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Background: Various foods and nutrients are linked with higher or lower risk of rheumatoid arthritis (RA), yet these associations are inconsistent across studies. Limited research has been done evaluating the association between diet quality and RA in a larger-scale prospective study on postmenopausal women., Objective: The objective of this study was to evaluate the association between dietary quality and risk of incident RA in postmenopausal women., Design: This was a prospective cohort study as part of the Women's Health Initiative (WHI), with an average follow-up time of 8.1 years. Baseline diet was measured using a food frequency questionnaire (FFQ). Diet quality was evaluated by the Healthy Eating Index (HEI)-2015 total score. In addition, intake of food groups and nutrients that align with HEI-2015 components was assessed., Participants/setting: Postmenopausal women (N = 109 591) were included in this study, which was conducted at various clinical centers across the United States with recruitment from 1993 to 1998. Women's Health Initiative participants who were missing outcome data, had unreliable/missing FFQ data, or had RA at baseline were excluded., Main Outcome Measures: The primary outcome measure was incident RA. Statistical analyses performed Multivariable Cox proportional regression analysis was performed evaluating the association of diet quality with self-reported physician-diagnosed RA after adjusting for age, race, ethnicity, education status, income, and body mass index (BMI)., Results: During 857 517 person-years of follow-up, 5823 incident RA cases were identified. After adjustment for multiple comparisons, compared with quartile 1, quartiles 2, 3, and 4 of the HEI-2015 total scores were associated with lower RA risks of 1%, 10%, and 19%, respectively (P-trend < .001). Greater consumption of total fruits (P-trend = .014), whole fruits (P-trend < .0002), total vegetables (P-trend = .008), greens and beans (P-trend < .0002), whole grains (P-trend = .008), and dairy (P-trend = .018) were significantly associated with lower rates of incident RA. Conversely, higher consumption of saturated fat (P-trend = .002) was significantly associated with higher rates of incident RA., Conclusion: A higher-quality diet reflected by higher HEI-2015 total scores was inversely associated with incident RA in postmenopausal women., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Previous dietary studies and current dietary guidelines have mainly focused on dietary intake and food patterns. Little is known about the association between eating behaviors such as meal frequency, skipping and intervals, and mortality., Objective: The objective was to examine the associations of meal frequency, skipping, and intervals with all-cause and cardiovascular disease (CVD) mortality., Design: This was a prospective study., Participants/setting: A total of 24,011 adults (aged ≥40 years) who participated in the National Health and Nutrition Examination Survey 1999-2014 were included in this study. Eating behaviors were assessed using 24-hour recall. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2015., Main Outcome Measures: The outcomes were all-cause and CVD mortality., Statistical Analyses Performed: Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) of all-cause and CVD mortality., Results: During 185,398 person-years of follow-up period, 4,175 deaths occurred, including 878 cardiovascular deaths. Most participants ate three meals per day. Compared with participants eating three meals per day, the multivariable-adjusted HRs for participants eating one meal per day were 1.30 (95% CI 1.03 to 1.64) for all-cause mortality, and 1.83 (95% CI 1.26 to 2.65) for CVD mortality. Participants who skipped breakfast have multivariable-adjusted HRs 1.40 (95% CI 1.09 to 1.78) for CVD mortality compared with those who did not. The multivariable-adjusted HRs for all-cause mortality were 1.12 (95% CI 1.01 to 1.24) for skipping lunch and 1.16 (95% CI 1.02 to 1.32) for skipping dinner compared with those who did not. Among participants eating three meals per day, the multivariable-adjusted HR for participants with an average interval of ≤4.5 hours in two adjacent meals was 1.17 (95% CI 1.04 to 1.32) for all-cause mortality, comparing with those having a meal interval of 4.6 to 5.5 hours., Conclusions: In this large, prospective study of US adults aged 40 years or older, eating one meal per day was associated with an increased risk of all-cause and CVD mortality. Skipping breakfast was associated with increased risk of CVD mortality, whereas skipping lunch or dinner was associated with increased risk of all-cause mortality. Among participant with three meals per day, a meal interval of ≤4.5 hours in two adjacent meals was associated with higher all-cause mortality., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: The prevalence of arthritis in the United States is substantial and on the rise. Long-chain n-3 polyunsaturated fatty acids, which have anti-inflammatory properties, have been shown to provide therapeutic benefit to arthritis patients; however, to date few have examined these associations with arthritis risk., Objective: The study objective was to examine the associations of long-chain n-3 polyunsaturated fatty acids intake with osteoarthritis (OA) and rheumatoid arthritis (RA) risk among postmenopausal women., Design: This was a prospective cohort study., Participants: The sample for this analysis consisted of 80,551 postmenopausal women, aged 55 to 79 years and with no history of arthritis, recruited into the Women's Health Initiative Observational Study and Clinical Trials cohort between 1993 and 1998. Women completed a 120-item food frequency questionnaire at baseline., Main Outcome Measures: After a median follow-up of 8 years, 22,306 incident OA and 3,348 RA cases were identified., Statistical Analyses Performed: Adjusted Cox regression models were used to estimate hazard ratios and 95% CI for the associations between dietary LCn-3PUFA intake and OA and RA risk., Results: