Teresa T. Fung

Adherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women

BACKGROUND The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure, but little is known about its long-term effect on cardiovascular end points. Our objective was to assess the association between a DASH-style diet adherence score and risk of coronary heart disease (CHD) and stroke in women. METHODS In this prospective cohort study, diet was assessed 7 times during 24 years of follow-up (1980-2004) with validated food frequency questionnaires. A DASH score based on 8 food and nutrient components (fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meats, sweetened beverages, and sodium) was calculated. Lifestyle and medical information was collected biennially with a questionnaire. The Cox proportional hazard model was used to adjust for potential confounders. The study population comprised 88,517 female nurses aged 34 to 59 years without a history of cardiovascular disease or diabetes in 1980. The main outcome measures were the numbers of confirmed incident cases of nonfatal myocardial infarction, CHD death, and stroke. RESULTS We documented 2129 cases of incident nonfatal myocardial infarction, 976 CHD deaths, and 2317 [corrected] cases of stroke. After adjustment for age, smoking, and other cardiovascular risk factors, the relative risks of CHD across quintiles of the DASH score were 1.0, 0.99, 0.86, 0.87, and 0.76 (95% confidence interval, 0.67-0.85) (P<.001 for trend). The magnitude of risk difference was similar for nonfatal myocardial infarction and fatal CHD. The DASH score was also significantly associated with lower risk of stroke (multivariate relative risks across quintiles of the DASH score were 1.0, 0.92, 0.91, 0.89, and 0.82) (P=.002 for trend). Cross-sectional analysis in a subgroup of women with blood samples showed that the DASH score was significantly associated with lower plasma levels of C-reactive protein (P=.008 for trend) and interleukin 6 (P=.04 for trend). CONCLUSION Adherence to the DASH-style diet is associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up.

Favorable Impact of a Multidisciplinary Antibiotic Management Program Conducted During 7 Years

OBJECTIVE To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years. DESIGN Prospective study with comparison with preintervention trends. SETTING University-affiliated teaching hospital. PATIENTS All adult inpatients. INTERVENTION A multidisciplinary antibiotic management program to minimize the inappropriate use of third-generation cephalosporins was implemented in 1991. Its impact was evaluated prospectively. The incidence of nosocomial C. difficile and resistant Enterobacteriaceae infections as well as the rate of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were compared with those of National Nosocomial Infections Surveillance System hospitals of similar size. RESULTS Following implementation of the program, there was a 22% decrease in the use of parenteral broad-spectrum antibiotics (P < .0001) despite a 15% increase in acuity of patient care during the following 7 years. Concomitantly, there was a significant (P = .002) decrease in nosocomial infections caused by C. difficile and a significant (P = .02) decrease in nosocomial infections caused by resistant Enterobacteriaceae. The program also appeared to have a favorable impact on VRE rates without a sustained impact on MRSA rates. CONCLUSION These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.

Prospective Study of Major Dietary Patterns and Stroke Risk in Women

Background and Purpose— Many foods have been suggested to influence the risk of stroke. However, no previous studies have examined the relationship between overall dietary patterns and risk of stroke. Methods— Using dietary information collected in 1984 from 71 768 women aged 38 to 63 years without a history of cardiovascular disease or diabetes in 1984, we conducted factor analysis and identified 2 major dietary patterns: “prudent” and “Western.” We calculated scores for each participant for each pattern and prospectively examined their associations with stroke risk using a proportional hazard model, adjusting for other stroke risk factors. Results— The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, and whole grains, whereas the Western pattern by higher intakes of red and processed meats, refined grains, and sweets and desserts. During 14 years of follow-up, we identified 791 incidents of stroke, with 476 ischemic and 189 hemorrhagic strokes. After adjusting for potential confounders, we observed a relative risk (RR) of 1.58 (95% CI, 1.15 to 2.15; P = 0.0002 for trend) for total strokes and 1.56 (95% CI, 1.05 to 2.33; P = 0.02 for trend) for ischemic stroke when comparing the highest with lowest quintiles of the Western pattern. For the prudent pattern, the RRs comparing extreme quintiles were 0.78 (95% CI, 0.61 to 1.01) for total stroke and 0.74 (95% CI, 0.54 to 1.02) for ischemic stroke. Conclusions— These data suggest that a dietary pattern typified by higher intakes of red and processed meats, refined grains, and sweets and desserts may increase stroke risk, whereas a diet higher in fruits and vegetables, fish, and whole grains may protect against stroke.

