Faculty Bibliography

BACKGROUND: Consuming a wider variety of nutrient-dense foods may promote adherence to healthful dietary patterns, leading to improved dietary quality and enhanced metabolic health. OBJECTIVE: We used the US Healthy Food Diversity (HFD) index to simultaneously measure dietary variety, quality, and proportionality, hypothesizing a priori that race/ethnicity may moderate associations between diet and health. METHODS: A representative sample of adults (n = 7470) aged 20+ y with two 24-h recalls and complete outcome data from the cross-sectional NHANES 2003-2006 were selected. US HFD values were generated using a previously validated equation with a theoretical range from 0 to nearly 1, with higher scores indicative of more varied diets with a higher proportion of healthful food groups. Metabolic syndrome (MetS) was defined using the most recent harmonized definition. Survey-weighted multivariable linear and logistic regression, adjusted for demographic factors, smoking, energy, screen time, and leisure activity, were used to compute means and ORs (95% CIs). RESULTS: Adults in the third vs. first US HFD tertile had 21% lower odds of MetS [OR (95% CI): 0.79 (0.64, 0.98)] as well as lower odds of hypertension [0.83 (0.70, 0.995] and elevated waist circumference [0.75 (0.66, 0.86] after multivariable adjustment (P-trend < 0.05). The age- and sex-adjusted odds of low serum HDL cholesterol and impaired fasting plasma glucose (P-trend < 0.05) were lower in the highest vs. lowest US HFD tertile but attenuated with multivariable adjustment (P = 0.06 and 0.22, respectively). Notably, the US HFD index was only protective against adiposity among non-Hispanic white (NHW) and non-Hispanic black (NHB) adults, and MetS associations were driven by NHW adults. No associations were observed among Hispanic adults for any MetS components. CONCLUSIONS: Greater healthful food variety was associated with lower odds of MetS and some MetS components in the total population, NHW adults, and NHB adults. This study provides preliminary evidence that healthful food diversity may protect against MetS and highlights the need for longitudinal and experimental research.

PURPOSE: This prospective cohort study evaluates associations between healthful behaviors consistent with WCRF/AICR cancer prevention guidelines and obesity-related cancer risk, as a third of cancers are estimated to be preventable. METHODS: The study sample consisted of adults from the Framingham Offspring cohort (n = 2,983). From 1991 to 2008, 480 incident doctor-diagnosed obesity-related cancers were identified. Data on diet, measured by a food frequency questionnaire, anthropometric measures, and self-reported physical activity, collected in 1991 was used to construct a 7-component score based on recommendations for body fatness, physical activity, foods that promote weight gain, plant foods, animal foods, alcohol, and food preservation, processing, and preparation. Multivariable Cox regression models were used to estimate associations between the computed score, its components, and subcomponents in relation to obesity-related cancer risk. RESULTS: The overall score was not associated with obesity-related cancer risk after adjusting for age, sex, smoking, energy, and preexisting conditions (HR 0.94, 95 % CI 0.86-1.02). When score components were evaluated separately, for every unit increment in the alcohol score, there was 29 % lower risk of obesity-related cancers (HR 0.71, 95 % CI 0.51-0.99) and 49-71 % reduced risk of breast, prostate, and colorectal cancers. Every unit increment in the subcomponent score for non-starchy plant foods (fruits, vegetables, and legumes) among participants who consume starchy vegetables was associated with 66 % reduced risk of colorectal cancer (HR 0.44, 95 % CI 0.22-0.88). CONCLUSIONS: Lower alcohol consumption and a plant-based diet consistent with the cancer prevention guidelines were associated with reduced risk of obesity-related cancers in this population.