Biomarker-Calibrated Macronutrient Intake and Chronic Disease Risk among Postmenopausal Women

ABSTRACT Background Knowledge about macronutrient intake and chronic disease risk has been limited by the absence of objective macronutrient measures. Recently, we proposed novel biomarkers for protein, protein density, carbohydrate, and carbohydrate density, using established biomarkers and serum and urine metabolomics profiles in a human feeding study. Objectives We aimed to use these biomarkers to develop calibration equations for macronutrient variables using dietary self-reports and personal characteristics and to study the association between biomarker-calibrated intake estimates and cardiovascular disease, cancer, and diabetes risk in Women's Health Initiative (WHI) cohorts. Methods Prospective disease association analyses are based on WHI cohorts of postmenopausal US women aged 50–79 y when enrolled at 40 US clinical centers (n = 81,954). We used biomarker intake values in a WHI nutritional biomarker study (n = 436) to develop calibration equations for each macronutrient variable, leading to calibrated macronutrient intake estimates throughout WHI cohorts. We then examined the association of these intakes with chronic disease incidence over a 20-y (median) follow-up period using HR regression methods. Results In analyses that included doubly labeled water–calibrated total energy, HRs for cardiovascular diseases and cancers were mostly unrelated to calibrated protein density. However, many were inversely related to carbohydrate density, with HRs (95% CIs) for a 20% increment in carbohydrate density of 0.81 (0.69, 0.95) and 0.83 (0.74, 0.93), respectively, for primary outcomes of coronary heart disease and breast cancer, as well as 0.74 (0.60, 0.91) and 0.87 (0.81, 0.93) for secondary outcomes of heart failure and total invasive cancer. Corresponding HRs (95% CIs) for type 2 diabetes incidence in relation to protein density and carbohydrate density were 1.17 (1.09, 1.75) and 0.73 (0.66, 0.80), respectively. Conclusions At specific energy intake, a diet high in carbohydrate density is associated with substantially reduced risk of major chronic diseases in a population of US postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00000611.

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Preventing chronic disease risk factors: Rationale and feasibility

Medicina ◽

10.3390/medicina44100094 ◽

2008 ◽

Vol 44 (10) ◽

pp. 745 ◽

Cited By ~ 13

Author(s):

Courtney Jordan ◽

Megan Slater ◽

Thomas Kottke

Keyword(s):

Health Care ◽

Risk Factor ◽

Chronic Disease ◽

Disease Risk ◽

Disease Incidence ◽

Developed Countries ◽

The United States ◽

Hazardous Drinking ◽

Chronic Disease Risk ◽

Risk Factor Prevention

Objective. The majority of the mortality, morbidity, and disability in the United States and other developed countries is due to chronic diseases. These diseases could be prevented to a great extent with the elimination of four root causes: physical inactivity, poor nutrition, smoking, and hazardous drinking. The objective of this analysis was to determine whether efficacious risk factor prevention interventions exist and to examine the evidence that populationwide program implementation is justified. Materials and methods. We conducted a literature search for meta-analyses and systematic reviews of trials that tested interventions to increase physical activity, improve nutrition, reduce smoking and exposure to environmental tobacco smoke, and reduce hazardous drinking. Results. We found that appropriately designed interventions can produce behavioral change for the four behaviors. Effective interventions included tailored fact-to-face counseling, phone counseling, and computerized tailored feedback. Computer-based health behavior assessment with feedback and education was documented to be an effective method of determining behavior, assessing participant interest in behavior change and delivering interventions. Some programs have documented reduced health care costs associated with intervention. Conclusions. Positive results to date suggest that further investments to improve the effectiveness and efficiency of chronic disease risk factor prevention programs are warranted. Widespread implementation of these programs could have a significant impact on chronic disease incidence rates and costs of health care.

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