In epidemiologic studies, total energy intake is often related to disease risk because of associations between physical activity or body size and the probability of disease. In theory, differences in disease incidence may also be related to metabolic efficiency and therefore to total energy intake. Because intakes of most specific nutrients, particularly macronutrients, are correlated with total energy intake, they may be noncausally associated with disease as a result of confounding by total energy intake. In addition, extraneous variation in nutrient intake resulting from variation in total energy intake that is unrelated to disease risk may weaken associations. Furthermore, individuals or populations must alter their intake of specific nutrients primarily by altering the composition of their diets rather than by changing their total energy intake, unless physical activity or body weight are changed substantially. Thus, adjustment for total energy intake is usually appropriate in epidemiologic studies to control for confounding, reduce extraneous variation, and predict the effect of dietary interventions. Failure to account for total energy intake can obscure associations between nutrient intakes and disease risk or even reverse the direction of association. Several disease-risk models and formulations of these models are available to account for energy intake in epidemiologic analyses, including adjustment of nutrient intakes for total energy intake by regression analysis and addition of total energy to a model with the nutrient density (nutrient divided by energy).

These data support a protective role for grains (particularly whole grains), cereal fiber, and dietary magnesium in the development of diabetes in older women.

The waist-hip ratio offers additional prognostic information beyond BMI and waist circumference.

Objective.\p=m-\To assess whether the dietary intake of long-chain n-3 polyunsaturated fatty acids from seafood, assessed both directly and indirectly through a biomarker, is associated with a reduced risk of primary cardiac arrest.Design.\p=m-\Population-based case-control study.Setting.\p=m-\Seattle and suburban King County, Washington. Participants\p=m-\A total of 334 case patients with primary cardiac arrest, aged 25 to 74 years, attended by paramedics during 1988 to 1994 and 493 population-based control cases and controls, matched for age and sex, randomly identified from the community. All cases and controls were free of prior clinical heart disease, major comorbidity, and use of fish oil supplements.Measures of Exposure.\p=m-\Spouses of case patients and control subjects were interviewed to quantify dietary n-3 polyunsaturated fatty acid intake from seafood during the prior month and other clinical characteristics. Blood specimens from 82 cases (collected in the field) and 108 controls were analyzed to determine red blood cell membrane fatty acid composition, a biomarker of dietary n-3 polyunsaturated fatty acid intake.Results.\p=m-\Compared with no dietary intake of eicosapentaenoic acid (C20:5n-3) and docosahexaenoic acid (C22:6n-3), an intake of 5.5 g of n-3 fatty acids per month (the mean of the third quartile and the equivalent of one fatty fish meal per week) was associated with a 50% reduction in the risk of primary cardiac arrest (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.4 to 0.8), after adjustment for potential confounding factors. Compared with a red blood cell membrane n-3 polyunsaturated fatty acid level of 3.3% of total fatty acids (the mean of the lowest quartile), a red blood cell n-3 polyunsaturated fatty acid level of 5.0% of total fatty acids (the mean of the third quartile) was associated with a 70% reduction in the risk of primary cardiac arrest (OR, 0.3; 95% CI, 0.2 to 0.6).Conclusion.\p=m-\Dietary intake of n-3 polyunsaturated fatty acids from seafood is associated with a reduced risk of primary cardiac arrest.

The American Cancer Society (ACS) publishes the Diet and Physical Activity Guideline to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. This guideline is developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and reflects the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS guideline focuses on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors.

A clear inverse association between whole-grain intake and risk of IHD death existed. A causal association is plausible because whole-grain foods contain many phytochemicals, including fiber and antioxidants, that may reduce chronic disease risk. Whole-grain intake should be studied further for its potential to prevent IHD and cancer.

Deceleration in the decline of all CVD, HD, and stroke mortality rates has occurred since 2011. If this trend continues, strategic goals for lowering the burden of CVD set by the American Heart Association and the Million Hearts Initiative may not be reached.

OBJECTIVE -To examine the associations between reported intakes of dietary fat and incident type 2 diabetes.RESEARCH DESIGN AND METHODS -We studied the relation between dietary fatty acids and diabetes in a prospective cohort study of 35,988 older women who initially did not have diabetes. Diet was assessed with a food frequency questionnaire at baseline, and 1,890 incident cases of diabetes occurred during 11 years of follow-up. RESULTS -After adjusting for age, smoking, alcohol consumption, BMI, waist-to-hip ratio, physical activity, demographic factors, and dietary magnesium and cereal fiber, diabetes incidence was negatively associated with dietary polyunsaturated fatty acids, vegetable fat, and trans fatty acids and positively associated with -3 fatty acids, cholesterol, and the Keys score. After simultaneous adjustment for other dietary fat, only vegetable fat remained clearly related to diabetes risk. Relative risks across quintiles of vegetable fat intake were 1.00, 0.90, 0.87, 0.84, and 0.82 (P ϭ 0.02). Diabetes risk was also inversely related to substituting polyunsaturated fatty acids for saturated fatty acids and positively correlated to the Keys dietary score.CONCLUSIONS -These data support an inverse relation between incident type 2 diabetes and vegetable fat and substituting polyunsaturated fatty acids for saturated fatty acids and cholesterol. Diabetes Care 24:1528 -1535, 2001A lthough a low-fat diet is recommended for diabetic and nondiabetic patients (1), findings from epidemiological studies on the association of total dietary fat with type 2 diabetes or insulin sensitivity have been inconsistent (2-8). Metabolic and epidemiological studies suggest that dietary fat subtypes may be relevant to diabetes pathophysiology. Specific dietary fatty acids may influence the development of diabetes by modifying the phospholipid composition of cell membranes, which in turn may alter the function of the insulin receptor (9,10).While women who returned the baseline questionnaire. Respondents had a lower mean BMI (0.4 kg/m 2 less), were 3 months older, and were more likely to live in counties that were rural and less affluent than nonrespondents (11).Women were excluded from analysis if they reported implausibly high (Ͼ5,000 kcal) or low (Ͻ600 kcal) energy intakes, left Ն30 items blank on the foodfrequency questionnaire, or had diabetes at baseline. Women were considered to have diabetes at baseline if they responded "yes" or "don't know" to one of the following questions: 1) have you ever been told by a doctor that you have sugar diabetes? and 2) have you ever taken insulin or pills for sugar diabetes (or to lower blood glucose)? After exclusions, 35,988 women remained eligible for the study. Data collectionThe baseline questionnaire included questions on known or suspected risk factors for diabetes, such as age, BMI, waistto-hip ratio (WHR), physical activity, alcohol consumption, and smoking history. BMI was calculated from weight and height measurements provided by the participants. WHR was calculated as...