IJE Advance Access originally published online on April 20, 2009
International Journal of Epidemiology 2010 39(1):197-209; doi:10.1093/ije/dyp191
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Dietary patterns and the risk of mortality: impact of cardiorespiratory fitness
1Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada.
2School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada.
3Department of Exercise Science, University of South Carolina, Columbia, SC, USA.
4Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
5South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
* Corresponding author. School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada K7L 3N6. E-mail: ian.janssen{at}queensu.ca
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Abstract |
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Background While dietary patterns that are both predictive of chronic disease and mortality have been identified, the confounding effects of cardiorespiratory fitness have not been properly addressed. The primary objective was to assess the relation between dietary patterns with all-cause mortality, while controlling for the potentially confounding effects of fitness.
Methods This was a prospective cohort study. Participants consisted of 13 621 men and women from the Aerobics Center Longitudinal Study (ACLS). Participants completed a clinical exam and 3-day diet record between 1987 and 1999. Participants were followed for mortality until 2003. Reduced rank regression (RRR) was used to identify dietary patterns that predicted unfavourable total and high-density lipoprotein-cholesterol, triglyceride, glucose, blood pressure, uric acid, white blood cell and body mass index values.
Results One primary dietary pattern emerged and was labelled the Unhealthy Eating Index. This pattern was characterized by elevated consumption of processed and red meat, white potato products, non-whole grains, added fat and reduced consumption of non-citrus fruits. The hazard ratio for all-cause mortality in the fifth vs the first quintile of the Unhealthy Eating Index was 1.40 (1.02–1.91). This risk estimate was reduced by 13.5 and 55.0% after controlling for self-reported physical activity and fitness, respectively.
Conclusion In this study the association between diet and overall mortality was, in large part, confounded by fitness.
Keywords All-cause mortality, cardiorespiratory fitness, reduced rank regression
Accepted 17 March 2009
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