Examining energy density: comments on diet quality, dietary advice, and the cost of healthful eating.
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Costs and Cost Analysis↗
Biomedical subjects
P K Newby
Publications and source records attributed to P K Newby.
Longitudinal changes in food patterns predict changes in weight and body mass index and the effects are greatest in obese women.
The prevalence of obesity is increasing in most parts of the world. The objective of this study was to examine whether changes in food patterns were associated with changes in BMI among women over 9 y. Data were from 33,840 women participating in the Swedish Mammography Cohort in 1987 and 1997. Diet was assessed with a FFQ at both time points and 4 food patterns were derived using confirmatory factor analysis (Healthy, Western/Swedish, Alcohol, and Sweets). Our exposure variables were defined as change in factor score for each food pattern from 1987 to 1997. Our outcome variable was defined as change in BMI during the same period, and we also examined change in weight. Normal weight and overweight women had positive changes in weight and BMI during follow-up, whereas obese women had negative changes in BMI and weight; we observed a significant interaction between change in food patterns and baseline BMI. Obese subjects who increased their factor score for the Healthy pattern had larger decreases in BMI (beta = -0.18 kg/m(2) for a 1 unit increase in SD score, CI: -0.26 to -0.10; P < 0.0001), whereas normal weight and overweight women who increased their Healthy pattern score had smaller increases in BMI (-0.05 kg/m(2) and -0.11 kg/m(2), respectively; P < 0.05 for both). Obese women who increased their Healthy pattern score >3 SD had almost a 4 kg decrease in weight and a 1 unit decrease in BMI at follow-up. In conclusion, changes in eating patterns were significantly related to changes in BMI over 9 y and the effect was modified by baseline BMI. Pattern analysis is helpful in generating hypotheses regarding the role of diet in obesity, and additional research is needed to understand which elements of our patterns are protective or risk factors for weight gain.
Aged↗
Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women.
Emerging evidence suggests that diet quality indices may serve as prognostic indicators of disease. However, the ability of these indices to predict breast cancer risk has not been evaluated previously. We assessed the association between several diet quality scores and the risk of breast cancer in postmenopausal women. The indices we used were the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), Diet Quality Index-Revised (DQI-R), Recommended Food Score (RFS), and the alternate Mediterranean Diet Score (aMed). We calculated diet quality indices from dietary information collected in FFQ administered 5 times between 1984 and 1998 among women in the Nurses' Health Study cohort. Relative risks (RR) were computed using Cox proportional hazards models and adjusted for known risk factors for breast cancer. Separate analyses were conducted for estrogen receptor positive (ER+) and negative (ER-) tumors. Between 1984 and 2002, we documented 3,580 cases of breast cancer, of which 2,367 were ER+, and 575 were ER-. We did not observe any association between the diet quality indices and total or ER+ breast cancer risk. However, for ER- breast cancer, after adjusting for potential confounders, the RR comparing highest to lowest quintiles were 0.78 (95% CI=0.59-1.04, P for trend=0.01) for the AHEI, 0.69 (95% CI=0.51-0.94, P for trend=0.003) for the RFS, and 0.79 (95% CI=0.60-1.03, P for trend=0.03) for the aMed. These observations appeared to be the result of an inverse association (P for trend=0.01) with the vegetable component of the scores. We conclude that women who scored high in AHEI, RFS, and aMed had a lower risk of ER- breast cancer. The HEI and DQI-R appeared to be of limited value in predicting breast cancer risk.
Adult↗
Long-term stability of food patterns identified by use of factor analysis among Swedish women.
