TY - JOUR
T1 - Biomarker-Calibrated Macronutrient Intake and Chronic Disease Risk among Postmenopausal Women
AU - Prentice, Ross L.
AU - Pettinger, Mary
AU - Neuhouser, Marian L.
AU - Raftery, Daniel
AU - Zheng, Cheng
AU - Nagana Gowda, G. A.
AU - Huang, Ying
AU - Tinker, Lesley F.
AU - Howard, Barbara V.
AU - Manson, Jo Ann E.
AU - Wallace, Robert
AU - Mossavar-Rahmani, Yasmin
AU - Johnson, Karen C.
AU - Lampe, Johanna W.
N1 - Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute, NIH, US Department of Health and Human Services (contracts HHSN268201600046C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, HHSN268201600004C, and HHSN271201600004C); National Cancer Institute grants R01 CA119171 and P30 CA15704; and NIH instrumentation grant S10 OD021562.
Funding Information:
The WHI is funded primarily by the National Heart, Lung, and Blood Institute. Participants provided written informed consent for their overall WHI, NPAAS, and NPAAS-FS activities. Related protocols were approved by the Institutional Review Boards at the Fred Hutchinson Cancer Research Center and at each participating clinical center.
Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the American Society for Nutrition.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - 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.
AB - 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.
KW - biomarker
KW - cancer
KW - cardiovascular disease
KW - diabetes
KW - diet
KW - macronutrient
KW - measurement error
KW - metabolomics
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U2 - 10.1093/jn/nxab091
DO - 10.1093/jn/nxab091
M3 - Article
C2 - 33880504
AN - SCOPUS:85114071741
SN - 0022-3166
VL - 151
SP - 2330
EP - 2341
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 8
ER -