Dietary patterns and the risk of postmenopausal breast cancer.

The association between individual foods and breast cancer has been inconsistent. Therefore, we examined the association between diet and risk of postmenopausal breast cancer by the alternative approach of dietary patterns. Dietary patterns were identified with factor analysis from food consumption data collected from a food frequency questionnaire in 1984. Relative risks were computed using proportional hazard models and adjusted for known risk factors for breast cancer. Between 1984 and 2000, we ascertained 3,026 incident cases of postmenopausal breast cancer. We identified 2 major dietary patterns. The prudent pattern is characterized by higher intake of fruits, vegetables, whole grains, low‐fat dairy products, fish and poultry, while the Western pattern is characterized by higher intake of red and processed meats, refined grains, sweets and desserts and high‐fat dairy products. Neither of the patterns was associated with overall risk of postmenopausal breast cancer. However, a positive association between the Western pattern score was observed among smokers at baseline (relative risk = 1.44, comparing top to bottom quintiles; 95% CI = 1.02–2.03; p for trend = 0.03). An inverse association was observed between the prudent pattern and estrogen receptor‐negative cancer (relative risk = 0.62; 95% CI = 0.45–0.88; p for trend = 0.006). Among the major food groups, higher consumptions of fruits (relative risk for 1 serving/day increase = 0.88; 95% CI = 0.80–0.97; p = 0.009) and vegetables (relative risk = 0.94; 95% CI = 0.88–0.99; p = 0.03) were significantly associated with decreased risk for ER− breast cancer. In conclusion, we did not observe an overall association between the prudent or Western pattern and overall breast cancer risk. However, a Western‐type diet may elevate risk of breast cancer among smokers, and a prudent diet may protect against estrogen receptive‐negative tumors.

Dietary Patterns and Changes in Body Weight in Women

Objective: Our objective was to examine the association between adherence to dietary patterns and weight change in women.

Diet-Quality Scores and the Risk of Type 2 Diabetes in Men

OBJECTIVE To 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata. RESEARCH DESIGN AND METHODS Men from the Health Professionals Follow-Up Study, who were initially free of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for ≤20 years. The Healthy Eating Index (HEI) 2005, the alternative HEI (aHEI) the Recommended Food Score, the alternative Mediterranean Diet (aMED) Score, and the Dietary Approaches to Stop Hypertension (DASH) Score were calculated from food-frequency questionnaires. Cox proportional hazard models with time-varying covariates were used to assess risk by quintiles and continuous intervals. RESULTS There were 2,795 incident cases of type 2 diabetes. After multivariate adjustment, the aHEI, aMED, and DASH scores were significantly associated with reduced risk. A 1-SD increase was associated with 9–13% reduced risk (P < 0.01), and the DASH score was associated with lower risk independent of other scores. These scores were associated with lower absolute risk among those who were overweight or obese compared with normal weight (P for interaction < 0.01). CONCLUSIONS Several diet-quality scores were associated with a lower risk of type 2 diabetes and reflect a common dietary pattern characterized by high intakes of plant-based foods such as whole grains; moderate alcohol; and low intakes of red and processed meat, sodium, sugar-sweetened beverages, and trans fat. High-quality diets may yield the greatest reduction in diabetes cases when followed by those with a high BMI.

The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and colorectal cancer

BACKGROUND Although the Mediterranean diet has been studied for cancer mortality and the Dietary Approaches to Stop Hypertension (DASH) diet shares similarities with the Mediterranean diet, few studies have specifically examined these 2 diets and incident colorectal cancer. OBJECTIVE The objective was to prospectively assess the association between the Alternate Mediterranean Diet (aMed) and the DASH-style diet scores and risk of colorectal cancer in middle-aged men and women. DESIGN A total of 87,256 women and 45,490 men (age 30-55 y for women and 40-75 y for men at baseline) without a history of cancer were followed for ≤ 26 y. The aMed and DASH scores were calculated for each participant by using dietary information that was assessed ≤ 7 times during follow-up. Relative risks (RRs) for colorectal cancer were computed with adjustment for potential confounders. RESULTS We documented 1432 cases of incident colorectal cancer among women and 1032 cases in men. Comparing top with bottom quintiles of the DASH score, the pooled RR for total colorectal cancer was 0.80 (95% CI: 0.70, 0.91; P for trend = 0.0001). The corresponding RR for DASH score and colon cancer was 0.81 (95% CI: 0.69, 0.95; P for trend = 0.002). There was a suggestion of an inverse association with rectal cancer with a pooled RR of 0.73 (95% CI: 0.55, 0.98; P for trend = 0.31) when comparing top with bottom quintiles of DASH score. No association was observed with aMed score. CONCLUSION Adherence to the DASH diet (which involves higher intakes of whole grains, fruit, and vegetables; moderate amounts of low-fat dairy; and lower amounts of red or processed meats, desserts, and sweetened beverages) was associated with a lower risk of colorectal cancer.

Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men

Background: Many foods are associated with chronic obstructive pulmonary disease (COPD) symptoms or lung function. Because foods are consumed together and nutrients may interact, dietary patterns are an alternative way of characterising diet. A study was undertaken to assess the relation between dietary patterns and newly diagnosed COPD in men. Methods: Data were collected from a large prospective cohort of US men (Health Professionals Follow-up Study). Using principal component analysis, two dietary patterns were identified: a prudent pattern (high intake of fruits, vegetables, fish and whole grain products) and a Western pattern (high intake of refined grains, cured and red meats, desserts and French fries). Dietary patterns were categorised into quintiles and Cox proportional hazards models were adjusted for age, smoking, pack-years, (pack-years)2, race/ethnicity, physician visits, US region, body mass index, physical activity, multivitamin use and energy intake. Results: Between 1986 and 1998, 111 self-reported cases of newly diagnosed COPD were identified among 42 917 men. The prudent pattern was inversely associated with the risk of newly diagnosed COPD (RR for highest vs lowest quintile 0.50 (95% CI 0.25 to 0.98), p for trend = 0.02), and the Western pattern was positively associated with the risk of newly diagnosed COPD (RR for highest vs lowest quintile 4.56 (95% CI 1.95 to 10.69), p for trend <0.001). Conclusions: In men, a diet rich in fruits, vegetables and fish may reduce the risk of COPD whereas a diet rich in refined grains, cured and red meats, desserts and French fries may increase the risk of COPD.

Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study

Objective To examine whether adherence to the Mediterranean diet was associated with longer telomere length, a biomarker of aging. Design Population based cohort study. Setting Nurses’ Health Study, an ongoing prospective cohort study of 121 700 nurses enrolled in 1976; in 1989-90 a subset of 32 825 women provided blood samples. Participants 4676 disease-free women from nested case-control studies within the Nurses’ Health Study with telomere length measured who also completed food frequency questionnaires. Main outcome measure Association between relative telomere lengths in peripheral blood leukocytes measured by quantitative real time polymerase chain reaction and Alternate Mediterranean Diet score calculated from self reported dietary data. Results Greater adherence to the Mediterranean diet was associated with longer telomeres after adjustment for potential confounders. Least squares mean telomere length z scores were −0.038 (SE 0.035) for the lowest Mediterranean diet score groups and 0.072 (0.030) for the highest group (P for trend=0.004). Conclusion In this large study, greater adherence to the Mediterranean diet was associated with longer telomeres. These results further support the benefits of adherence to the Mediterranean diet for promoting health and longevity.

Overweight and Obesity Predict Time to Periodontal Disease Progression in Men

AIMS To examine whether overweight and obesity indicators - body mass index (BMI), waist circumference (WC), and WC-to-height ratio - predict progression of periodontal disease in men. MATERIAL AND METHODS Participants were 1038 medically healthy, non-Hispanic, white males in the VA Dental Longitudinal Study who were monitored with triennial oral and medical examinations between 1969 and 1996. Periodontal disease progression in an individual was defined as having two or more teeth advance to levels of alveolar bone loss ≥40%, probing pocket depth ≥5 mm, or clinical attachment loss ≥5 mm after baseline. Extended Cox regression analyses estimated hazards of experiencing periodontal disease progression events due to overweight/obesity status, controlling for age, smoking, education, diabetes, recent periodontal treatment, recent prophylaxis, and number of filled/decayed surfaces. RESULTS Body mass index and WC-to-height ratio were significantly associated with hazards of experiencing periodontal disease progression events regardless of periodontal disease indicator. Adjusted hazard ratios for periodontal disease progression were 41-72% higher in obese men (BMI ≥30 kg/m(2)) relative to men with both normal weight and WC-to-height ratio (≤50%). CONCLUSION Both overall obesity and central adiposity are associated with an increased hazards of periodontal disease progression events in men.