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Lipids and cardiovascular/metabolic health

Stability of the Framingham Nutritional Risk Score and its component nutrients over 8 years: the Framingham Nutrition Studies

European Journal of Clinical Nutrition volume 66, pages 336–344 (2012)Cite this article

Abstract

Background/Objectives:

Diet quality indices are increasingly used in nutrition epidemiology as dietary exposures in relation to health outcomes. However, literature on the long-term stability of these indices is limited. We aimed to assess the stability of the validated Framingham Nutritional Risk Score (FNRS) and its component nutrients over 8 years, as well as the validity of the follow-up FNRS.

Subjects/Methods:

Framingham Offspring/Spouse Study women and men (n=1734) aged 22–76 years were evaluated over 8 years. Individuals’ nutrient intake and nutritional risk scores were assessed using 3-day dietary records administered at baseline (1984–1988) and at follow-up (1992–1996). Agreement between baseline and follow-up FNRS and nutrient intakes was evaluated by Bland–Altman method; stability was assessed using intra-class correlation (ICC) and weighted Kappa statistics. The effect of diet quality (as assessed by the FNRS) on cardiometabolic risk factors was evaluated using analysis of covariance.

Results:

Modest changes from baseline (⩽15%) were observed in nutrient intake. The stability coefficients for the FNRS (ICC: women, 0.49; men, 0.46; P<0.0001) and many nutrients (ICC ⩾0.3) were moderate. Over half of the women and men (58%) remained in the same or contiguous baseline and follow-up quartile of the FNRS and few (3–4%) shifted >1 quartile. The FNRS was directly associated with body mass index in women (P<0.01) and high-density lipoprotein cholesterol among both women (P<0.001) and men (P<0.01).

Conclusions:

The FNRS and its constituent nutrients remained relatively stable over 8 years of follow-up. The stability of diet quality has implications for prospective epidemiological investigations.

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References

  • Abraham S, Johnson CL, Najjar MF (1979). Weight and height of adults 18–74 years of age. United States, 1971–1974. Vital Health Stat 11 211, 1–49.

    Google Scholar 

  • American Dietetic Association (2007). Position of the American Dietetic Association and Dietitians of Canada: dietary fatty acids. J Am Diet Assoc 107, 1599–1611.

    Google Scholar 

  • American Heart Association Nutrition Committee (2006). Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114, 82–96.

    Article  Google Scholar 

  • Bland JM, Altman DG (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1, 307–310.

    Article  CAS  PubMed  Google Scholar 

  • Borland SE, Robinson SM, Crozier SR, Inskip HM, SWS Study Group (2008). Stability of dietary patterns in young women over a 2-year period. Eur J Clin Nutr 62, 119–126.

    Article  CAS  PubMed  Google Scholar 

  • Briefel RR, Johnson CL (2004). Secular trends in dietary intake in the United States. Annu Rev Nutr 24, 401–431.

    Article  CAS  PubMed  Google Scholar 

  • Cupples LA, D’Agostino RB (1987). Some risk factors related to the annual incidence of cardiovascular disease and death by using pooled repeated biennial measurements: Framingham Heart Study, 30-year follow-up. In: Kannel WB, Wolf PA, Garrison RJ (eds). The Framingham Study: an Epidemiological Investigation of Cardiovascular Disease, Section 34. Department of Health and Human Services: Washington, DC. Section 34 (NIH publication 87-2703 (NTIS PB87-177499)).

    Google Scholar 

  • Dawber T (1980). The Framingham Study: the Epidemiology of Atherosclerotic Disease. Harvard University Press: Cambridge, MA.

    Book  Google Scholar 

  • Drewnoski A, Fifddler EC, Dauchet L, Galan P, Hercberg S (2009). Diet quality measures and cardiovascular risk factors in France: applying the Healthy Eating Index to the SU.VI.MAX study. J Am Coll Nutr 28, 22–29.

    Article  Google Scholar 

  • Du H, van der A DL, van Bakel MM, Verberne LD, Ocké M, Feskens EJ (2009). Reproducibility and relative validity of dietary glycaemic index and glycaemic load assessed by the food-frequency questionnaire used in the Dutch cohorts of the European Prospective Investigation into Cancer and Nutrition. Br J Nutr 102, 601–604.

    Article  CAS  PubMed  Google Scholar 

  • Fleiss JL, Cohen J (1973). The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Measure 33, 613–619.

    Article  Google Scholar 

  • Food and Nutrition Board, Institute of Medicine (2005). Dietary Reference Intakes: Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). National Academy Press: Washington, DC. Internet: http://books.nap.edu/openbook.php?isbn=0309085373 (accessed 22 October 2010).

  • Friedewald WT, Levy RI, Fredrickson DS (1972). Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without the use of preparative ultracentrifuge. Clin Chem 18, 499–502.

    CAS  PubMed  Google Scholar 

  • Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB, Basiotis PP (2007). Development and Evaluation of the Healthy Eating Index—2005: Technical Report. Center for Nutrition Policy and Promotion, US Department of Agriculture: Alexandria, VA. Internet: http://www.cnpp.usda.gov/HealthyEatingIndex.htm (accessed 10 July 2011).

