National Cancer Institute Dietary Patterns Methods Project: Examining multi-level patterns to support policy for cancer control

Transcription

1 National Cancer Institute Patterns Methods Project: Examining multi-level patterns to support policy for cancer control Jill Reedy, PhD, MPH, RD

2 Disclosures: none

3 Acknowledgements: Patterns Methods Project US National Cancer Institute Jill Reedy Susan Krebs-Smith Amy Subar Stephanie George Paige Miller TusaRebecca Schap Maggie Wilson University of Hawaii Carol Boushey Reynolette Ettienne Brook Harmon Fred Hutchinson Cancer Research Center Marian Neuhouser University of South Carolina Angela Liese

4 Outline patterns background Progress in dietary patterns research and need for standardization Patterns Methods Project patterns across the food stream Summary

5 patterns background

6 Nutritional factors and cellular processes Food, nutrition, obesity, and physical activity Proliferation Hormone regulation Differentiation Inflammation/immunity Apoptosis Cell cycle Carcinogen metabolism DNA repair Mayne ST, Rock C, Playdon M. Diet, nutrition, and cancer: past, present and future. Nat Rev Clin Oncol, 2006.

7 Diet and cancer prevention May decrease risk May increase risk Possible synergism Multicollinearity Cancer Risk & interactions Source: Miller PE. 2012

8 patterns and cancer prevention Totality of ta diet

9 Why study dietary patterns? Complexity of diet Correlation among dietary constituents Clinical trials show positive health outcomes with changes in total diet Relevance for policy and guidance

10 Progress in dietary patterns research and need for standardization

11 Progress in dietary patterns research 2010 Guidelines for Americans

12 Progress in dietary patterns research 2010 Guidelines for Americans 2011 Nutrition Evidence Library Workshop

13 Progress in dietary patterns research 2010 Guidelines for Americans 2013 Patterns Methods Project 2011 Nutrition Evidence Library Workshop

14 Progress in dietary patterns research 2010 Guidelines for Americans 2013 Patterns Methods Project 2011 Nutrition Evidence Library Workshop 2015 Guidelines for Americans

15 Progress in dietary patterns research 2010 Guidelines for Americans 2013 Patterns Methods Project Ex 2016 Extending Methods in Patterns Research Workshop 2011 Nutrition Evidence Library Workshop 2015 Guidelines for Americans

16 Progress in dietary patterns research Ex 1997 WCRF/AICR Report 2010 Guidelines for Americans 2013 Patterns Methods Project 2016 Extending Methods in Patterns Research Workshop 2011 Nutrition Evidence Library Workshop 2015 Guidelines for Americans

17 Progress in dietary patterns research Ex 1997 WCRF/AICR Report 2010 Guidelines for Americans 2013 Patterns Methods Project 2016 Extending Methods in Patterns Research Workshop 2007 WCRF/AICR Report 2011 Nutrition Evidence Library Workshop 2015 Guidelines for Americans

18 Progress in dietary patterns research Ex 1997 WCRF/AICR Report 2010 Guidelines for Americans 2013 Patterns Methods Project 2016 Extending Methods in Patterns Research Workshop 2007 WCRF/AICR Report 2011 Nutrition Evidence Library Workshop 2015 Guidelines for Americans 2017 WCRF/AICR Report

19 Progress in dietary patterns research Ex 1997 WCRF/AICR Report 2010 Guidelines for Americans 2013 Patterns Methods Project 2016 Extending Methods in Patterns Research Workshop 2027 WCRF/AICR Report 2007 WCRF/AICR Report 2011 Nutrition Evidence Library Workshop 2015 Guidelines for Americans 2017 WCRF/AICR Report

20 Patterns Methods Project

21 Patterns Methods Project: Aims Aim 1: Systematic analysis of index-based dietary patterns and associations with mortality Aim 2: Explore the issue of measurement error in all models Aim 3: Apply these methods to other US and international cohorts, perhaps with other dietary assessment tools and/or databases

22 How does the project define dietary patterns? Methods to derive dietary patterns Data-driven approaches Investigatordriven approaches Hybrid approaches Factor analysis Cluster analysis Diet quality index scores Reduced rank regression

23 Are diet quality indices associated with reduced mortality?

24 Are diet quality indices associated with reduced mortality? NIH-AARP Multiethnic Cohort Women s Health Initiative

25 Adjusted for age, race/ethnicity, education, marital status, physical activity, smoking, energy, BMI, diabetes, alcohol (HEI & DASH), HRT (women only). Liese AD et al, J Nutr, 2015 Are diet quality indices associated with reduced mortality? NIH-AARP Multiethnic Cohort Women s Health Initiative

26 Findings A dietary pattern that achieves a high diet quality index score is associated with lower risk of mortality in men and women in the US Findings were consistent across cohorts and across indexes Associations with mortality may tend to converge because scores are derived from many of the same core tenets Potential to inform both policy makers and those developing guidelines as to the role of dietary patterns and health Provides evidence regarding the benefit of an overall healthy eating pattern and suggests the need to optimize the US food environment to support whole grains, vegetables, fruit, and plant-based proteins

27 patterns across the food stream

28 Levels of the food stream Food supply Market/Community Individual

29 patterns at multiple levels of the food stream Food supply Market/Community Individual

30 patterns at multiple levels of the food stream How does adherence to dietary recommendations relate to health? Individual Liese AD, Krebs-Smith SM, George SM, Harmon BE, Neuhouser ML, Boushey CJ, Subar AF, Schap T, Reedy J. The Patterns Methods Project: Synthesis of findings across cohorts and relevance to dietary guidance. Journal of Nutrition, 2015.

31 patterns at multiple levels of the food stream Does the food supply align with current dietary recommendations? Food supply Miller PE, Reedy J, Kirkpatrick SI, Krebs-Smith SM. Healthfulness of the food supply: Journal of the Academy of Nutrition and Dietetics, 2014.

32 US Food Supply: 55/100 points, not a very good grade Video at

33 Findings US food supply is not consistent with federal dietary recommendations Little improvement over decades: fruit, vegetables, whole grains Efforts needed to target the architects of the food environment

34 Summary

35 Summary There are inter-related mechanisms regarding the biological effects of individual dietary constituents and the totality of diet, or dietary patterns To best understand these relationships and interpret findings it is important to consider how diet is measured, defined, and modeled: each of these aspects influences the ability to examine relationships between diet patterns and cancer Efforts to standardize, harmonize, and synthesize the growing literature related to dietary patterns and cancer is critical Guidance related to dietary patterns can further extend efforts to target the architects of the food environment across the food stream

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