Dietary Fat and Coronary Heart Disease: A Comparison of Approaches for Adjusting for Total Energy Intake and Modeling Repeated Dietary Measurements
Open accessAbstract
Previous cohort studies of fat intake and risk of coronary heart disease (CHD) have been inconsistent, probably due in part to methodological differences and various limitations, including inadequate dietary assessment and incomplete adjustment for total energy intake. The authors analyzed repeated assessment of diet from the Nurses' Health Study to examine the associations between intakes of four major types of fat (saturated, monounsaturated, polyunsaturated, and trans fats) and risk of CHD during 14 years of follow-up (1980-1994) by using alternative methods for energy adjustment. In particular, the authors compared four risk models for energy adjustment: the standard multivariate model, the energy-partition model, the nutrient residual model, and the multivariate nutrient density model. Within each model, the authors compared four different approaches for analyzing repeated dietary measurements: baseline diet only, the most recent diet, and two different algorithms for calculating cumulative average diets. The substantive results were consistent across all models; that is, higher intakes of saturated and trans fats were associated with increased risk of CHD, while higher intakes of monounsaturated and polyunsaturated fats were associated with reduced risk. When nutrients were considered as continuous variables, the four energy-adjustment methods yielded similar associationS. However, the interpretation of the relative risks differed across models. In addition, within each model, the methods using the cumulative averages in general yielded stronger associations than did those using either only baseline diet or the most recent diet. When the nutrients were categorized according to quintiles, the residual and the nutrient density models, which gave similar results, yielded statistically more significant tests for linear trend than did the standard and the partition models.
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We used the cumulative average of the AHEI-based diet score from repeated dietary assessments to represent long-term dietary information and minimize within-person variation.
“We used the cumulative average of the AHEI-based diet score from repeated dietary assessments to represent long-term dietary information and minimize within-person variation.29”
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Self-citationSun, Q., Ma, J., Campos, H., Hankinson, S. E., & Hu, F. B. (2007) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/86.1.74 · Cited by 433 · see citing works
Self-citationCocoa Intake, Blood Pressure, and Cardiovascular Mortality
Buijsse, B., Feskens, E. J. M., Kok, F. J., & Kromhout, D. (2006) · Archives of Internal Medicine · doi:10.1001/.411 · Cited by 427 · see citing works
Yang, Q. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.257 · Cited by 419 · see citing works
Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men
McCullough, M. L., Feskanich, D., Rimm, E. B., Giovannucci, E. L., Ascherio, A., Variyam, J. N., Spiegelman, D., Stampfer, M. J., & Willett, W. C. (2000) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/72.5.1223 · Cited by 403 · see citing works
Self-citationBhupathiraju, S. N., Tobias, D. K., Malik, V. S., Pan, A., Hruby, A., Manson, J. E., Willett, W. C., & Hu, F. B. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.079533 · Cited by 402 · see citing works
Self-citationIntake of Dairy Products, Calcium, and Vitamin D and Risk of Breast Cancer
Myung-Hee, S. (2002) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/94.17.1301 · Cited by 391 · see citing works
Dietary Carotenoids and Vitamins A, C, and E and Risk of Breast Cancer
Zhang, S., Hunter, D. J., Forman, M. R., ROSNER, B. A., Speizer, F. E., Colditz, G. A., Manson, J. E., Hankinson, S. E., & Willett, W. C. (1999) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/91.6.547 · Cited by 390 · see citing works
Self-citationDietary pattern, inflammation, and incidence of type 2 diabetes in women
Schulze, M. B., Hoffmann, K., Manson, J. E., Willett, W. C., Meigs, J. B., Weikert, C., Heidemann, C., Colditz, G. A., & Hu, F. B. (2005) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.3.675 · Cited by 457 · see citing works
