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Comparison of two statistical approaches to predict all-cause mortality by dietary patterns in German elderly subjects

Published online by Cambridge University Press:  08 March 2007

Kurt Hoffmann ,
Heiner Boeing ,
Paolo Boffetta ,
Gabriele Nagel ,
Philippos Orfanos ,
Pietro Ferrari  and
Christina Bamia
Kurt Hoffmann*
Affiliation:
Department of Epidemiology, German Institute of Human Nutrition, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
Heiner Boeing
Affiliation:
Department of Epidemiology, German Institute of Human Nutrition, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
Paolo Boffetta
Affiliation:
Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany
Gabriele Nagel
Affiliation:
Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany
Philippos Orfanos
Affiliation:
Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
Pietro Ferrari
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, Lyon, France
Christina Bamia
Affiliation:
Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
*
*Corresponding author: Dr Kurt Hoffmann, fax +49 33200 88 721, email khoff@mail.dife.de
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Abstract

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Dietary patterns are comprehensive variables of dietary intake appropriate to model the complex exposure in nutritional research. The objectives of this study were to identify dietary patterns by applying two statistical methods, principal component analysis (PCA) and reduced rank regression (RRR), and to assess their ability to predict all-cause mortality. Motivated by previous studies we chose percentages of energy from different macronutrients as response variables in the RRR analysis. We used data from 9356 German elderly subject enrolled in the European Prospective Investigation into Cancer and Nutrition study. The first RRR pattern, subjects which explained 30·8 % of variation in energy sources and especially much variation in intake of saturated fat, monounsaturated fat and carbohydrates was a significant predictor of all-cause mortality. The pattern score had high positive loadings in all types of meat, butter, sauces and eggs, and was inversely associated with bread and fruits. After adjustment for other known risk factors, the relative risks from the lowest to highest quintiles of the first RRR pattern score were 1·0, 1·01, 0·96, 1·32, 1·61 (P for trend: 0·0004). In contrast, the first two PCA patterns explaining 19·7 % of food intake variation but only 7·0 % of variation in energy sources were not related to mortality. These results suggest that variation in macronutrients is meaningful for mortality and that the RRR method is more appropriate than the classic PCA method to identify dietary patterns relevant to mortality.

Keywords

NutritionMortalityDietary patternsStatistical methods
Type
Research Article
Information
British Journal of Nutrition , Volume 93 , Issue 5 , May 2005 , pp. 709 - 716
Copyright
Copyright © The Nutrition Society 2005