    Google Scholar 

  • Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D et al. (1999). Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 149, 531–540.

    Article  CAS  PubMed  Google Scholar 

  • Iqbal R, Anand S, Ounpuu S, Islam S, Zhang X, Rangarajan S et al. (2008). Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation 118, 1929–1937.

    Article  CAS  PubMed  Google Scholar 

  • Kannel WB, Feinleib M, McNamara PM, Garrison RJ, Castelli WP (1979). An investigation of coronary heart disease in families: the Framingham Offspring Study. Am J Epidemiol 110, 281–290.

    Article  CAS  PubMed  Google Scholar 

  • Kannel WB, Sorlie P (1979). Some health benefits of physical activity. The Framingham Study. Arch Intern Med 139, 857–861.

    Article  CAS  PubMed  Google Scholar 

  • Kant AK, Graubard BI (2005). A comparison of three dietary pattern indexes for predicting biomarkers of diet and disease. J Am Coll Nutr 24, 294–303.

    Article  CAS  PubMed  Google Scholar 

  • Kimokoti RW, Newby PK, Gona P, Jasuja GK, Pencina MJ, McKeon-O’Malley C et al. (2010). Diet quality, physical activity, smoking status, and weight fluctuation are associated with weight change in women and men. J Nutr 140, 1287–1293.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Koch GG (1982). Intraclass correlation coefficient. In: Kotz S, Johnson NL (eds). Encyclopedia of Statistical Sciences 4th edn. John Wiley & Sons: New York, pp 213–217.

    Google Scholar 

  • Lomax RG (2007). An Introduction to Statistical Concepts. Lawrence Erlbaum Associates, Publishers: Mahwah, NJ.

    Google Scholar 

  • McNamara JR, Schaefer EJ (1987). Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. Clin Chem Acta 166, 1–8.

    Article  CAS  Google Scholar 

  • Meigs JB, D’Agostino Sr RB., Wilson PWF, Cupples LA, Nathan DM, Singer DE (1997). Risk variable clustering in the insulin resistance syndrome: the Framingham Offspring Study. Diabetes 46, 1594–1600.

    Article  CAS  PubMed  Google Scholar 

  • Millen BE, Pencina MJ, Kimokoti RW, Meigs JB, Ordovas JM, D’Agostino RB (2006). Nutritional risk and the metabolic syndrome in women: opportunities for preventive intervention from the Framingham Nutrition Studies. Am J Clin Nutr 84, 434–441.

    Article  CAS  PubMed  Google Scholar 

  • Millen BE, Quatromoni PA (2001). Nutritional research within the Framingham Heart Study. J Nutr Health Aging 5, 139–143.

    CAS  PubMed  Google Scholar 

  • Mikkilä V, Räsänen L, Raitakari OT, Pietinen P, Viikari J (2005). Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study. Br J Nutr 93, 923–931.

    Article  PubMed  Google Scholar 

  • Millen BE, Quatromoni PA, Copenhafer DL, Demissie S, O’Horo CE, D’Agostino RB (2001). Validation of a dietary pattern approach for evaluating nutritional risk: the Framingham Nutrition Studies. J Am Diet Assoc 101, 187–194.

    Article  CAS  PubMed  Google Scholar 

  • Millen BE, Quatromoni PA, Franz MM, Epstein BE, Cupples A, Copenhafer DL (1997). Population nutrient intake approaches dietary recommendations: 1991 to 1995 Framingham Nutrition Studies. J Am Diet Assoc 97, 742–749.

    Article  CAS  PubMed  Google Scholar 

  • Millen BE, Quatromoni PA, Pencina MJ, Kimokoti R, Nam BH, Cobain S et al. (2005). Unique dietary patterns and chronic disease risk profiles of adult men: the Framingham Nutrition Studies. J Am Diet Assoc 105, 1723–1734.

    Article  PubMed  Google Scholar 

  • Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN et al. (2011). Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 123, 1723–1734.

    Google Scholar 

  • Mishra GD, McNaughton SA, Bramwell GD, Wadsworth ME (2006). Longitudinal changes in dietary patterns during adult life. Br J Nutr 96, 735–744.

    CAS  PubMed  Google Scholar 

  • Moeller SM, Reedy J, Millen AE, Dixon LB, Newby PK, Tucker KL et al. (2007). Dietary patterns: challenges and opportunities in dietary patterns research. An Experimental Biology workshop, April 1, 2007. J Am Diet Assoc 107, 1233–1239.

    Article  PubMed  Google Scholar 

  • Murakami K, Sasaki S, Takahashi Y, Okubo H, Hirota N, Notsu A et al. (2008). Reproducibility and relative validity of dietary glycaemic index and load assessed with a self-administered diet-history questionnaire in Japanese adults. Br J Nutr 99, 639–648.

    Article  CAS  PubMed  Google Scholar 

  • National Cholesterol Education Program (2001). Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285, 2486–2497.

