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(Circulation. 2008;118:230-237.)
© 2008 American Heart Association, Inc.

Epidemiology

Dietary Patterns and Risk of Mortality From Cardiovascular Disease, Cancer, and All Causes in a Prospective Cohort of Women

Christin Heidemann, DrPH, MSc; Matthias B. Schulze, DrPH; Oscar H. Franco, MD, DSc, PhD; Rob M. van Dam, PhD; Christos S. Mantzoros, MD, DSc; Frank B. Hu, MD, PhD

From the Departments of Nutrition (C.H., R.M.v.D., F.B.H.) and Epidemiology (F.B.H.), Harvard School of Public Health, Boston, Mass; Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass (R.M.v.D., F.B.H.); Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (C.S.M.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.B.S.); and Unilever Corporate Research, Bedfordshire, UK (O.H.F.).

Reprint requests to Dr Frank B. Hu, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02215. E-mail frank.hu{at}channing.harvard.edu

Received February 7, 2008; accepted April 9, 2008.

Background— The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown.

Methods and Results— We prospectively evaluated the relation between dietary patterns and risk of cardiovascular, cancer, and all-cause mortality among 72 113 women who were free of myocardial infarction, angina, coronary artery surgery, stroke, diabetes mellitus, or cancer and were followed up from 1984 to 2002. Dietary patterns were derived by factor analysis based on validated food frequency questionnaires administered every 2 to 4 years. Two major dietary patterns were identified: High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high Western pattern scores reflected high intakes of red meat, processed meat, refined grains, french fries, and sweets/desserts. During 18 years of follow-up, 6011 deaths occurred, including 1154 cardiovascular deaths and 3139 cancer deaths. After multivariable adjustment, the prudent diet was associated with a 28% lower risk of cardiovascular mortality (95% confidence interval [CI], 13 to 40) and a 17% lower risk of all-cause mortality (95% CI, 10 to 24) when the highest quintile was compared with the lowest quintile. In contrast, the Western pattern was associated with a higher risk of mortality from cardiovascular disease (22%; 95% CI, 1 to 48), cancer (16%; 95% CI, 3 to 30), and all causes (21%; 95% CI, 12 to 32).

Conclusion— Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality, whereas greater adherence to the Western pattern may increase the risk among initially healthy women.

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