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The Framingham Nutrition Studies
Insights into Weight History, Dietary Patterns, Obesity Prevention, and Risk Reduction
Barbara E. Millen, Michael Pencina, Ruth Kimokoti, Ralph B. D’Agostino
Boston University School of Medicine
Agenda and Abstracts
The Framingham Nutrition Studies (FNS) were initiated in 1984-88 with a comprehensive assessment of population nutritional risk at the third examination of the Framingham Offspring-Spouse (FOS) cohort (n=5135 adult men and women). The major goals of FNS were to develop innovative nutritional risk assessment methods, to quantify trends in food and nutrient intake in relation to expert health and nutrition guidelines, to examine relationships between diet and CVD-related disease risk and outcomes (controlling for genetic, biological, and behavioral factors), and to identify opportunities for preventive nutrition interventions.
FNS utilized historical nutrition data sets from the original Framingham cohort (n=5209) to initiate studies of population dietary trends and to explore selected diet:disease hypotheses. The experiences of the FOS cohort members, 20-64 years of age at baseline and who participated in the FNS, were examined to assess the adult cohort’s experience with overweight and obesity over 28 years of follow-up (1971+). At baseline, these FOS men were more overweight (52%) and obese (17%) than women (20% and 9%, respectively), indicating an earlier onset of excess weight in men. Over follow-up, FOS men gained a mean level of 10-16 pounds and women added 8-21 pounds of body weight. Nearly 60% of men and 50% of women who were normal weight at baseline became overweight or obese. In addition, one-third of overweight men and half of overweight women became obese over follow-up. Over 28 years, only 14-15% of men or women remained “weight stable” (within 5 pounds of baseline weight). Weight gain persisted into the 5th decade in FOS men and the 6th decade in FOS women. At 28 years, 18.5% of FOS men and 38% of FOS women were within normal weight range; 48% of men and 35% of women were overweight; and 33% of FOS men and 27% of women were obese.
In addition to exploring the FOS cohort experience with the development of overweight and obesity, relationships were examined between nutrient intake, weight change, and the development of overweight and obesity or obesity-related outcomes. These models suggested the potential role of the following nutrients in the development of excess body weight: higher energy, total and saturated fat, and alcohol intakes and lower total carbohydrate intakes. A composite nutrient risk score (based upon the intakes of 19 protective and disease risk-related nutrients) was predictive of weight change over time.
The Framingham Nutrition Studies also applied cluster analysis to food frequency data collected at FOS cohort Exam 3 (1984-88), five non-overlapping and unique dietary patterns of FOS women were identified (Heart Healthy, Lighter Eating, Wine and Moderate Eating, High Fat, and Empty Calories) and five in FOS men (Transition to Heart Healthy, Higher Starch, Average Male, Lower Variety, and Empty Calories). The dietary patterns of both men and women varied in terms of food and nutrient intake, levels of compliance with expert nutrition guidelines, and the composite nutritional risk score. The biological risk factor profile of FOS men and women varied by dietary pattern at baseline and follow-up; prevalence rates of overweight and obesity were particularly high. The nutritional risk profile associated with the dietary patterns of both men and women was stable over eight years of follow-up. Weight gain over follow-up in FOS female subjects who were at or near ideal body weight at Exam 3 baseline varied by dietary pattern. In multivariate analyses controlling for genetic, biological, and behavioral risk factors, FOS male and female subjects who had differing dietary patterns and were free of the Metabolic Syndrome (MetS) risk factors, CHD, and diabetes at baseline had varying risks for the development of MetS outcomes at follow-up. Discriminant analysis was employed to cross-validate the clustering methodology and confirmed substantial agreement between the predicted and actual dietary pattern classification in men and women.
The evidence that the dietary patterns of adult males and females were associated with varying nutritional risk, levels of compliance with expert nutrition guidelines, biological risk factor profiles, and an array of health outcomes (including overweight, obesity, and CVD and MetS risk) indicates their importance in epidemiological investigations and suggests their potential for application to the design of clinical nutrition interventions. The identification of unique dietary patterns of adult men and women provides a mechanism for evaluating key aspects of compliance and non-compliance with expert nutrition guidelines and for targeting specific foods and nutrients in behavioral interventions aimed at obesity risk reduction as well as other health outcomes. Furthermore, the dietary pattern approach provides a framework for considering the unique nutritional and health risk profile of population subgroups while formulating nutrition intervention strategies. Dietary patterns also enable the articulation of specific health and nutrition messages for use in targeting population subgroups with direct communications in health promotion programs and campaigns.
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