    Article  Google Scholar 

  • Nettleton JA, Schulze MB, Jiang R, Jenny NS, Burke GL, Jacobs DR (2008). A priori-defined dietary patterns and markers of cardiovascular disease risk in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 88, 185–194.

    Article  CAS  PubMed  Google Scholar 

  • Newby PK, Hu FB, Rimm EB, Smith-Warner SA, Feskanich D, Sampson L et al. (2003). Reproducibility and validity of the Diet Quality Index Revised as assessed by use of a food-frequency questionnaire. Am J Clin Nutr 78, 941–949.

    Article  CAS  PubMed  Google Scholar 

  • Newby PK, Tucker KL (2004). Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev 62, 177–203.

    Article  CAS  PubMed  Google Scholar 

  • O’Sullivan AJ (2009). Does oestrogen allow women to store fat more efficiently? A biological advantage for fertility and gestation. Obes Rev 10, 168–177.

    Article  PubMed  Google Scholar 

  • Posner BM, Martin-Munley SS, Smigelski C, Cupples LA, Cobb JL, Schaefer E et al. (1992a). Comparison of techniques for estimating nutrient intake: the Framingham Study. Epidemiology 3, 171–177.

    Article  CAS  PubMed  Google Scholar 

  • Posner BM, Smigelski C, Duggal A, Morgan JL, Cobb J, Cupples LA (1992b). Validation of two-dimensional models for estimation of portion size in nutrition research. J Am Diet Assoc 92, 738–741.

    CAS  PubMed  Google Scholar 

  • Prynne CJ, Paul AA, Mishra GD, Greenberg DC, Wadsworth ME (2005). Changes in intake of key nutrients over 17 years during adult life of a British birth cohort. Br J Nutr 94, 368–376.

    Article  CAS  PubMed  Google Scholar 

  • Quatromoni PA, Copenhafer DL, Demissie S, D’Agostino RB, O’Horo CE, Nam BH et al. (2002). The internal validity of a dietary pattern analysis. The Framingham Nutrition Studies. J Epidemiol Community Health 56, 381–388.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schakel SF, Sievert YA, Buzzard IM (1988). Sources of data for developing and maintaining a nutrient database. J Am Diet Assoc 88, 1268–1271.

    CAS  PubMed  Google Scholar 

  • Statistical Applications Software (2008): SAS Institute Inc.: Cary, NC. Version 9.1.

  • Stoudt H, Damon A, McFarland R (1970). Skinfolds, body girths, biacromial diameter and selected anthropometric indices of adults. United States, 1960–1962. Vital Health Stat 11 35, 1–69.

    Google Scholar 

  • Thomas JE, Schirger A, Fealey RD, Sheps SG (1981). Orthostatic hypotension. Mayo Clin Proc 56, 117–125.

    CAS  PubMed  Google Scholar 

  • US Department of Health and Human Services and US Department of Agriculture (2005). Dietary Guidelines for Americans 2005 6th edn US Government Printing Office: Washington, DC. Internet: http://www.health.gov/dietaryguidelines/dga2005/document/default.htm (accessed 22 October 2010).

  • Warnick GR, Benderson J, Albers JJ (1982). Dextran sulfate–magnesium precipitation procedure for quantification of high-density lipoprotein cholesterol. Clin Chem 28, 1379–1382.

    CAS  PubMed  Google Scholar 

  • Willett W (1998). Nutritional Epidemiology 2nd edn Oxford University Press: New York.

    Book  Google Scholar 

  • Wolongevicz DM, Zhu L, Pencina MJ, Kimokoti RW, Newby PK, D’Agostino RB et al. (2009). Diet quality and obesity in women: the Framingham Nutrition Studies. Br J Nutr 24, 1–7.

    Article  Google Scholar 

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Acknowledgements

This research was supported by the National Institutes of Health/National Heart, Lung and Blood Institute Grant contracts R01-HL-60700, R01-HL-54776 and N01-HC-25195 (Bethesda, MD, USA).

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Authors and Affiliations

  1. Department of Nutrition, Simmons College, Boston, MA, USA

    R W Kimokoti

  2. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA

    P K Newby

  3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    P K Newby

  4. Department of Mathematics and Statistics, Statistics and Consulting Unit, Boston University, Boston, MA, USA

    P Gona, L Zhu & R B D'Agostino

  5. Framingham Heart Study, Framingham, MA, USA

    P Gona & R B D'Agostino

  6. New England School of Law, Boston, MA, USA

    W R Campbell

  7. Boston Nutrition Foundation and Millennium Nutrition, Westwood, MA, USA

    B E Millen

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  1. R W Kimokoti
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Correspondence to R W Kimokoti.

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Appendix

Appendix

Table A1

Table A1 Recommended adult intake levels of Framingham Nutrition Risk Score nutrients as specified by expert nutrition guidelinesa,b,c,d
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Kimokoti, R., Newby, P., Gona, P. et al. Stability of the Framingham Nutritional Risk Score and its component nutrients over 8 years: the Framingham Nutrition Studies. Eur J Clin Nutr 66, 336–344 (2012). https://doi.org/10.1038/ejcn.2011.167

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