Limited data exist on the reproducibility of food patterns measured by factor analysis as well as on the use of stability of patterns over time. Our primary objective was to explore the long-term stability of food patterns derived by confirmatory factor analysis among 33,840 women participating in the Swedish Mammography Cohort. Our secondary objective was to compare factor solutions from confirmatory factor analysis with those derived by use of exploratory factor analysis. Diet was assessed by a food frequency questionnaire in 1987 and 1997, and food patterns were derived by the use of exploratory and confirmatory factor analysis. We observed four major food patterns (Healthy, Western/Swedish, Alcohol, and Sweets) at both time points. Correlations between confirmed food patterns in 1987 and 1997 were 0.37 for the Healthy pattern, 0.27 for the Western/Swedish pattern, 0.54 for the Alcohol pattern, and 0.44 for the Sweets pattern (P < 0.0001 for all associations). Patterns derived by the use of exploratory factor analysis were strongly associated with those derived by the use of confirmatory factor analysis (r >/= 0.90, P < 0.0001, for all associations). The patterns derived in this study were similar to those derived in other studies, indicating reproducibility of food patterns across populations. Our study suggests that food patterns measured by the use of confirmatory factor analysis are reproducible over time, and weaker correlations observed may reflect natural changes in eating behavior, the food supply, and/or perceptions of what is considered healthy. Testing whether patterns measured over a long time period can be used in analytic studies is the next step in assessing the validity of this method.
Alcohol Drinking↗
Early anthropometric measures and reproductive factors as predictors of body mass index and obesity among older women.
OBJECTIVE: To examine whether early anthropometric measures and reproductive factors were associated with body mass index (BMI), overweight, and obesity. DESIGN: Cross-sectional, observational study. SUBJECTS: In all, 18 109 healthy women who participated in the Swedish Mammography Cohort aged 49-83 y. MEASUREMENTS: Early anthropometric (birthweight and body shape at age 10 y) and reproductive (age at menarche, age at the birth of the first child, and parity) variables were our predictors and current BMI, overweight (BMI 25-29.99 kg/m(2)), and obesity (BMI > or =30 kg/m(2)) were our outcomes. RESULTS: In multivariate-adjusted polytomous logistic regression analysis, risk of overweight and obesity increased with increasing body shape at age 10 y and decreased with increasing age at menarche and age at first birth (P for trend <0.0001). A U-shaped relation with birthweight was observed. In our tests for effect modification of the relation with overweight/obesity (ow/ob; BMI > or =25 kg/m(2)), we detected significant interactions between body shape at 10 y and age (P<0.0001); body shape at 10 y and physical activity (P<0.0001); age at first birth and smoking (P=0.02); and parity and physical activity (P=0.004). The increased risk of ow/ob among women who reported a larger childhood body shape was reduced as women moved from the lowest to highest quartile of physical activity in adulthood. Likewise, the increasing risk of ow/ob among women with greater parity was reduced with increased physical activity. CONCLUSION: Early anthropometric measures and reproductive factors are significantly associated with BMI, overweight, and obesity among older women. The effects of childhood body weight, age at first birth, and parity may be modified by adult lifestyle choices, as well as age.
Age Factors↗
Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction.
BACKGROUND: Endothelial dysfunction is one of the mechanisms linked to an increased risk of cardiovascular disease. OBJECTIVE: We assessed the association between several diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. DESIGN: Diet-quality scores on the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), Diet Quality Index Revised (DQI-R), Recommended Food Score (RFS), and the alternate Mediterranean Diet Index (aMED) were calculated by using a food-frequency questionnaire that was administered in 1990 to 690 women in the Nurses' Health Study (ages 43-69 y, no cardiovascular disease or diabetes). Blood collection was completed in the same year. We used regression analysis to assess the associations between these diet-quality scores and plasma concentrations of C-reactive protein, interleukin 6, E-selectin, soluble intercellular cell adhesion molecule 1, and soluble vascular cell adhesion molecule 1. RESULTS: The various diet-quality scores were significantly correlated with each other; correlation coefficients ranged from 0.56 to 0.80 (all P values < 0.0001). After adjustment for age, body mass index, alcohol intake, physical activity, smoking status, and energy intake, the HEI and DQI-R were not significantly associated with any of the biomarkers, whereas the AHEI and aMED scores were associated with significantly lower concentrations of most biomarkers. The RFS was significantly associated with a lower concentration of E-selectin only. C-reactive protein concentrations were 30% (P < 0.05) and 24% (P < 0.05) lower in the top than in the bottom quintile of the AHEI and of the aMED, respectively CONCLUSION: Higher AHEI and aMED scores were associated with lower concentrations of biomarkers of inflammation and endothelial dysfunction and therefore may be useful as guidelines for reducing the risk of diseases involving such biological pathways.