Individual and total long-chain n-3 polyunsaturated fatty acids (Quintile 5 vs Quintile 1: hazard ratio 1.04, 95% CI 0.99 to 1.09 for OA; hazard ratio 1.01, 95% CI 0.90 to 1.13 for RA) were not associated with OA and RA risk. Further, no associations were observed between n-6 polyunsaturated fatty acids intake and either arthritis outcome., Conclusions: This study is the first to examine associations of long-chain n-3 polyunsaturated fatty acids intake with OA risk and the largest to examine associations with RA risk. Despite their therapeutic potential, the study provides no evidence of benefit of these nutrients in relation to arthritis risk., (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Dietary energy density (DED) is the ratio of energy (kilocalories or kilojoules) intake to food weight (grams) and is a measure of diet quality. Consumption of foods high in DED has been associated with weight gain in adults., Objective: To investigate the association between baseline DED and incident obesity-associated cancers in the Women's Health Initiative., Design: Prospective cohort study of clinical trial and observational study participants., Participants/setting: Postmenopausal women aged 50 to 79 years (N=92,295) enrolled in the observational study or the calcium and vitamin D trial and hormone replacement therapy trials of the Women's Health Initiative., Main Outcome Measures: Incident, medical record-adjudicated, obesity-related cancers during follow-up. Exposure variable was DED (kilocalories per gram for the total diet) from self-reported dietary intake at baseline using a food frequency questionnaire., Statistical Analyses: The associations between DED and each incident cancer, or any obesity-related cancer, were examined using competing-risks regression models, with death as a competing risk. Body mass index-stratified models were generated to investigate body mass index as a potential modifying factor., Results: DED was associated with higher body mass index (28.9±6.0 vs 26.3±4.9) and waist circumference (89.3±14.2 vs 82.4±12.4 cm) for DED quintiles 5 vs 1, respectively. DED was associated with a 10% increased risk of any obesity-related cancer (subhazard ratio Q5 vs Q1 : 1.1, 95% CI 1.03 to 1.2; P=0.004). This increased risk appeared limited to women who were normal weight at enrollment., Conclusions: Higher DED may be a contributing factor for obesity-related cancers, especially among normal-weight postmenopausal women and, as such, could serve as a modifiable behavior for dietary interventions to reduce obesity-associated cancer risk., (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women., Objective: Our aim was to evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories., Design: We performed a cross-sectional analysis of a prospective cohort., Participants/setting: Participants were postmenopausal women from the Women's Health Initiative with body composition measurements by dual-energy x-ray absorptiometry (n=8,298)., Main Outcome Measures: Our study measured percent lean mass, percent fat mass, and lean body mass index., Statistical Analyses Performed: Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers., Results: Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P<0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (P interaction =0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P<0.001). Physical activity further reduced percent fat mass (P interaction =0.022) and lean body mass index (P interaction =0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P<0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women., Conclusions: Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories., Competing Interests: There are no conflicts of interest to disclose., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Data on the association between dietary patterns and age-related cognitive decline are inconsistent., Objective: To determine whether dietary patterns assessed by the alternate Mediterranean diet score (aMED), the Healthy Eating Index-2010 (HEI-2010), the Alternate Healthy Eating Index 2010 (AHEI-2010), or the Dietary Approach to Stop Hypertension (DASH) diet score are associated with cognitive decline in older women, and to examine whether dietary patterns modify the risk for cognitive decline in women with hypertension., Design: Prospective, longitudinal cohort study. Food frequency questionnaires were used to derive dietary patterns at baseline. Hypertension was defined as self-report of current drug therapy for hypertension or clinic measurement of systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg., Participants and Setting: Postmenopausal women (N=6,425) aged 65 to 79 years who participated in the Women's Health Initiative Memory Study and were cognitively intact at baseline., Main Outcome Measures: Cognitive decline was defined as cases of mild cognitive impairment (MCI) or probable dementia (PD). Cases were identified through rigorous screening and expert adjudication., Statistical Analyses Performed: Cox proportional hazards models with multivariable adjustment were used to estimate the relative risk for developing MCI or PD., Results: During a median follow-up of 9.11 years, we documented 499 cases of MCI and 390 of PD. In multivariable analyses we did not detect any statistically significant relationships across quintiles of aMED, HEI-2010, DASH, and AHEI-2010 scores and MCI or PD (P values for trend=0.30, 0.44, 0.23, and 0.45). In women with hypertension, we found no significant association between dietary patterns and cognitive decline (P values for trend=0.19, 0.08, 0.07, and 0.60)., Conclusions: Dietary patterns characterized by the aMED, HEI-2010, AHEI-2010, or DASH dietary score were not associated with cognitive decline in older women. Adherence to a healthy dietary pattern did not modify the risk for cognitive decline in women with hypertension., (Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Intensive dietary intervention programs may lead to benefits in vitality and other components of health quality. The Women's Health Initiative Dietary