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Background Assessing estimated sodium (Na) and potassium (K) intakes derived from 24-h urinary excretions compared with a spot urine sample, if comparable, could reduce participant burden in epidemiologic and clinical studies. Objectives In a 2-week controlled-feeding study, Na and K excretions from a 24-h urine collection were compared with a first-void spot urine sample, applying established algorithms and enhanced models to estimate 24-h excretion. Actual and estimated 24-h excretions were evaluated relative to mean daily Na and K intakes in the feeding study. Methods A total of 153 older postmenopausal women ages 75.4 ± 3.5 y participated in a 2-wk controlled-feeding study with a 4-d repeating menu cycle based on their usual intake (ClinicalTrials.gov Identifier: NCT00000611). Of the 150 participants who provided both a first-void spot urine sample and a 24-h urine collection on the penultimate study day, statistical methods included Pearson correlations for Na and K between intake, 24-h collections, and the 24-h estimated excretions using 4 established algorithms: enhanced biomarker models by regressing ln-transformed intakes on ln-transformed 24-h excretions or ln-transformed 24-h estimated excretions plus participant characteristics and sensitivity analyses for factors potentially influencing Na or K excretion (e.g., possible kidney disease estimated glomerular filtration rate, Twenty-four-hour urine excretion measurement performs better than estimated 24-h excretion from a spot urine as a biomarker for Na and K intake among a sample of primarily white postmenopausal women.

Background Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive. Objectives Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity. Methods Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities (n = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1–3 (n = 795), 4 (n = 713), and ≥5 (n = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outcome. Results Approximately 15% (15.4%, n = 332) of the WHI-DM 24HR cohort reported incident diabetes at follow-up. Cox proportional hazards regression tested associations of eating occasions with T2D adjusted for neighborhood socioeconomic status, BMI, waist circumference, race/ethnicity, family history of T2D, recreational physical activity, Healthy Eating Index-2005, 24HR energy intake, and WHI-DM arm. Compared with women reporting 1–3 meals/d, those consuming 4 meals/d had a T2D HR = 1.38 (95% CI: 1.03, 1.84) without further increases in risk for ≥5 meals/d. In stratified analyses, associations for 4 meals/d compared with 1–3 meals/d were stronger in women with BMI, Four meals/day compared to fewer meals may increase the risk of Type 2 diabetes in older women but no dose response effect seen for higher frequency.

OBJECTIVES: Lignans are bioactive compounds exhibiting various biological properties, including anti-inflammatory, antioxidant and antitumor activities. Epidemiological studies regarding long-term health effects of lignans are sparse. In humans, most lignans in plant-based foods are converted by the intestinal microbiota to enterolactone and enterodiol after ingestion. We examined the association of urinary levels of enterolactone and enterodiol with the risk of mortality among adults in the United States. METHODS: This is a prospective cohort study including 6262 adults aged 40 years or older who participated in the National Health and Nutrition Examination Survey 1999–2010. These participants were linked to mortality data through December 31, 2015. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of urinary enterolactone and enterodiol levels with mortality from all causes, cardiovascular disease (CVD), and cancer. RESULTS: During on average 9.3 years (maximum 16.8 years) of observation, 1456 death occurred including 329 death from CVD, and 330 death from cancer. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, and urinary creatinine levels, the HRs (95% CIs) of all-cause mortality across increasing quartiles of urinary enterolactone levels were 1.00 (reference), 0.90 (0.77–1.05), 0.83 (0.71–0.97), and 0.81 (0.66–0.99), respectively (P for trend 0.02). We did not observe significant associations of urinary enterolactone levels with CVD mortality (HR for the highest vs. lowest quartiles 1.17, 95% CI 0.71–1.91) or cancer mortality (HR 0.82, 95% CI 0.55–1.21). For enterodiol, the HRs (95% CIs) of all-cause mortality, CVD mortality, and cancer mortality comparing the highest with lowest quartile of urinary enterodiol levels were 1.17 (0.94–1.45), 1.23 (0.83–1.81), and 1.05 (0.69–1.58), respectively. There was no significant interaction effects by sex and race/ethnicity for the observed associations. CONCLUSIONS: In this nationally representative sample of US adults, urinary enterolactone levels was inversely associated with all-cause mortality. Further studies are needed to replicate the findings and determine the underlying mechanisms. FUNDING SOURCES: N/A.

OBJECTIVES: We aimed to evaluate diet quality as reflected by multiple a priori dietary pattern indices in relation to incident PAD. METHODS: We included 138,506 US postmenopausal women aged 50–79 years without known PAD at baseline (1993–1998) of the Women's Health Initiative. Score of 4 dietary pattern indices, including the alternate Mediterranean diet (aMED) index, the alternate Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet index, and the Healthy Eating Index (HEI)-2015, were derived using data collected by a validated food frequency questionnaire. Incident cases of symptomatic PAD in the lower extremities were ascertained and adjudicated through March 2019 by reviewing medical record. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models, with adjustment for multiple potential confounders including known risk factors for PAD (i.e., smoking, high blood pressure, dyslipidemia, and diabetes). RESULTS: During a median 18.6 years of follow-up, 1036 incident cases of PAD were identified. All 4 dietary pattern indices were inversely associated with risk of PAD. The multivariable-adjusted HRs (95% CI) comparing the highest with the lowest score quartiles were 0.74 (0.61–0.91) for aMED index (P-trend across quartile = 0.010), 0.79 (0.65–0.95) for AHEI-2010 (P-trend

OBJECTIVES: The objective was to examine the prospective association of major dietary protein sources with all-cause and cause-specific mortality in U.S. women. METHODS: We included 127,495 postmenopausal women aged 50 to 79 years old at study entry who were enrolled between 1993 and 1998 in the Women's Health Initiative from September 1993, and followed through February 2017. Prospective cohort study. We used multivariable Cox proportional hazards models to estimate adjusted HRs of all cause, cardiovascular, cancer and dementia mortality in relation to major protein sources. RESULTS: During 2,302,230 person-years of follow-up, 35,043 deaths occurred. Total protein or animal protein intake was not significantly associated with all-cause or cause-specific mortality. Plant protein intake was inversely associated with all-cause, CVD and dementia mortality, with multivariable-adjusted HRs (95% CIs), comparing the higher with the lowest quintile, as 0.91 (0.86, 0.95), 0.87 (0.79, 0.95), and 0.81 (0.70, 0.94), respectively. Substituting 5% energy from animal protein with plant protein was associated with a 13% lower risk of all-cause mortality. For major protein sources, consumption of unprocessed red meat, processed red meat, and eggs, was associated with higher risk of all-cause mortality, with multivariable-adjusted HRs (95% CIs), comparing the higher with the lowest quintile, as 1.07 (1.03, 1.11), 1.07 (1.03, 1.11), and 1.14 (1.10, 1.18), respectively, while nut consumption was associated with a slightly lower risk of all-cause mortality, with multivariable-adjusted HRs (95% CIs), comparing the higher with the lowest quintile, as 0.97 (0.93, 0.99). Substituting 4 ounce equivalent/day of total red meat with poultry, fish/shellfish, or nuts, was associated with a 8%, a 12%, and a 12% lower risk of all-cause mortality, respectively. CONCLUSIONS: Different dietary protein sources have varying associations with lower all-cause, CVD and dementia mortality. Substituting total red meat with poultry, fish/shellfish, or nuts was associated with lower risk of all-cause mortality. FUNDING SOURCES: NIH.