Adult↗
Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women.
BACKGROUND: Observational studies suggest that a plant-based diet is inversely related to body mass index (BMI), overweight, and obesity. OBJECTIVE: Our objective was to examine the BMI (kg/m(2)) and risk of overweight and obesity of self-defined semivegetarian, lactovegetarian, and vegan women. DESIGN: Data analyzed in this cross-sectional study were from 55459 healthy women participating in the Swedish Mammography Cohort. Women were asked whether they considered themselves to be omnivores (n = 54257), semivegetarians (n = 960), lactovegetarians (n = 159), or vegans (n = 83), and this question was the main exposure variable in this study. In secondary analyses, we reclassified women as lactovegetarians on the basis of food intakes reported on the food-frequency questionnaire. RESULTS: The prevalence of overweight or obesity (BMI >/= 25) was 40% among omnivores, 29% among both semivegetarians and vegans, and 25% among lactovegetarians. In multivariate, adjusted logistic regression analyses, self-identified vegans had a significantly lower risk of overweight or obesity [odds ratio (OR) = 0.35; 95% CI: 0.18, 0.69] than did omnivores, as did lactovegetarians (OR = 0.54; 95% CI: 0.35, 0.85) and semivegetarians (OR = 0.52; 95% CI: 0.43, 0.62). Risk of overweight or obesity remained significantly lower among lactovegetarians classified on the basis of the food-frequency questionnaire (OR = 0.48; 95% CI: 0.30, 0.78). CONCLUSIONS: Even if vegetarians consume some animal products, our results suggest that self-identified semivegetarian, lactovegetarian, and vegan women have a lower risk of overweight and obesity than do omnivorous women. The advice to consume more plant foods and less animal products may help individuals control their weight.
Anthropometry↗
Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota.
OBJECTIVE: To examine prospectively the association between beverage consumption (fruit juice, fruit drinks, milk, soda, and diet soda) and changes in weight and body mass index among preschool children. DESIGN: A prospective cohort study that collected dietary, anthropometric, and sociodemographic data.Subjects/Setting The study population included 1,345 children age 2 to 5 years participating in the North Dakota Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on two visits between 6 to 12 months apart. Statistical analyses We performed linear regression analyses to examine whether beverage consumption was associated with annual change in weight and body mass index. Intakes were measured as continuous (oz/day) and we also dichotomized fruit juice, fruit drinks, and milk at high intakes. RESULTS: In multivariate regression analyses adjusted for age, sex, energy intake, change in height, and additional sociodemographic variables, weight change was not significantly related to intakes (per ounce) of fruit juice (beta=0.01 lb/year, 95% CI: -0.01 to 0.20, P=.28), fruit drinks (beta=-0.03 lb/year, 95% CI: -0.07 to 0.01, P=.28), milk (beta=0.00 lb/year, 95% CI: -0.02 to 0.02, P=.86), soda (beta=-0.00 lb/year, 95% CI: -0.08 to 0.08, P=.95), or diet soda (beta=0.01 lb/year, 95% CI: -0.11 to 0.13, P=.82). Findings remained null when we examined associations with body mass index and when fruit juice, fruit drinks, and milk were dichotomized at high intake levels in both analyses. CONCLUSIONS: Our study does not show an association between beverage consumption and changes in weight or body mass index in this population of low-income preschool children in North Dakota.
Beverages↗
Food patterns measured by factor analysis and anthropometric changes in adults.
