Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
Am J Clin Nutr. 2021 Aug 2;114(2):690-703. doi: 10.1093/ajcn/nqab100.
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.
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.
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.
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.
We estimated that adherence to the food-based AHA 2020 Dietary Goals starting in midlife may reduce the 20-y risk of mortality.
由于长期结果的持续饮食改变的随机试验有时不切实际，因此使用观察数据明确模拟（假设）目标试验可能是营养流行病学的重要工具。
我们描述了一种旨在使用来自美国男性（健康专业人员随访研究（HPFS））和女性（护士健康研究（NHS）和护士健康研究 II（NHS II））的前瞻性观察队列研究数据来模拟长期实施的饮食干预的目标试验的方法。
我们使用来自三项符合条件的前瞻性观察性队列研究（美国男性健康专业人员随访研究（HPFS）、美国女性护士健康研究（NHS）和护士健康研究 II（NHS II）的数据，估计了全因死亡率的 20 年风险。），以实现美国心脏协会（AHA）2020 年的基于食物的目标。我们应用参数 g 公式来估计在饮食干预和无饮食干预下的 20 年死亡率风险。
共有 165411 名符合条件的参与者。在 HPFS 中，基线时的平均年龄为 57.4 岁（范围为 43-82 岁），NHS 为 52.4 岁（范围为 39-66 岁），NHS II 为 40.2 岁（范围为 30-50 岁）。在 20 年的随访期间，有 13241 名参与者死亡。在 HPFS 中，饮食干预与无干预相比，估计 20 年死亡率风险分别为 21.9%和 25.8%（风险差异为-3.9%；95%CI：-4.9%至-3.2%）；在 NHS 中，分别为 10.0%和 12.6%（风险差异为-2.6%；95%CI：-3.1%至-1.8%）；在 NHS II 中，分别为 2.1%和 2.5%（风险差异为-0.35%；95%CI：-0.56%至-0.09%）。相应的风险比分别为 0.85（95%CI：0.81-0.88）、0.79（95%CI：0.75-0.85）和 0.86（95%CI：0.78-0.96）在 HPFS、NHS 和 NHS II 中。
我们估计从中年开始坚持基于食物的美国心脏协会 2020 年饮食目标可能会降低 20 年的死亡率风险。