References

Boeing, H, Korfmann, A & Bergmann, MM (1999) Recruitment procedures of EPIC-Germany. Ann Nutr Metab 43, 205–215.CrossRefGoogle ScholarPubMed
Boeing, H, Wahrendorf, J & Becker, N (1999) EPIC-Germany – a source for studies into diet and risk of chronic diseases. Ann Nutr Metab 43, 195–204.CrossRefGoogle ScholarPubMed
Costacou, T, Bamia, C, Ferrari, P, Riboli, E, Trichopoulos, D & Trichopoulou, A (2003) Tracing the Mediterranean diet through principal components and cluster analyses in the Greek population. Eur J Clin Nutr 57, 1378–1385.CrossRefGoogle ScholarPubMed
Dehne, LI, Klemm, C, Henseler, G, Herrmann-Kunz, E (1999) The German Food Code and Nutrient Data Base (BLSII.2). Eur J Epidemiol 15, 255–259.CrossRefGoogle Scholar
Fortes, C, Forastiere, F, Farchi, S, Rapiti, E, Pastori, G & Perucci, CA (2000) Diet and overall survival in a cohort of very elderly people. Epidemiology 11, 440–445.CrossRefGoogle Scholar
Haftenberger, M, Schuit, AJ & Tormo, MJ (2002) Physical activity of subjects aged 50–64 years involved in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5, 1163–1176.CrossRefGoogle ScholarPubMed
Haines, PS, Siega-Riz, AM & Popkin, BM (1999) The Diet Quality Index revised: a measurement instrument for populations. J Am Diet Assoc 99, 697–704.CrossRefGoogle ScholarPubMed
He, K, Merchant, A, Rimm, EB, Rosner, BA, Stampfer, MJ, Willett, WC & Ascherio, A (2003) Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study. Br Med J 327, 777–782.CrossRefGoogle ScholarPubMed
Hoffmann, K, Schulze, MB, Schienkiewitz, A, Nöthlings, U & Boeing, H (2004a) Application of a new statistical method to derive dietary patterns in nutritional epidemiology. Am J Epidemiol 159, 935–944.CrossRefGoogle ScholarPubMed
Hoffmann, K, Zyriax, BC, Boeing, H & Windler, E (2004b) A dietary pattern derived to explain biomarker variation is strongly associated with risk of coronary artery disease. Am J Clin Nutr 80, 633–640.CrossRefGoogle ScholarPubMed
Hooper, L, Summerbell, CD, Higgins, JP, Thompson, RL, Capps, NE, Smith, GD, Riemersma, RA & Ebrahim, S (2001) Dietary fat intake and prevention of cardiovascular disease: systematic review. Br Med J 322, 757–763.CrossRefGoogle ScholarPubMed
Hu, FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 3–9.CrossRefGoogle ScholarPubMed
Hu, FB, Rimm, EB, Stampfer, MJ, Ascherio, A, Spiegelman, D & Willett, WC (2000) Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 72, 912–921.CrossRefGoogle ScholarPubMed
Hu, FB, Stampfer, MJ, Manson, JE, Rimm, E, Colditz, GA, Rosner, BA, Hennekens, CH & Willett, WC (1997) Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 337, 1491–1499.CrossRefGoogle ScholarPubMed
Hu, FB & Willett, WC (2002) Optimal diets for prevention of coronary heart disease. JAMA 288, 2569–2578.CrossRefGoogle ScholarPubMed
Huijbregts, P, Feskens, E, Räsänen, L, Fidanza, F, Nissinen, A, Menotti, A & Kromhout, D (1997) Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study. Br Med J 315, 13–17.CrossRefGoogle ScholarPubMed
Institute of Medicine of the National Academies, Panel on Dietary Reference Intakes for Macronutrients (2002) Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids, Washington, DC: National Academy Press.Google Scholar
Jakobsen, MU, Overvad, K, Dyerberg, J, Schroll, M & Heitmann, BL (2004) Dietary fat and risk of coronary heart disease: possible effect modification by gender and age. Am J Epidemiol 160, 141–149.CrossRefGoogle ScholarPubMed
Kant, AK, Schatzkin, A, Graubard, BI & Schairer, C (2000) A prospective study of diet quality and mortality in women. JAMA 283, 2109–2115.CrossRefGoogle ScholarPubMed
Kennedy, ET, Ohls, J, Carlson, S & Fleming, K (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 1103–1108.CrossRefGoogle ScholarPubMed
Kris-Etherton, PM, Kris-Etherton, PM, Binkoski, AE, Zhao, G, Coval, SM, Clemmer, KF, Hecker, KD, Jacques, H & Etherton, TD (2002) Dietary fat: assessing the evidence in support of a moderate-fat diet; the benchmark based on lipoprotein metabolism. Proc Nutr Soc 61, 287–298.CrossRefGoogle ScholarPubMed
Kroke, A, Bergmann, MM, Lotze, G, Jeckel, A, Klipstein-Grobusch, K & Boeing, H (1999a) Measures of quality control in the German component of the EPIC Study. Ann Nutr Metab 43, 216–224.CrossRefGoogle ScholarPubMed
Kroke, A, Klipstein-Grobusch, K, Voss, S, Möseneder, J, Thielecke, F, Noack, R & Boeing, H (1999b) Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods. Am J Clin Nutr 70, 439–447.CrossRefGoogle Scholar
Kumagai, S, Shibata, H, Watanabe, S, Suzuki, T & Haga, H (1999) Effect of food intake pattern on all-cause mortality in the community elderly: a 7-year longitudinal study. J Nutr Health Aging 3, 29–33.Google ScholarPubMed
Lasheras, C, Fernandez, S & Patterson, AM (2000) Mediterranean diet and age with respect to overall survival in institutionalised, non-smoking elderly people. Am J Clin Nutr 71, 987–992.CrossRefGoogle Scholar
Lichtenstein, AH (2003) Dietary fat and cardiovascular disease risk: quantity or quality?. J Womens Health 12, 109–114.CrossRefGoogle ScholarPubMed
