This competing renewal of R01 CA119171, """"""""Nutrition and Physical Activity Assessment Study"""""""" (NPAAS), continues to focus on the use of biomarkers to evaluate and compare measurement properties of prominent nutritional and physical activity assessment methods, and on the use of biomarker-calibrated nutrient consumption and activity-related energy expenditure (AREE) estimates in studies in Women's Health Initiative (WHI) cohorts of postmenopausal women.
Our aims are: 1) To conduct a controlled feeding study to develop biomarkers for additional nutrients and foods, and 2) To use biomarkers from the ongoing and proposed NPAAS study phases to develop biomarker-calibrated nutrient consumption and AREE estimates, throughout the WHI cohorts for use in disease-association studies. We will recruit 150 women, in the age range 60-80 y, enrolled in the WHI Seattle Field Center, into a feeding study of a highly individualized controlled diet, with each woman's diet designed to approximate her usual food consumption patterns. Women will receive all foods and beverages during the 2-week feeding period. We will obtain 24-h urine-derived nutritional measures, including nitrogen (protein), fructose, sucrose (sugars), alkylresorcinols (whole grains) and 1- and 3- methylhistidine (meat);and blood-derived nutritional measures, including carotenoids (fruits &vegetables), 1- and 3 -tocopherols (fats &oils), phospholipid fatty acids (fats &oils), and folate (fruits &vegetables) at the beginning and end of the 2-week feeding period. Biomarker evaluation will include an assessment of the ability of urine and blood measures, and study subject characteristics to explain variation in nutrients and foods provided during the feeding study. Total energy expenditure (TEE) will be measured using a doubly-labeled water protocol, as will resting energy expenditure (REE) using indirect calorimetry with 0.9TEE-REE as objective measure of AREE. We will develop calibration equations for each nutrient/food or activity measure having a suitable biomarker, by regression analysis of the biomarker on corresponding self-report measures using specimens and data from the women in both NPAAS project phases. Suitable biomarkers will be available for total energy, protein, percent of energy from protein, and for total activity-related energy expenditure. We will apply these calibration equations in the WHI cohorts using a food-frequency questionnaire and multiple-day food record to produce calibrated consumption estimates and using a WHI activity questionnaire to produce calibrated AREE estimates. These calibrated estimates will be related to the subsequent incidence of a broad range of clinical outcomes (e.g., cancer, cardiovascular disease, diabetes, frailty, obesity, etc) among the 161,808 women in the WHI cohorts. This work addresses fundamental gaps in diet and physical activity epidemiology research, in the context of national and international obesity epidemics, and in much related chronic disease morbidity and mortality.

Public Health Relevance

Dietary and physical activity patterns have an important role in maintaining body weight and overall health (in preventing obesity-related diseases). However, because previous research in this area has been conflicting, public health campaigns and health care provider instructions for diet and physical activity typically lack specificity and force. A major reason for the lack of convincing data to support lifestyle-related disease risk- reduction efforts is that the tools and methods used to gather data on diet and physical activity may incorporate major systematic biases. This study will develop and use biomarkers in blood and urine to calibrate self- reported diet and physical activity and will examine the relationship of calibrated 'exposures'to cancer, cardiovascular disease, and diabetes in postmenopausal women.

National Institute of Health (NIH)
National Cancer Institute (NCI)
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Special Emphasis Panel (ZRG1-PSE-B (80))
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Subar, Amy
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Fred Hutchinson Cancer Research Center
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Tasevska, Natasha; Pettinger, Mary; Kipnis, Victor et al. (2018) Associations of Biomarker-Calibrated Intake of Total Sugars With the Risk of Type 2 Diabetes and Cardiovascular Disease in the Women's Health Initiative Observational Study. Am J Epidemiol 187:2126-2135
Freedman, Laurence S; Midthune, Douglas; Arab, Lenore et al. (2018) Combining a Food Frequency Questionnaire With 24-Hour Recalls to Increase the Precision of Estimation of Usual Dietary Intakes-Evidence From the Validation Studies Pooling Project. Am J Epidemiol 187:2227-2232
Rossouw, Jacques E; Prentice, Ross L (2018) Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple? Lancet 391:1677
Yun, Hee Young; Lampe, Johanna W; Tinker, Lesley F et al. (2018) Serum Nitrogen and Carbon Stable Isotope Ratios Meet Biomarker Criteria for Fish and Animal Protein Intake in a Controlled Feeding Study of a Women's Health Initiative Cohort. J Nutr 148:1931-1937
Neuhouser, Marian L (2018) The importance of healthy dietary patterns in chronic disease prevention. Nutr Res :
Song, Xiaoling; Huang, Ying; Neuhouser, Marian L et al. (2017) Dietary long-chain fatty acids and carbohydrate biomarker evaluation in a controlled feeding study in participants from the Women's Health Initiative cohort. Am J Clin Nutr 105:1272-1282
Prentice, Ross L; Huang, Ying; Neuhouser, Marian L et al. (2017) Prentice et al. Respond to ""Improving Estimation of Sodium Intake"". Am J Epidemiol 186:1047-1048
Isanejad, Masoud; LaCroix, Andrea Z; Thomson, Cynthia A et al. (2017) Branched-chain amino acid, meat intake and risk of type 2 diabetes in the Women's Health Initiative. Br J Nutr 117:1523-1530
Freedman, Laurence S; Commins, John M; Willett, Walter et al. (2017) Evaluation of the 24-Hour Recall as a Reference Instrument for Calibrating Other Self-Report Instruments in Nutritional Cohort Studies: Evidence From the Validation Studies Pooling Project. Am J Epidemiol 186:73-82
Lampe, Johanna W; Huang, Ying; Neuhouser, Marian L et al. (2017) Dietary biomarker evaluation in a controlled feeding study in women from the Women's Health Initiative cohort. Am J Clin Nutr 105:466-475

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