Modification (DM) intervention includes a large randomized controlled trial of an intensive intervention., Objective: To evaluate whether the intervention is associated with improved health-related quality of life (HRQoL) subscales, overall self-reported health, depression symptoms, cognitive functioning, and sleep quality., Design: This randomized controlled trial was analyzed as intent to treat., Participants: Between 1993 and 1998, 48,835 women aged 50 to 79 years were recruited by 40 clinical centers across the United States. Eligibility included having fat intake at baseline ≥32% of total calories, and excluded women with any prior colorectal or breast cancer, recent other cancers, type 1 diabetes, or medical conditions with predicted survival <3 years., Intervention: Goals were to reduce calories from fat to 20%, increase vegetables and fruit to 5+ servings, and increase grain servings to 6+ servings a day. During the first year, 18 group sessions were held, with quarterly sessions thereafter., Main Outcome Measures: The RAND 36-Item Health Survey was used to assess HRQoL at baseline, Year 1, and close-out (about 8 years postrandomization), and estimate differential HRQoL subscale change scores., Statistical Analyses Performed: Mean change in HRQoL scores (Year 1 minus baseline) were compared by randomization group using linear models., Results: At 1 year, there was a differential change between intervention and comparison group of 1.7 units (95% CI 1.5, 2.0) in general health associated with the intervention. DM intervention improved physical functioning by 2.0 units (95% CI 1.7, 2.3), vitality by 1.9 units (95% CI 1.6, 2.2), and global quality of life by 0.09 units (95% CI 0.07, 0.12). With the exception of global quality of life, these effects were significantly modified by body mass index at baseline., Conclusions: DM intervention was associated with small, but significant improvements in three HRQoL subscales: general health, physical functioning, and vitality at 1 year follow-up, with the largest improvements seen in the women with the greatest baseline body mass index., (Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Parenthood is associated with decreased physical activity and dietary changes. Previously, mothers have been the focus of studies examining the influence of children on parents' body mass index (BMI), largely ignoring whether parenting affects fathers. This study assessed weight gain in mothers and fathers (by birth or other), using longitudinal repeated-measures models to assess BMI changes over time; parents were compared with nonparents. Data were from the Coronary Artery Risk Development in Young Adults cohort study and included 2,881 black and white adults, ages 18 to 30 years, without children at baseline (1985-1986), and from four urban locations. At each time point (years 2, 5, and 7), changes in BMI from baseline were analyzed, comparing those who had their children in their household at that time point (parents) and those without children (nonparents). The "child effect" is the mean difference in BMI change in parents compared with nonparents. In fathers, overall, the child effect was not significant (black males: 0.30; P=0.09; white males: 0.03; P=0.77). Among black men, however, interactions between age and parental status were significant (P=0.02). Black men who were aged 18 to 24 years at baseline and became fathers during the next 7 years demonstrated a significant child effect, gaining an average of 0.68 more in BMI than nonfathers (P=0.003). Mothers of both races demonstrated the child effect; for blacks it was 0.65 (P=0.003) and for whites it was 1.12 (P≤0.001). These data reveal that becoming a parent can affect the BMI of some adults and suggest that obesity-prevention interventions for children and adult-focused healthy-lifestyle interventions could have additional impact through a family focus targeting both parent and child outcomes., (Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Cross-sectional studies suggest that parents eat more saturated fat than nonparents. Few studies exist on other dietary factors or using longitudinal data., Objective: To compare change in daily dietary intake of selected foods and nutrients across 7 years between adults who have children enter the home and those who do not., Design: Analysis of data from the Coronary Artery Risk Development in Young Adults cohort study. Dietary intake was assessed by the diet history questionnaire used in that study. The main dependent variables were change from baseline (1985-1986) to Year 7 (1992-1993) for intake of percent saturated fat, energy, daily servings of fruits and vegetables and sugar-sweetened beverages, and frequency of fast-food intake. The primary independent variable was whether or not participants had children in their home by Year 7., Participants: Two thousand five hundred sixty-three black and white adults who did not have children at baseline from four urban centers., Statistical Analyses Performed: Linear regression adjusting for baseline demographics, energy intake, physical activity, and smoking status., Results: Parents were more likely to be women, full-time workers, married, and older. Diet did not differ at baseline. Seven-year change in diet for parents and nonparents did not differ for fruit and vegetable, sugar-sweetened beverages, or fast food. Percent saturated fat decreased among both groups but parents showed a smaller decrease in percent saturated fat (1.59 vs 2.10; P<0.001). Compared with nonparents, parents increased energy intake by 79 kcal/day (P=0.058), but this difference did not reach statistical significance., Conclusions: Parenthood does not have unfavorable effects on parents' diets, but neither does it lead to significant improvements. In fact, parents lag behind their childless counterparts in decreasing intake of saturated fat and overall diets remain poor. Nutrition education programs and food and nutrition practitioners should develop strategies to support and motivate healthy eating habits in parents., (Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)