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Teresa T. Fung, ScD, RD; Walter C. Willett, MD, DrPH; Meir J. Stampfer, MD, DrPH; JoAnn E. Manson, MD, DrPH; Frank B. Hu, MD, PhD

Arch Intern Med. 2001;161:1857-1862.

Background  Although substantial information on individual nutrients or foods and risk of coronary heart disease (CHD) is available, little is known about the role of overall eating pattern.

Methods  Using dietary information from a food frequency questionnaire in 1984 from the Nurses' Health Study, we conducted factor analysis and identified 2 major dietary patterns—"prudent" and "Western"—and calculated factor scores of each pattern for individuals in the cohort. We used logistic regression to examine prospectively the associations between dietary patterns and CHD risk among 69 017 women aged 38 to 63 years in 1984 without history of major chronic diseases.

Results  The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, poultry, and whole grains, while the Western pattern was characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains. Between 1984 and 1996, we documented 821 CHD cases. After adjusting for coronary risk factors, the prudent diet score was associated with a relative risk (RR) of 0.76 (95% confidence interval (CI), 0.60-0.98; P for trend test, .03) comparing the highest with lowest quintile. Extreme quintile comparison yielded an RR of 1.46 (95% CI, 1.07-1.99; P for trend test, .02) for the Western pattern. Those who were jointly in the highest prudent diet quintile and lowest Western diet quintile had an RR of 0.64 (95% CI, 0.44-0.92) compared with those with the opposite pattern profile.

Conclusion  A diet high in fruits, vegetables, whole grains, legumes, poultry, and fish and low in refined grains, potatoes, and red and processed meats may lower risk of CHD.

From the Departments of Nutrition (Drs Fung, Willett, Stampfer, and Hu) and Epidemiology (Drs Willett, Stampfer, and Manson), Harvard School of Public Health, Boston, Mass; Channing Laboratory (Drs Willett, Stampfer, and Manson), Department of Medicine, and Department of Preventive Medicine (Dr Manson), Brigham and Women's Hospital and Harvard Medical School, Boston; and Programs in Nutrition, Simmons College, Boston (Dr Fung).

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