat contents in relation to type 2 diabetes (T2D) risk, although data regarding dairy fat intake per se are sparse. OBJECTIVES: We aimed to evaluate the association between dairy fat intake and risk of T2D in 3 prospective cohorts. We also examined associations for isocalorically replacing dairy fat with other macronutrients. METHODS: We prospectively followed 41,808 men in the Health Professionals Follow-Up Study (HPFS; 1986-2012), 65,929 women in the Nurses' Health Study (NHS; 1984-2012), and 89,565 women in the NHS II (1991-2013). Diet was assessed quadrennially using validated FFQs. Fat intake from dairy products and other relevant sources was expressed as percentage of total energy. Self-reported incident T2D cases were confirmed using validated supplementary questionnaires. Time-dependent Cox proportional hazards regression was used to estimate the HR for dairy fat intake and T2D risk. RESULTS: During 4,219,457 person-years of follow-up, we documented 16,511 incident T2D cases. Dairy fat was not associated with risk of T2D when compared with calories from carbohydrates (HR for extreme quintiles: 0.98; 95% CI: 0.95, 1.02). Replacing 5% of calories from dairy fat with other sources of animal fat or carbohydrate from refined grains was associated with a 17% (HR: 1.17; 95% CI: 1.13, 1.21) and a 4% (HR: 1.04; 95% CI: 1.00, 1.08) higher risk of T2D, respectively. Conversely, a 5% calorie replacement with carbohydrate from whole grains was associated with a 7% lower risk of T2D (HR: 0.93; 95% CI: 0.88, 0.98). CONCLUSIONS: Dairy fat intake was not associated with T2D risk in these cohort studies of US men and women when compared with calories from carbohydrate. Replacing dairy fat with carbohydrates from whole grains was associated with lower risk of T2D. Replacement with other animal fats or refined carbohydrates was associated with higher risk.

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