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Applications of dietary pattern analysis.

机译：饮食模式分析的应用。

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摘要

Diet modification is considered important for prevention and treatment of cardiovascular diseases and type 2 diabetes mellitus (T2DM). However, research on overall diet and chronic disease risk remains scarce. To examine the impact of overall diet on health, an examination of the dietary pattern approach has only recently been undertaken in nutritional epidemiology. Although the popularity of dietary pattern studies is growing, the associated methods remain somewhat immature with unaddressed limitations. Here, three applications of dietary pattern analyses were proposed to introduce a novel technique and to address underlying limitations.;My first study focused on the criterion-based dietary pattern approach. This approach calculates a dietary index score of an individual's diet based on dietary components related to diet quality and dietary recommendations. The approach involves an untested assumption that all index components have equal health contributions. To examine this assumption, we used data from 224 postmenopausal women with established heart disease in the Estrogen and Atherosclerosis Progression Trial conducted between 1996 and 2000. The degree of adherence to key Dietary Guidelines for Americans (DGA, 2005) recommendations was scaled as a measure of overall diet by the DGA Adherence Index (DGAI) with each component equally weighted and a modified version of the DGAI (wDGAI) with each component weighted differentially by its established relationship with atherosclerosis progression. By mixed model regression analyses, the wDGAI, but not DGAI, was inversely associated with atherosclerosis progression (P=0.004); the higher the score by one standard deviation, the less narrowing the coronary arteries by 0.049 mm (standard error=0.017). Although the identical criterion-based dietary pattern was used with the DGAI and the wDGAI, only when differential weights were considered was adherence to these dietary recommendations associated with disease progression. This demonstrates the importance of considering differential weights based on health outcomes for criterion-based dietary indexes.;A common limitation in dietary pattern studies is a lack of information on generalizability of a dietary pattern derived from a single study population. My second study used data from the Framingham Offspring Study (FOS, N=2,879) to examine the generalizability of three dietary patterns identified in the US and European studies for prediction of T2DM risk. Based on predictability of T2DM risk in the FOS, the dietary patterns determined in the US population and in the FOS were similar; HRs (95%CI) were 4.14 (2.45-6.99) and 3.22 (1.93-5.38), respectively, comparing top to bottom quartile groups of each dietary pattern score. However, the predictability of T2DM risk based on dietary patterns identified in the European studies was weaker. The study suggests possible limitations of generalizability in published dietary patterns.;The third study used data from the FOS to examine the use of dietary patterns for confounding adjustment. In general, dietary pattern approach is considered advantageous for aggregating small effects of individual foods on health outcomes. This raised the hypothesis that dietary pattern analyses may aggregate small confounding effects of many individual, but related, dietary factors. The inverse association between alcohol and T2DM was tested for confounding by dietary pattern variables derived from factor analysis. Cox-proportional hazard models showed that hazard ratio (HR) comparing the top quartile group of drinkers to abstainers significantly shifted away from the null by 40.0% (95% confidence interval [CI]: 16.8 to 57.0%, P=0.002) after adjustment for dietary patterns. Therefore, the association between alcohol consumption and T2DM risk was confounded by dietary patterns. This study suggests that dietary pattern analyses are useful to adjust for dietary confounding.;In conclusion, our studies advanced the methods of dietary pattern analyses. The advances will help strengthen the applications of dietary pattern analyses and improve the knowledge and interpretation of analytical techniques used in nutritional epidemiology research on overall diet and its associations with health outcomes.
机译：饮食调整被认为对于预防和治疗心血管疾病和2型糖尿病（T2DM）具有重要意义。但是，关于整体饮食和慢性疾病风险的研究仍然很少。为了检查总体饮食对健康的影响，最近在营养流行病学中对饮食模式方法进行了检查。尽管饮食模式研究的受欢迎程度在增长，但相关方法仍处于不成熟阶段，且存在未解决的局限性。在这里，饮食模式分析的三种应用被提出来介绍一种新技术并解决潜在的局限性。我的第一个研究集中在基于标准的饮食模式方法上。该方法基于与饮食质量和饮食建议相关的饮食成分，计算个人饮食的饮食指数评分。该方法涉及未经检验的假设，即所有指数成分均具有相同的健康贡献。为了检验这一假设，我们使用了1996年至2000年之间进行的224名绝经后患有心脏病的女性的数据进行了雌激素和动脉粥样硬化进展试验。对美国主要饮食指南（DGA，2005）建议的遵守程度进行了衡量通过DGA粘附指数（DGAI）对每种食物的平均摄入量进行加权，并根据其与动脉粥样硬化进展之间的既定关系对DGAI的修改版本（wDGAI）进行加权加权。通过混合模型回归分析，wDGAI（而非DGAI）与动脉粥样硬化进展呈负相关（P = 0.004）；分数越高，标准偏差越大，则冠状动脉的狭窄程度就越小0.049 mm（标准误差= 0.017）。尽管DGAI和wDGAI使用相同的基于标准的饮食模式，但只有在考虑体重差异时，才遵守与疾病进展相关的这些饮食建议。这证明了基于健康结果对基于标准的饮食指标考虑差异权重的重要性。饮食模式研究中的一个普遍限制是缺乏有关来自单个研究人群的饮食模式可推广性的信息。我的第二项研究使用了弗雷明汉后代研究（FOS，N = 2,879）的数据来检验在美国和欧洲的研究中确定的三种饮食模式对T2DM风险预测的普遍性。根据FOS中T2DM风险的可预测性，在美国人群和FOS中确定的饮食模式是相似的。比较每个饮食模式得分的前四分位组和最低四分位组，HR（95％CI）分别为4.14（2.45-6.99）和3.22（1.93-5.38）。但是，根据欧洲研究确定的饮食模式，T2DM风险的可预测性较弱。这项研究提出了在已公布的饮食模式中普遍性的可能限制。第三项研究使用了来自FOS的数据来检验饮食模式对混杂调整的使用。通常，饮食模式方法被认为有利于汇总单个食品对健康结果的微小影响。这就提出了一种假设，即饮食模式分析可能会综合许多个体但相关的饮食因素的微小混淆作用。通过从因素分析得出的饮食模式变量测试了酒精与T2DM之间的逆相关性是否混淆。考克斯比例风险模型显示，比较调整后的前四分之一饮酒者和戒酒者的危险比（HR）从零值显着偏离40.0％（95％置信区间[CI]：16.8至57.0％，P = 0.002）饮食习惯。因此，饮食习惯混淆了饮酒与2型糖尿病风险之间的关系。这项研究表明，饮食模式分析对于调整饮食混杂是有用的。总之，我们的研究提高了饮食模式分析的方法。这些进展将有助于加强饮食模式分析的应用，并提高营养流行病学研究中整体饮食及其与健康结局之间关系的分析技术的知识和解释。

著录项

  • 作者

    Imamura, Fumiaki.;

  • 作者单位

    Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy.;

  • 授予单位 Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy.;
  • 学科 Biology Biostatistics.;Health Sciences Epidemiology.;Health Sciences Nutrition.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 149 p.
  • 总页数 149
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 生物数学方法;预防医学、卫生学;
  • 关键词

  • 入库时间 2022-08-17 11:38:24

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