Self-citationMilk intake and risk of mortality and fractures in women and men: cohort studies
Michaëlsson, K., Wolk, A., Langenskiöld, S., Basu, S., Lemming, E. W., Melhus, H., & Byberg, L. (2014) · BMJ · doi:10.1136/bmj.g6015 · Cited by 374 · see citing works
Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis
Chen, M., Sun, Q., Giovannucci, E., Mozaffarian, D., Manson, J. E., Willett, W. C., & Hu, F. B. (2014) · BMC Medicine · doi:10.1186/s12916-014-0215-1 · Cited by 370 · see citing works
Self-citationLow-Carbohydrate Diets and All-Cause and Cause-Specific Mortality
Fung, T. T., van Dam, R. M., Hankinson, S. E., Stampfer, M. J., Willett, W. C., & Hu, F. B. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-153-5-201009070-00003 · Cited by 358 · see citing works
Self-citationMagnesium Intake and Incidence of Metabolic Syndrome Among Young Adults
He, K., Liu, K., Daviglus, M. L., Morris, S. J., Loria, C. M., Horn, L. V., Jacobs, D. R., & Savage, P. J. (2006) · Circulation · doi:10.1161/circulationaha.105.588327 · Cited by 353 · see citing works
Arts, I. C. W., Hollman, P. C. H., Feskens, E. J. M., Bueno-de-Mesquita, H. B., & Kromhout, D. (2001) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/74.2.227 · Cited by 346 · see citing works
Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men
Jensen, M. K., Koh-Banerjee, P., Hu, F. B., FRANZ, M. M., Sampson, L., Grønbæk, M., & Rimm, E. B. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/80.6.1492 · Cited by 338 · see citing works
Self-citationSteffen, L. M., Kroenke, C. H., Yu, X., Pereira, M. A., Slattery, M. L., Horn, L. V., Gross, M. D., & Jacobs, D. R. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.6.1169 · Cited by 334 · see citing works
Tanasescu, M., Leitzmann, M. F., Rimm, E. B., & Hu, F. B. (2003) · Circulation · doi:10.1161/01.cir.0000066906.11109.1f · Cited by 329 · see citing works
Self-citationMills, S., Brown, H., Wrieden, W. L., White, M. J., & Adams, J. M. (2017) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0567-y · Cited by 327 · see citing works
Fung, T. T., Hu, F. B., McCullough, M. L., Newby, P. K., Willett, W. C., & Holmes, M. D. (2006) · The Journal of Nutrition · doi:10.1093/jn/136.2.466 · Cited by 321 · see citing works
Self-citationCahill, L. E., Chiuve, S. E., Mekary, R. A., Jensen, M. K., Flint, A. J., Hu, F. B., & Rimm, E. B. (2013) · Circulation · doi:10.1161/circulationaha.113.001474 · Cited by 317 · see citing works
Self-citationA prospective cohort study of endometriosis and subsequent risk of infertility
Prescott, J., Farland, L. V., Tobias, D. K., Gaskins, A. J., Spiegelman, D. L., Chavarro, J. E., Rich-Edwards, J. W., Barbieri, R. L., & Missmer, S. A. (2016) · Human Reproduction · doi:10.1093/humrep/dew085 · Cited by 310 · see citing works
Self-citationWhole Grain Consumption and Risk of Ischemic Stroke in Women: A Prospective Study
Liu, S., Manson, J. E., Stampfer, M. J., Rexrode, K. M., Hu, F. B., Rimm, E. B., & Willett, W. C. (2000) · JAMA · doi:10.1001/jama.284.12.1534 · Cited by 303 · see citing works
Self-citationHu, F. B., Cho, E., Rexrode, K. M., Albert, C. M., & Manson, J. E. (2003) · Circulation · doi:10.1161/01.cir.0000062644.42133.5f · Cited by 302 · see citing works
Self-citationFruit and vegetable consumption and cognitive decline in aging women
Kang, J. H., Ascherio, A., & Grodstein, F. (2005) · Annals of Neurology · doi:10.1002/ana.20476 · Cited by 300 · see citing works
Self-citationDASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease
Rebholz, C. M., Crews, D. C., Grams, M. E., Steffen, L. M., Levey, A. S., Miller, E. R., Appel, L. J., & Coresh, J. (2016) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2016.05.019 · Cited by 298 · see citing works
Zong, G., Li, Y., Wanders, A. J., Alssema, M., Zock, P. L., Willett, W. C., Hu, F. B., & Sun, Q. (2016) · BMJ · doi:10.1136/bmj.i5796 · Cited by 293 · see citing works
Self-citationHealthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women
Chomistek, A. K., Chiuve, S. E., Eliassen, A. H., Mukamal, K. J., Willett, W. C., & Rimm, E. B. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.10.024 · Cited by 283 · see citing works
Self-citationA prospective study of intake of fish and marine fatty acids and prostate cancer.
