Published Online
on June 23, 2008

A more recent version of this article appeared on July 15, 2008

This Article Full Text (PDF) All Versions of this Article: 118/3/230    most recent CIRCULATIONAHA.108.771881v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions patientINFORMation Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Heidemann, C. Articles by Hu, F. B. Search for Related Content PubMed PubMed Citation Articles by Heidemann, C. Articles by Hu, F. B. Pubmed/NCBI databases Medline Plus Health Information Cancer Coping with Chronic Illness Diets Related Collections Nutrition Epidemiology Related Article

Submitted on February 7, 2008
Accepted on April 9, 2008

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, and 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.).

^* To whom correspondence should be addressed. E-mail: frank.hu{at}channing.harvard.edu.

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.

Key words: cardiovascular diseases • diet • epidemiology • mortality • nutrition

Find additional patient-related information at:

Read a summary of this article at americanheart.org

Related Article:

Clinical Summaries
Circulation 2008 118: 211-212. [Extract] [Full Text]

This article has been cited by other articles:

				C N Lopez, M A Martinez-Gonzalez, A Sanchez-Villegas, A Alonso, A M Pimenta, and M Bes-Rastrollo Costs of Mediterranean and western dietary patterns in a Spanish cohort and their relationship with prospective weight change J Epidemiol Community Health, November 1, 2009; 63(11): 920 - 927. [Abstract] [Full Text] [PDF]

				M. J. Karpa, P. Mitchell, K. Beath, E. Rochtchina, R. G. Cumming, and J. J. Wang Direct and Indirect Effects of Visual Impairment on Mortality Risk in Older Persons: The Blue Mountains Eye Study Arch Ophthalmol, October 1, 2009; 127(10): 1347 - 1353. [Abstract] [Full Text] [PDF]

				S. A. Quandt, H. Chen, R. A. Bell, M. R. Savoca, A. M. Anderson, X. Leng, T. Kohrman, G. H. Gilbert, and T. A. Arcury Food Avoidance and Food Modification Practices of Older Rural Adults: Association With Oral Health Status and Implications for Service Provision Gerontologist, July 2, 2009; (2009) gnp096v1. [Abstract] [Full Text] [PDF]

				A. S. Leon and U. G. Bronas Dyslipidemia and Risk of Coronary Heart Disease: Role of Lifestyle Approaches for Its Management American Journal of Lifestyle Medicine, July 1, 2009; 3(4): 257 - 273. [Abstract] [PDF]

				C. Johnston Functional Foods as Modifiers of Cardiovascular Disease American Journal of Lifestyle Medicine, July 1, 2009; 3(1_suppl): 39S - 43S. [Abstract] [PDF]

				S.-A. Lee, X.-O. Shu, H. Li, G. Yang, H. Cai, W. Wen, B.-T. Ji, J. Gao, Y.-T. Gao, and W. Zheng Adolescent and adult soy food intake and breast cancer risk: results from the Shanghai Women's Health Study Am. J. Clinical Nutrition, June 1, 2009; 89(6): 1920 - 1926. [Abstract] [Full Text] [PDF]

				M. Heroux, I. Janssen, M. Lam, D.-c. Lee, J. R Hebert, X. Sui, and S. N Blair Dietary patterns and the risk of mortality: impact of cardiorespiratory fitness Int. J. Epidemiol., April 20, 2009; (2009) dyp191v1. [Abstract] [Full Text] [PDF]

				WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al. Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 27, 2009; 119(3): e21 - e181. [Full Text] [PDF]

				L. J. Appel Dietary Patterns and Longevity: Expanding the Blue Zones Circulation, July 15, 2008; 118(3): 214 - 215. [Full Text] [PDF]