| Abstrakt: |
Background: Studies of diet and chronic disease include a recent important focus on dietary patterns. Patterns are typically defined by listing dietary variables, and by totaling scores that reflect whether consumption is encouraged or discouraged for listed variables. However, precision may be improved by including total energy consumption among the dietary variables, and by scoring dietary variables empirically.Objectives: To relate Healthy Eating Index (HEI)-2010 components and total energy intake to all-cause and cause-specific mortality in Women's Health Initiative (WHI) cohorts, and to define and evaluate an associated empirical-scores healthy eating index (E-HEI).Design: Analyses are conducted in WHI cohorts (n = 67,247) of healthy post-menopausal women, aged 50-79 years when enrolled during 1993-1998 at 40 US clinical centers, with embedded nutrition biomarker studies. Replicate food frequency assessments for HEI-2010 ratio variables and doubly-labeled water total energy assessments, separated by about 6 months, are used as response variables to jointly calibrate baseline dietary data to reduce measurement error influences, using two nutrition biomarker studies (n = 199). Calibrated dietary variables are associated with mortality risk, and an E-HEI is defined, using cross-validated hazard ratio regression estimation.Results: Of 15 dietary variables considered all but empty calories calibrated well. Ten variables related significantly (P < 0.05) to total mortality, with favorable fruits, vegetables, whole grains, refined grains, and unsaturated fat associations, and unfavorable sodium, saturated fat, and total energy associations. The E-HEI had cross-validated total mortality HRs (95% CIs) of 0.87 (0.82, 0.93), 0.80 (0.76, 0.86), 0.77 (0.72, 0.82), and 0.74 (0.69, 0.79) respectively, for quintiles 2 through 5 compared to quintile 1. These depart more strongly from the null than do HRs for HEI-2010 quintiles, primarily because of total energy.Conclusion: Mortality among US postmenopausal women depends strongly on diet, as evidenced by a new E-HEI that differs substantially from earlier dietary pattern score specifications. [ABSTRACT FROM AUTHOR] |