BACKGROUND: Sixty-five percent of US adults are overweight, and 31% of these adults are obese. Obesity results from weight gains over time; however, dietary determinants of weight gain remain controversial. OBJECTIVE: Our objective was to examine whether food patterns derived from exploratory factor analysis are related to anthropometric changes. We hypothesized that we would derive a healthy food pattern and that it would predict smaller changes in body mass index (BMI; in kg/m(2)) and waist circumference (in cm) than would other food patterns in models adjusted for baseline anthropometric measures. DESIGN: The subjects were 459 healthy men and women participating in the Baltimore Longitudinal Study of Aging. Diet was assessed by using 7-d dietary records, from which 40 food groups were formed and entered into a factor analysis. RESULTS: Six food patterns were derived. Factor 1 (reduced-fat dairy products, fruit, and fiber) was most strongly associated with fiber (r = 0.39) and loaded heavily on reduced-fat dairy products, cereal, and fruit and loaded moderately on fruit juice, nonwhite bread, nuts and seeds, whole grains, and beans and legumes. In a multivariate-adjusted model in which the highest and lowest quintiles were compared, factor 1 was inversely associated with annual change in BMI (beta = -0.51; 95% CI: -0.82, -0.20; P < 0.05; P for trend < 0.01) in women and inversely associated with annual change in waist circumference (beta = -1.06 cm; 95% CI: -1.88, -0.24 cm; P < 0.05; P for trend = 0.04) in both sexes. CONCLUSION: Our results suggest that a pattern rich in reduced-fat dairy products and high-fiber foods may lead to smaller gains in BMI in women and smaller gains in waist circumference in both women and men.
Aging↗
Associations of empirically derived eating patterns with plasma lipid biomarkers: a comparison of factor and cluster analysis methods.
BACKGROUND: Despite the growing use of patterning methods in nutritional epidemiology, a direct comparison of factor and cluster analysis methods has not been performed. OBJECTIVE: Our main objective was to compare patterns derived from the cluster and factor analysis procedures with measures of plasma lipids. DESIGN: This cross-sectional study included 459 healthy subjects who participated in the Baltimore Longitudinal Study of Aging and had measures of diet and plasma lipids. Eating patterns were derived by using both factor and cluster analysis methods. RESULTS: In separate multivariate-adjusted regression models, subjects in the healthy cluster had lower plasma triacylglycerols than did those not in the healthy cluster (beta = -15.97; 95% CI: -29.51, -2.43; P < 0.05), and factor 1 (reduced-fat dairy products, fruit, and fiber) was inversely related to plasma triacylglycerols (beta = -7.02 mg/dL for a one-unit increase in z score; 95% CI: -12.92, -1.12; P < 0.05). Those in the alcohol cluster had higher total cholesterol concentrations than did those not in the alcohol cluster (beta = 12.81; 95% CI: 2.74, 22.88; P < 0.05), and factor 2 (protein and alcohol) was also directly associated with total cholesterol (beta = 1.59 for a one-unit increase in z score; 95% CI: 0.55, 2.63; P < 0.05). The multivariate model containing all of the clusters was not significantly different from the model containing all of the factors in predicting each lipid outcome. CONCLUSION: Our study provides evidence of comparability between cluster and factor analysis methods in relation to plasma lipid biomarkers.
Adult↗
Empirically derived eating patterns using factor or cluster analysis: a review.
This paper reviews studies performed to date that have employed cluster or factor analysis to empirically derive eating patterns. Since 1980, at least 93 studies were published that used cluster or factor analysis to define dietary exposures, of which 65 were used to test hypotheses or examine associations between patterns and disease outcomes or biomarkers. Studies were conducted in diverse populations across many countries and continents and suggest that patterns are associated with many different biomarkers and disease outcomes, whether measured by cluster or factor analysis. Despite clear differences in approaches and interpretations, there is some evidence that underlying eating patterns are revealed by either method. Although the research considered herein has created a meaningful body of literature, refining both the factor and cluster analysis methods will help to further establish eating patterns as a sound dietary assessment method.
Cluster Analysis↗
Dietary composition and weight change among low-income preschool children.
