Estimating the effect of nutritional interventions using observational data: the American Heart Association's 2020 Dietary Goals and mortality

Yu-Han Chiu; Jorge E Chavarro; Barbra A Dickerman; JoAnn E Manson; Kenneth J Mukamal; Kathryn M Rexrode; Eric B Rimm; Miguel A Hernán

doi:10.1093/ajcn/nqab100

Estimating the effect of nutritional interventions using observational data: the American Heart Association's 2020 Dietary Goals and mortality

Am J Clin Nutr. 2021 Aug 2;114(2):690-703. doi: 10.1093/ajcn/nqab100.

Authors

Yu-Han Chiu^{1

2}, Jorge E Chavarro^{1

3

4}, Barbra A Dickerman¹, JoAnn E Manson^{1

4

5}, Kenneth J Mukamal^{4

6}, Kathryn M Rexrode⁷, Eric B Rimm^{1

3

4}, Miguel A Hernán^{1

8

9}

Affiliations

¹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
³ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁵ Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁷ Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA.

Abstract

Background: Because randomized trials of sustained dietary changes are sometimes impractical for long-term outcomes, the explicit emulation of a (hypothetical) target trial using observational data may be an important tool for nutritional epidemiology.

Objectives: We describe a methodological approach that aims to emulate a target trial of dietary interventions sustained over many years using data from observational cohort studies.

Methods: We estimated the 20-y risk of all-cause mortality under the sustained implementation of the food-based goals of the American Heart Association (AHA) 2020 using data from 3 prospective observational studies of US men [Health Professionals Follow-up Study (HPFS)] and women [Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II)]. We applied the parametric g-formula to estimate the 20-y mortality risk under a dietary intervention and under no dietary intervention.

Results: There were 165,411 participants who met the eligibility criteria. The mean age at baseline was 57.4 y (range, 43-82 y) in the HPFS, 52.4 y (range, 39-66 y) in the NHS, and 40.2 y (range, 30-50 y) in the NHS II. During 20 y of follow-up, 13,241 participants died. The estimated 20-y mortality risks under a dietary intervention versus no intervention were 21.9% compared with 25.8%, respectively, in the HPFS (risk difference, -3.9%; 95% CI: -4.9% to -3.2%); 10.0% compared with 12.6%, respectively, in the NHS (risk difference, -2.6%; 95% CI: -3.1% to -1.8%); and 2.1% compared with 2.5%, respectively, in the NHS II (risk difference, -0.35%; 95% CI: -0.56% to -0.09%). The corresponding risk ratios were 0.85 (95% CI: 0.81-0.88) in the HPFS, 0.79 (95% CI: 0.75-0.85) in the NHS, and 0.86 (95% CI: 0.78-0.96) in the NHS II.

Conclusions: We estimated that adherence to the food-based AHA 2020 Dietary Goals starting in midlife may reduce the 20-y risk of mortality.

Keywords: American Heart Association 2020 Dietary Goals; g-formula; mortality; nutritional epidemiology; target trial.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
American Heart Association*
Diet*
Female
Heart Diseases / mortality*
Heart Diseases / prevention & control*
Humans
Male
Middle Aged
Mortality / trends*
Nutrition Policy*
Nutritional Status*
United States

Abstract

Publication types

MeSH terms

Grants and funding