Bälter, K. A., Michaud, D. S., Rimm, E. B., Leitzmann, M. F., Stampfer, M. J., Willett, W. C., & Giovannucci, E. L. (2003) · PubMed · Cited by 276 · see citing works
Self-citationPremenopausal Fat Intake and Risk of Breast Cancer
Cho, E., Spiegelman, D. L., Hunter, D. J., Chen, W. Y., Stampfer, M. J., Colditz, G. A., & Willett, W. C. (2003) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/95.14.1079 · Cited by 275 · see citing works
Self-citationCoffee, Caffeine, and Risk of Type 2 Diabetes
van Dam, R. M., Willett, W. C., Manson, J. E., & Hu, F. B. (2006) · Diabetes Care · doi:10.2337/diacare.29.02.06.dc05-1512 · Cited by 273 · see citing works
Self-citationCoffee, Caffeine, and Risk of Depression Among Women
Lucas, M. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.393 · Cited by 270 · see citing works
Kröger, J., Zietemann, V., Enzenbach, C., Weikert, C., Jansen, E. H., Döring, F., Joost, H.-G., Boeing, H., & Schulze, M. B. (2011) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.110.005447 · Cited by 270 · see citing works
Lin, J., Fung, T. T., Hu, F. B., & Curhan, G. C. (2011) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2010.09.027 · Cited by 270 · see citing works
Self-citationLiu, S., Lee, I.-M. M., Ajani, U. A., Cole, S. R., Buring, J. E., & Manson, J. E. (2001) · International Journal of Epidemiology · doi:10.1093/ije/30.1.130 · Cited by 269 · see citing works
Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index
McCullough, M. L., & Willett, W. C. (2006) · Public Health Nutrition · doi:10.1079/phn2005938 · Cited by 267 · see citing works
Self-citationCho, E. (2004) · Archives of Ophthalmology · doi:10.1001/archopht.122.6.883 · Cited by 266 · see citing works
Major Dietary Patterns and the Risk of Colorectal Cancer in Women
Fung, T. T., Hu, F. B., Fuchs, C. S., Giovannucci, E. L., Hunter, D. J., Stampfer, M. J., Colditz, G. A., & Willett, W. C. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.3.309 · Cited by 266 · see citing works
Self-citationDicken, S. J., & Batterham, R. L. (2021) · Nutrients · doi:10.3390/nu14010023 · Cited by 264 · see citing works
Michaëlsson, K., Melhus, H., Lemming, E. W., Wolk, A., & Byberg, L. (2013) · BMJ · doi:10.1136/bmj.f228 · Cited by 260 · see citing works
Potato and french fry consumption and risk of type 2 diabetes in women
Halton, T. L., Willett, W. C., Liu, S., Manson, J. E., Stampfer, M. J., & Hu, F. B. (2006) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.2.284 · Cited by 257 · see citing works
Self-citationHaring, B., Selvin, E., Liang, M., Coresh, J., Grams, M. E., Petruski-Ivleva, N., Steffen, L. M., & Rebholz, C. M. (2017) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2016.11.004 · Cited by 254 · see citing works
Dietary protein intake and risk of type 2 diabetes in US men and women
Malik, V. S., Li, Y., Tobias, D. K., Pan, A., & Hu, F. B. (2016) · American Journal of Epidemiology · doi:10.1093/aje/kwv268 · Cited by 251 · see citing works
Self-citationA prospective study of dietary fat consumption and endometriosis risk
Missmer, S. A., Chavarro, J. E., Malspeis, S., Bertone-Johnson, E. R., Hornstein, M. D., Spiegelman, D., Barbieri, R. L., Willett, W. C., & Hankinson, S. E. (2010) · Human Reproduction · doi:10.1093/humrep/deq044 · Cited by 251 · see citing works
Self-citation
- Authors
- Hu, F. B., Stampfer, M. J., Rimm, E., Ascherio, A., Rosner, B. A., Spiegelman, D., & Willett, W. C.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Hu, F. B.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1999-03-15
- Volume
- 149
- Issue
- 6
- Pages
- 531-540
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2171753645
- Cited by
- 1,085
- References
- 28
- Citations by year
- 2026: 30 · 2025: 34 · 2024: 55 · 2023: 52 · 2022: 53 · 2021: 57 · 2020: 59 · 2019: 46 · 2018: 52 · 2017: 46 · 2016: 58 · 2015: 51 · 2014: 43 · 2013: 57 · 2012: 50
- FWCI
- 22.62
- Type
- journal article
- Language
- en
- Open access
- green
- nrs.harvard.edu
- Licence
- cc-by
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Heart, Lung, and Blood Institute (HL24074, HL34594, R01HL034594)
- National Cancer Institute (CA-40356)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- dietary fat, coronary artery disease, saturated fat, trans fatty acids, monounsaturated fatty acids, polyunsaturated fat, energy adjustment, Nurses' Health Study, dietary assessment
- MeSH terms
- Adult, Energy Intake, Coronary Disease, Data Interpretation, Statistical, Dietary Fats, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Risk, Models, Statistical, Cohort Studies, Nutrition Assessment
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