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Using data from the Women's Health Initiative (1993-2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2-3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.

Using data from the Women's Health Initiative (1993-2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2-3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.

ObjectiveTo examine determinants of racial/ethnic differences in diabetes incidence among postmenopausal women participating in the Women's Health Initiative.Research design and methodsData on race/ethnicity, baseline diabetes prevalence, and incident diabetes were obtained from 158,833 women recruited from 1993-1998 and followed through August 2009. The relationship between race/ethnicity, other potential risk factors, and the risk of incident diabetes was estimated using Cox proportional hazards models from which hazard ratios (HRs) and 95% CIs were computed.ResultsParticipants were aged 63 years on average at baseline. The racial/ethnic distribution was 84.1% non-Hispanic white, 9.2% non-Hispanic black, 4.1% Hispanic, and 2.6% Asian. After an average of 10.4 years of follow-up, compared with whites and adjusting for potential confounders, the HRs for incident diabetes were 1.55 for blacks (95% CI 1.47-1.63), 1.67 for Hispanics (1.54-1.81), and 1.86 for Asians (1.68-2.06). Whites, blacks, and Hispanics with all factors (i.e., weight, physical activity, dietary quality, and smoking) in the low-risk category had 60, 69, and 63% lower risk for incident diabetes. Although contributions of different risk factors varied slightly by race/ethnicity, most findings were similar across groups, and women who had both a healthy weight and were in the highest tertile of physical activity had less than one-third the risk of diabetes compared with obese and inactive women.ConclusionsDespite large racial/ethnic differences in diabetes incidence, most variability could be attributed to lifestyle factors. Our findings show that the majority of diabetes cases are preventable, and risk reduction strategies can be effectively applied to all racial/ethnic groups.

Inflammation is associated with a number of chronic conditions, such as cancer and cardiovascular disease. Reducing inflammation may help prevent or treat these conditions. Diet has consistently been shown to modulate inflammation. To facilitate research into the inflammatory effect of diet on health in humans, we sought to develop and validate an Inflammatory Index designed to assess the inflammatory potential of individuals' diets. An Inflammatory Index was developed based on the results of an extensive literature search. Using data from a longitudinal observational study that carefully measured diet and the inflammatory marker, serum high-sensitivity (hs) C-reactive protein (CRP), in ~600 adults for 1 y, we conducted analyses to test the effect of Inflammatory Index score on hs-CRP as a continuous and dichotomous ([less than or equal to] 3 mg/L, >3 mg/L) indicator of inflammatory response, while controlling for important potential confounders. Results based on continuous measures of hs-CRP suggested that an increasing Inflammatory Index score (representing movement toward an antiinflammatory diet) was associated with a decrease in hs-CRP. Analyses using hs-CRP as a dichotomous variable showed that an antiinflammatory diet was associated with a decrease in the odds of an elevated hs-CRP (P = 0.049). The results are consistent with the ability of the Inflammatory Index to predict hs-CRP and provide additional evidence that diet plays a role in the regulation of inflammation, even after careful control of a wide variety of potential confounders. J. Nutr. 139: 2365-2372, 2009. Manuscript received August 7, 2009. Initial review completed August 27, 2009. Revision accepted October 15, 2009. First published online October 28, 2009; doi: 10.3945/jn.109.114025.

Popular weight-loss plans often have conflicting recommendations, which makes it difficult to determine the most healthful approach to weight loss. Our study compares the dietary quality of popular weight-loss plans. Dietary quality, measured by the Alternate Healthy Eating Index (AHEI), was calculated via sample menus provided in published media for the New Glucose Revolution, Weight Watchers, Atkins, South Beach, Zone, Ornish, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans. The criterion for determining which weight-loss plans were the most popular was their status on the New York Times Bestseller list. Weight Watchers and the 2005 Food Guide Pyramid plan were included because they are the largest commercial weight-loss plan, and the current government recommendation, respectively. Analysis of variance was used to compare nutrient information among the weight-loss plans. The AHEI scores adjusted for energy content were also compared. Of a maximum possible score of 70, the AHEI scores for each weight-loss plan from the highest to the lowest plan were: Ornish (score 64.6), Weight Watchers high-carbohydrate (score 57.4), New Glucose Revolution (score 57.2), South Beach/Phase 2 (score 50.7), Zone (score 49.8), 2005 Food Guide Pyramid (score 48.7), Weight Watchers high-protein (score 47.3), Atkins/100-g carbohydrate (score 46), South Beach/Phase 3 (score 45.6), and Atkins/45-g carbohydrate (score 42.3). Dietary quality varied across popular weight-loss plans. Ornish, Weight Watchers high-carbohydrate, and New Glucose Revolution weight-loss plans have an increased capacity for cardiovascular disease prevention when assessed by the AHEI.

Objective To assess the effectiveness of a dietitian-based nutrition counseling and education program for patients with hyperlipidemia. Design A 4-session program implemented as a complement to a randomized physician-delivered intervention. Subjects/setting From 12 practice sites of the Fallon Clinic, 1,162 subjects with hyperlipidemia were recruited, 645 of whom had data sufficient for our primary analyses. Intervention Two individual and 2 group sessions conducted over 6 weeks. Main outcome measures Total and saturated fat levels; serum low-density lipoprotein cholesterol levels; and body weight, measured at baseline and after 1 year. Statistical analyses Multiple linear regression was used to evaluate changes in outcome measures. Results After 1 year, there were significant reductions in outcome measures for subjects attending 3 or 4 nutrition sessions vs subjects attending fewer than 3 sessions or those never referred to a nutrition session. Reductions (mean± standard error) in saturated fat (measured as percent of energy) were 2.7±0.5%, 2.1±0.5%, and 0.3±0.1%, respectively. These reductions correspond to roughly a 22% relative change from baseline in those attending 3 or 4 sessions. Corollary reductions were observed for total fat (measured as percent of energy): 8.2±1.4%, 5.0±1.4%, and 0.7±0.4%; low-density lipoprotein cholesterol: 0.48±0.11 mmol/L, 0.13±0.11 mmol/L, and 0.02±0.03 mmol/L; and body weight: 4.5±0.9 kg, 2.1±0.8 kg, and 1.1±0.2 kg. The specified changes were additive to those of the physician-delivered intervention. Applications/conclusions This investigation provides empirical data demonstrating the effectiveness of a dietitian-delivered intervention in the care of patients with hyperlipidemia., Although the relationship between dietary fat and risk for coronary heart disease (CHD) is well established (1), many physicians are relatively unfamiliar with dietary concepts and have limited time for [...]

The Nutrient Intake Report (NIR) is based on a 7-day dietary recall questionnaire used previously in research for dietary assessment and adapted for clinical use. Used to provide information and counseling as part of total patient care, the NIR acts as a cornerstone for dietary education and interaction between physician, registered dietitian, and patient. The NIR is ordered by physicians or registered dietitians, scanned and assessed by a registered dietitian, and incorporated into the laboratory section of the medical record. It documents the patient's dietary intake in the context of his or her diagnosis and general health status. The NIR also opens a dialogue between physicians and registered dietitians. Incorporation of the NIR into the medical record makes the work of the registered dietitian available to other health practitioners, which is welcome in an era when licensing and reimbursement are contingent on systematic documentation of dietary assessment and its role in patient care., In 1989, the US Preventive Services Task Force (1) declared that physicians should refer patients to registered dietitians or qualified nutritionists if they themselves are unable to perform a complete [...]