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

2. Disclosures: none

3. Acknowledgements: Dietary 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 Dietary patterns background
Progress in dietary patterns research and need for standardization
Dietary Patterns Methods Project
Dietary patterns across the food stream
Summary

5. Dietary 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
Cancer Risk
Possible synergism & interactions
Multicollinearity
Source: Miller PE. 2012

8. Dietary patterns and cancer prevention
Totality of 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
Complexity of diet
Background on dietary patterns
People eat foods (and meals), not nutrients
Correlation among dietary constituents
Analysis of single nutrients may be confounded by the effect of dietary patterns
Clinical trials show positive health outcomes with changes in “total diet”
Dietary Approaches to Stop Hypertension (DASH)
Lyon Diet Heart Study
Relevance for policy and guidance
(low fat diet associated with fruits/vegetables, fiber, whole grains, and folate)

10. Progress in dietary patterns research and need for standardization

11. Progress in dietary patterns research
2010 Dietary Guidelines for Americans

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

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

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

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

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

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

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

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

20. Dietary Patterns Methods Project

21. Dietary 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
Investigator-driven 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. Are diet quality indices associated with reduced mortality?
NIH-AARP
Multiethnic Cohort
Women’s Health Initiative
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

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. Dietary patterns across the food stream

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

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

30. Dietary 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 Dietary Patterns Methods Project: Synthesis of findings across cohorts and relevance to dietary guidance. Journal of Nutrition, 2015.

31. Dietary 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
Sue will have showed the video by this time, so they’ll know where this is from…
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