Liu, S & Manson, JE (2001) Dietary carbohydrates, physical inactivity, obesity, and the ‘metabolic syndrome’ as predictors of coronary heart disease. Curr Opin Lipidol 12, 395–404.CrossRefGoogle ScholarPubMed
Mann, JL (2002) Diet and risk of coronary heart disease and type 2 diabetes. Lancet 360, 783–789.CrossRefGoogle ScholarPubMed
McCullough, ML, Feskanich, D, Stampfer, MJ, Giovannucci, EL, Rimm, EB, Hu, FB, Spiegelman, D, Hunter, DJ, Colditz, GA & Willett, WC (2002) Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76, 1261–1271.CrossRefGoogle ScholarPubMed
Osler, M, Heitmann, BL, Gerdes, LU, Jorgensen, LM & Schroll, M (2001) Dietary patterns and mortality in Danish men and women: a prospective observational study. Br J Nutr 85, 219–225.CrossRefGoogle ScholarPubMed
Osler, M & Schroll, M (1997) Diet and mortality in a cohort of elderly people in a North European community. Int J Epidemiol 26, 155–159.CrossRefGoogle Scholar
Patterson, RE, Haines, PS & Popkin, BM (1994) Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 94, 57–64.CrossRefGoogle ScholarPubMed
Pelkman, CL, Fishell, VK, Maddox, DH, Pearson, TA, Mauger, DT, Kris-Etherton, PM (2004) Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr 79, 204–212.CrossRefGoogle ScholarPubMed
Randall, E, Marshall, JR, Brasure, J & Graham, S (1992) Dietary patterns and colon cancer in western New York. Nutr Cancer 18, 265–276.CrossRefGoogle ScholarPubMed
Rothman, KJ (1976) Causes. Am J Epidemiol 104, 587–592.CrossRefGoogle ScholarPubMed
Sacks, FM & Katan, M (2002) Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease Am J Med, Suppl., 9B 13S–24S.CrossRefGoogle Scholar
Salmeron, J, Hu, FB, Manson, JE, Stampfer, MJ, Colditz, GA, Rimm, EB & Willett, WC (2001) Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr 73, 1019–1026.CrossRefGoogle ScholarPubMed
SAS Institute Inc. (1999) SAS/STAT User's Guide, Cary, NC: SAS Institute Inc.Google Scholar
Schulze, MB, Brandstetter, BR, Kroke, A, Wahrendorf, J & Boeing, H (1999) Quantitative food intake in the EPIC-Germany cohorts. Ann Nutr Metab 43, 235–245.CrossRefGoogle ScholarPubMed
Schulze, MB, Hoffmann, K, Kroke, A & Boeing, H (2001) Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. Br J Nutr 85, 363–373.CrossRefGoogle ScholarPubMed
Schulze, MB, Hoffmann, K, Kroke, A & Boeing, H (2003) An approach to construct simplified measures of dietary patterns from exploratory factor analysis. Br J Nutr 89, 409–418.CrossRefGoogle ScholarPubMed
Schulze, MB & Hu, FB (2002) Dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease. Curr Atherosclerosis Reports 4, 462–467.CrossRefGoogle ScholarPubMed
Seymour, JD, Calle, EE, Flagg, EW, Coates, RJ, Ford, ES, Thun, MJ, American, Cancer Society (2003) Diet quality index as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort. Am J Epidemiol 157, 980–988.CrossRefGoogle ScholarPubMed
Slattery, ML, Boucher, KM, Caan, BJ, Potter, JP & Ma, K (1998) Eating patterns and risk of colon cancer. Am J Epidemiol 148, 4–16.CrossRefGoogle ScholarPubMed
Slimani, N, Fahey, M & Welch, AA (2002) Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr 5, 1311–1328.CrossRefGoogle ScholarPubMed
Strandhagen, E, Hansson, PO, Bosaeus, I, Isaksson, B & Eriksson, H (2000) High fruit intake may reduce mortality among middle-aged and elderly men. The study of men born in 1913. Eur J Clin Nutr 54, 337–341.CrossRefGoogle Scholar
Tanasescu, M, Cho, E, Manson, JE & Hu, FB (2004) Dietary fat and cholesterol and the risk of cardiovascular disease among women with type 2 diabetes. Am J Clin Nutr 79, 999–1005.CrossRefGoogle ScholarPubMed
Trichopoulou, A, Costacou, T, Bamia, C & Trichopoulos, D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 2599–2608.CrossRefGoogle Scholar
Trichopoulou, A, Kouris-Blazos, A, Wahlqvist, ML, Gnardellis, C, Lagiou, P, Polychronopoulos, E, Vassilakou, T, Lipworth, L & Trichopoulos, D (1995) Diet and overall survival in elderly. Br Med J 311, 1457–1460.CrossRefGoogle ScholarPubMed
Van Dam, RM, Grievink, L, Ocké, MC & Feskens, EJM (2003) Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population. Am J Clin Nutr 77, 1156–1163.CrossRefGoogle ScholarPubMed
Wareham, NJ, Jakes, RW, Rennie, KL, Schuit, J, Mitchell, J, Hennings, S & Day, NE (2003) Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition, (EPIC) study. Public Health Nutr 6, 407–413.CrossRefGoogle ScholarPubMed
Willett, W (1998) Nutritional Epidemiology New York Oxford University PressCrossRefGoogle Scholar
Willett, WC (2000) Nutritional epidemiology issues in chronic disease at the turn of the century. Epidem Rev 22, 82–86.CrossRefGoogle ScholarPubMed
Willett, WC (2000) Diet and cancer. Oncologist 5, 393–404.CrossRefGoogle ScholarPubMed
Wolfram, G (2003) Dietary fatty acids and coronary heart disease. Eur J Med Res 8, 321–324.Google ScholarPubMed
World, Cancer & Research, Fund (1997) Food, Nutrition, and the Prevention of Cancer: A Global Perspective Washington, DC World Cancer Research FundGoogle Scholar