Dietary fat and coronary heart disease: A comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements
Dietary fat and coronary heart disease: A comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements
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DOI：
10.1093/oxfordjournals.aje.a009849
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发表时间：
1999-03-15
影响因子：
5
通讯作者：
Willett, WC
中科院分区：
文献类型：
--
作者：
Hu, FB;Stampfer, MJ;Willett, WC
以前的队列研究脂肪摄入量和冠心病（CHD）的风险一直不一致，可能部分是由于方法的差异和各种限制，包括不充分的饮食评估和总能量摄入的不完全调整。作者分析了护士健康研究的饮食重复评估，以检查四种主要类型的脂肪（饱和脂肪、单不饱和脂肪、多不饱和脂肪和反式脂肪）的摄入量与冠心病风险之间的关系，随访时间为14年（1980-1994），采用替代方法进行能量调节。特别是，作者比较了四个风险模型的能量调整：标准的多变量模型，能量分配模型，营养残留模型，和多变量营养密度模型。在每个模型中，作者比较了分析重复饮食测量的四种不同方法：仅基线饮食，最近的饮食和计算累积平均饮食的两种不同算法。所有模型的实质性结果都是一致的;也就是说，较高的饱和脂肪和反式脂肪摄入量与冠心病风险增加有关，而较高的单不饱和脂肪和多不饱和脂肪摄入量与风险降低有关。当营养素被认为是连续变量时，四种能量调节方法产生了类似的关联。然而，不同模型对相对风险的解释不同。此外，在每个模型中，使用累积平均值的方法通常比仅使用基线饮食或最近饮食的方法产生更强的关联。当营养素根据五分位数分类时，残差和营养密度模型给出了类似的结果，比标准和分区模型产生了统计学上更显著的线性趋势检验。
Previous cohort studies of fat intake and risk of coronary heart disease (CHD) have been inconsistent, probably due in part to methodological differences and various limitations, including inadequate dietary assessment and incomplete adjustment for total energy intake. The authors analyzed repeated assessment of diet from the Nurses' Health Study to examine the associations between intakes of four major types of fat (saturated, monounsaturated, polyunsaturated, and trans fats) and risk of CHD during 14 years of follow-up (1980-1994) by using alternative methods for energy adjustment. In particular, the authors compared four risk models for energy adjustment: the standard multivariate model, the energy-partition model, the nutrient residual model, and the multivariate nutrient density model. Within each model, the authors compared four different approaches for analyzing repeated dietary measurements: baseline diet only, the most recent diet, and two different algorithms for calculating cumulative average diets. The substantive results were consistent across all models; that is, higher intakes of saturated and trans fats were associated with increased risk of CHD, while higher intakes of monounsaturated and polyunsaturated fats were associated with reduced risk. When nutrients were considered as continuous variables, the four energy-adjustment methods yielded similar associations. However, the interpretation of the relative risks differed across models. In addition, within each model, the methods using the cumulative averages in general yielded stronger associations than did those using either only baseline diet or the most recent diet, When the nutrients were categorized according to quintiles, the residual and the nutrient density models, which gave similar results, yielded statistically more significant tests for linear trend than did the standard and the partition models.