Cited by 1,085Nutritional Studies and DietFatty Acid Research and HealthCardiovascular Health and Risk Factors

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Dietary Fat and Coronary Heart Disease: A Comparison of Approaches for Adjusting for Total Energy Intake and Modeling Repeated Dietary Measurements

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Hu, F. B., Stampfer, M. J., Rimm, E., Ascherio, A., Rosner, B. A., Spiegelman, D., Willett, W. C.·1999·American Journal of Epidemiology

DOI 10.1093/oxfordjournals.aje.a009849

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Abstract

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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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.
ORCID: Hu, F. B.
Stampfer, M. J.
Rimm, E.
Ascherio, A.
Rosner, B. A.
Spiegelman, D.
Willett, W. C.
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
DOI: 10.1093/oxfordjournals.aje.a009849
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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Dietary Fat and Coronary Heart Disease: A Comparison of Approaches for Adjusting for Total Energy Intake and Modeling Repeated Dietary Measurements

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