The goals of this competing renewal are to illuminate the long-term relationships among overall diet quality, energy balance, weight gain, and cardiovascular disease (CVD) risk in the Nurses'Health Study (NHS), NHS II, and Health Professionals Follow-up Study (HPFS). Our proposal includes several specific aims. First, we will evaluate the long-term relationship between changes in diet quality indices (such as the alternate Healthy Eating Index [aHEI], alternate Mediterranean Diet [aMED], Dietary Approaches to Stop Hypertension [DASH], Food Quality Score [FQS]) and weight gain in over 120,000 participants in the NHS, NHS II, and HPFS. We will test the hypothesis that higher diet quality is inversely associated with long-term weight gain. Second, we will explore biological pathways that may mediate the effects of diet quality on weight change. In particular, we will evaluate the inter-relationships among diet quality, total energy intake (measured by doubly-labeled water [DLW]), physical activity (measured by accelerometers), sleep duration, and body weight in a subsample of NHS/HPFS participants (n=1,300) enrolled in the ongoing Lifestyle Validation Study (LVS). We hypothesize that the inverse association between diet quality and body mass index (BMI) is at least partially explained by lower energy intake. We will also evaluate the long-term relationships between change in diet quality and changes in biomarkers of the brain-adipose axis (leptin, soluble leptin receptor (sOB-R), insulin, adiponectin, retinol binding protein 4 [RBP4], tumor necrosis factor receptor 2 [TNF-R2], and interleukin 6 [IL-6]) among 1,000 healthy NHS II participants who provided repeated fasting bloods in 1996/1997 and 2011/2012. Furthermore, we will examine whether diet quality modifies the associations between genetic variants and BMI and waist-to-hip ratio (WHR). These analyses will be conducted among about 13,000 men and women in the NHS and HPFS with existing genome-wide association study (GWAS) data. We hypothesize that higher diet quality attenuates a genetic predisposition to a higher BMI and WHR. Finally, we will evaluate the role of weight change in mediating the relationship between improvement in the diet quality indices and subsequent lower risk of coronary heart disease (CHD) and stroke among over 100,000 men and women in the NHS and HPFS. We hypothesize that the inverse association between improved diet quality and subsequent risk of CHD and stroke is partly mediated through less weight gain during follow-up. This competing renewal builds upon our long-standing work on dietary pattern analysis and CVD risk and extends to novel areas of diet quality, energy balance, and novel biomarkers in the brain-adipose axis. This proposal is highly cost-effective because it utilizes existing uniquely rich data resources with repeated blood samples and objective measurements of total energy intake and physical activity and requests funds only for biomarker measurements and proposed data analysis.

Public Health Relevance

This study will be the first and largest of its kind to prospectively address the dynamic relationships between diet quality, energy balance, novel biomarkers, long-term weight gain, and risk of CVD. Our research aims will assess a broad range of diet quality indices to inform evidence-based dietary recommendations and improve current guidelines.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL060712-13
Application #
8699252
Study Section
Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Arteaga, Sonia M
Project Start
1998-08-01
Project End
2017-03-31
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
13
Fiscal Year
2014
Total Cost
$599,709
Indirect Cost
$173,206
Name
Harvard University
Department
Nutrition
Type
Schools of Public Health
DUNS #
149617367
City
Boston
State
MA
Country
United States
Zip Code
02115
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Saber, Hamidreza; Yakoob, Mohammad Yawar; Shi, Peilin et al. (2017) Omega-3 Fatty Acids and Incident Ischemic Stroke and Its Atherothrombotic and Cardioembolic Subtypes in 3 US Cohorts. Stroke 48:2678-2685
Satija, Ambika; Bhupathiraju, Shilpa N; Spiegelman, Donna et al. (2017) Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol 70:411-422
Juan, Juan; Liu, Gang; Willett, Walter C et al. (2017) Whole Grain Consumption and Risk of Ischemic Stroke: Results From 2 Prospective Cohort Studies. Stroke 48:3203-3209
Hruby, Adela; Guasch-Ferré, Marta; Bhupathiraju, Shilpa N et al. (2017) Magnesium Intake, Quality of Carbohydrates, and Risk of Type 2 Diabetes: Results From Three U.S. Cohorts. Diabetes Care 40:1695-1702
Hu, Yao; Tanaka, Toshiko; Zhu, Jingwen et al. (2017) Discovery and fine-mapping of loci associated with MUFAs through trans-ethnic meta-analysis in Chinese and European populations. J Lipid Res 58:974-981

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