OBJECTIVE: To examine the relation between dietary composition and weight change among children. We tested several hypotheses considering intake of nutrients (total fat and fiber) and predefined food groups (breads and grains, "fat foods," fruits, and vegetables) used in the North Dakota Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program). DESIGN: Prospective study. Subjects We collected dietary, anthropometric, and sociodemographic data from 1379 children aged 2 to 5 years participating in the North Dakota WIC Program on 2 visits ranging from 6 to 12 months apart. Main Outcome Measure Annual change in weight. RESULTS: In multiple regression analyses, no significant relations were found between total intake of fat, fiber, fruits, or vegetables and weight change. There was a 0.16-kg lower weight change per year (95% confidence interval [CI], -0.20 to -0.12 kg; P<.01) with each additional daily serving of breads and grains, and a 0.05-kg greater weight change per year (95% CI, 0.1-0.09 kg; P<.05) for each additional serving of fat foods in a model adjusting for sex, age, baseline weight, change in height, and sociodemographic variables. CONCLUSIONS: Intake of North Dakota WIC Program-defined fat foods, but not dietary fat per se, significantly predicted weight gain, whereas intake of North Dakota WIC Program-defined breads and grains, but not fiber per se, significantly predicted weight loss in preschool children.
Body Weight↗
Dietary patterns and changes in body mass index and waist circumference in adults.
BACKGROUND: Obesity has increased > 20% in the past decade in the United States, and more than one-half of US adults are overweight or obese. OBJECTIVE: Our objective was to further elucidate the nutritional etiology of changes in body mass index (BMI; in kg/m(2)) and waist circumference by dietary intake pattern. We hypothesized that a healthy dietary pattern would lead to smaller changes in BMI and waist circumference than would other dietary patterns. DESIGN: Subjects were 459 healthy men and women participating in the ongoing Baltimore Longitudinal Study of Aging. Diet was assessed with the use of 7-d dietary records, from which 41 food groups were created and entered into a cluster analysis. RESULTS: Five dietary patterns were derived (healthy, white bread, alcohol, sweets, and meat and potatoes). The mean annual change in BMI was 0.30 +/- 0.06 for subjects in the meat-and-potatoes cluster and 0.05 +/- 0.06 for those in the healthy cluster (P < 0.01). The mean annual change in waist circumference was more than 3 times as great for subjects in the white-bread cluster (1.32 +/- 0.29 cm) as for those in the healthy cluster (0.43 +/- 0.27 cm) (P < 0.05). CONCLUSIONS: Consuming a diet high in fruit, vegetables, reduced-fat dairy, and whole grains and low in red and processed meat, fast food, and soda was associated with smaller gains in BMI and waist circumference. Because foods are not consumed in isolation, dietary pattern research based on natural eating behavior may be useful in understanding dietary causes of obesity and in helping individuals trying to control their weight.
Adult↗
Reproducibility and validity of the Diet Quality Index Revised as assessed by use of a food-frequency questionnaire.
BACKGROUND: The Diet Quality Index Revised (DQI-R) is a dietary assessment instrument based on 10 dietary recommendations reflecting dietary guidelines and policy in the United States. OBJECTIVE: The objective of this study was to assess the reproducibility and validity of the DQI-R as measured by use of food-frequency questionnaires (FFQs). DESIGN: Diet was assessed separately by two FFQs at a 1-y interval and by two 1-wk diet records. DQI-R scores were computed from each method. Venous blood specimens were collected for measurement of dietary biomarkers. Participants (n = 127) were men aged 40-75 y in a validation study of the Health Professionals Follow-up Study. RESULTS: Mean DQI-R scores were 69.5 for FFQ-1, 67.2 for FFQ-2, and 62.0 for the diet records out of a possible score of 100. The reproducibility correlation for the 2 FFQ scores was 0.72. Correlations between scores for each of the 2 FFQs and diet records were 0.66 (FFQ-1) and 0.72 (FFQ-2). DQI-R scores from FFQ-2 were directly correlated with plasma biochemical measurements of alpha-carotene (r = 0.43, P < 0.0005), beta-carotene (r = 0.35, P < 0.005), lutein (r = 0.31, P <0.005), and alpha-tocopherol (r = 0.25, P < 0.05) and were inversely correlated with plasma total cholesterol (r = -0.22, P < 0.05). CONCLUSIONS: These data indicate reasonable reproducibility and validity of the DQI-R as assessed by an FFQ. Future studies are needed to examine whether this index and other instruments of diet quality can reliably predict disease outcomes.
Adult↗