Walter C Willett's research while affiliated with Savitar Research Group and other places

Publications (981)

Article
Background: The relationships between PTEN loss and/or PIK3CA mutation and breast cancer prognosis remain controversial. We aim to examine the associations in large epidemiological cohorts. Methods: We followed women with invasive breast cancer from the Nurses' Health Studies with available data on tumor PTEN expression (n=4,111) and PIK3CA muta...
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The obesity pandemic continues unabated despite a persistent public health campaign to decrease energy intake (“eat less”) and increase energy expenditure (“move more”). One explanation for this failure is that the current approach, based on the notion of energy balance, has not been adequately embraced by the public. Another possibility is that th...
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Background: Type 2 diabetes (T2D) has been associated with increased risk of breast cancer. However, the role of metformin, the first-line anti-diabetic drug, in breast cancer carcinogenesis has not been elucidated completely. We aimed to examine further the association between the use of metformin and other anti-diabetic medication and breast canc...
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Background: Epidemiological studies have demonstrated a favorable association of whole grain intake with coronary heart disease (CHD) risk, although whether such an inverse association holds true for individual whole grain foods that have various nutritional profiles has not been examined. Methods: We followed 74,244 women from Nurses' Health St...
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Importance: Results of several small randomized clinical trials have suggested that supplements of marine ω-3 fatty acids may be beneficial in treating signs and symptoms of dry eye disease (DED). However, randomized clinical trial data to examine whether ω-3 fatty acid supplements can prevent DED are lacking. Objective: To evaluate whether long...
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Background: Identifying risk factors for aggressive forms of breast cancer is important. Tumor factors (e.g., stage) are important predictors of prognosis, but may be intermediates between pre-diagnosis risk factors and mortality. Typically, separate models are fit for incidence and mortality post-diagnosis. These models have not been previously i...
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Purpose Epidemiologic evidence for specific types and sources of dietary fat and individual fatty acid with colorectal cancer (CRC) risk remains inconclusive. We aimed to comprehensively examine the associations of intakes of specific types (saturated, monounsaturated, polyunsaturated, and trans) and sources (animal, dairy, and vegetable) of dietar...
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Background and aims: Evidence supports a carcinogenic role of Escherichia coli carrying the polyketide synthase (pks) island that encodes enzymes for colibactin biosynthesis. We hypothesized that the association of western-style diet (rich in red and processed meat) with colorectal cancer incidence might be stronger for tumors containing higher am...
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Background The obesity epidemic in the USA continues to grow nationwide. Although excess weight-related mortality has been studied in general, less is known about how it varies by demographic subgroup within the USA. In this study we estimated excess mortality associated with elevated body weight nationally and by state and subgroup. Methods We de...
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Objective This study investigated associations between types and food sources of protein with overweight/obesity and underweight in Ethiopia. Design We conducted a cross-sectional dietary survey using a non-quantitative food frequency questionnaire. Linear regression models were used to assess associations between percent energy intake from total,...
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Importance: In the past 4 years, the American Cancer Society and the US Preventive Services Task Force updated recommendations to initiate colorectal cancer (CRC) screening at 45 years of age to address the increasing incidence of CRC among adults younger than 50 years. However, empirical evidence evaluating the potential benefits of screening in...
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Background Due to the increasing disease burden, strategies to predict and prevent heart failure (HF) are urgently needed. Objective We aimed to investigate whether the Alternative Healthy Eating Index (AHEI) and the clinically-abbreviated Prime Diet Quality Score (PDQS) are associated with the risk of overall HF, heart failure with preserved ejec...
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Background: Little is known about the current intake of sustainable diets globally and specifically in middle-income countries, considering nutritional, environmental and economic factors. Objective: To assess and characterize the sustainability of Mexican diets and their association with sociodemographic factors. Design: Dietary data of 2,438 adul...
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The association between egg consumption and mortality is extremely debatable. This study aimed to investigate the potential dose-response association of egg consumption with risk of mortality from all-causes and cause-specific in the general population. The primary comprehensive literature search was conducted in PubMed/Medline, Scopus, ISI Web of...
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Objective: The aim of this study was to test the individual and combined benefit of vitamin D, omega-3, and a simple home strength exercise program on the risk of any invasive cancer. Design: The DO-HEALTH trial is a three-year, multicenter, 2 × 2 × 2 factorial design double-blind, randomized-controlled trial to test the individual and combined ben...
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Background: There is evidence that an overall healthy diet is associated with lower risk of frailty. However, the effect of diet composition, specifically the role of protein intake on frailty, is mostly unclear. The aim of this study was to evaluate the intake of protein, including total, plant, animal, and dairy protein, in relation to frailty i...
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Objective To examine the associations between adherence to plant-based diets and mortality. Design prospective study. We calculated a plant-based diet index (PDI) by assigning positive scores to plant foods and reverse scores to animal foods. We also created a healthful PDI (hPDI) and an unhealthful PDI (uPDI) by further separate the healthy plant...
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Background and aim Iron deficiency is associated with increased morbidity and mortality in older adults. However, data on its prevalence and incidence among older adults is limited. The aim of this study was to investigate the prevalence and incidence of iron deficiency in European community-dwelling older adults aged ≥ 70 years. Methods Secondary...
Article
In the Men’s Lifestyle Validation Study (2011-2013), we examined the validity and relative validity of a physical activity questionnaire (PAQ), web-based 24-hour recalls (ACT24) and accelerometers by multiple comparison methods. Over one year, 609 men completed two PAQs, two 7-day accelerometer measures, one doubly labeled water (DLW)-physical acti...
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Background Few studies investigated very long-term overall survival and causes of death among men and women diagnosed with most commonly occurring cancers. Methods We estimated very long-term (≥30-year) overall and cause-specific cumulative mortality for men diagnosed with prostate (n = 6,873), lung and bronchus (n = 1,290), colon and rectum (n =...
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Objective: To examine the association between intakes of sodium and potassium and the ratio of sodium to potassium and incident myocardial infarction and stroke. Design, setting and participants: Prospective cohort study of 180,156 Veterans aged 19 to 107 years with plausible dietary intake measured by food frequency questionnaire (FFQ) who were...
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Background: To compare the prevalence of healthy aging among adults age 70 and older from 5 European countries recruited for the DO-HEALTH clinical trial. Participants were selected for absence of prior major health events. Methods: Cross-sectional analysis of DO-HEALTH baseline data. All 2,157 participants (mean age 74.9, SD 4.4; 61.7% women) w...
Article
Introduction: The relationship between artificially sweetened beverage (ASB) intake and type 2 diabetes (T2D) risk remains inconclusive. Few studies have evaluated whether circulating metabolites that reflect ASB consumption may unveil potential mechanisms underlying the association between ASB consumption and T2D risk. Hypothesis: We hypothesized...
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Introduction Although insufficient or prolonged sleep duration is associated with cardiovascular disease, sleep duration is not included in most lifestyle scores. This study evaluates the relationship between a lifestyle score, including sleep duration and cardiovascular disease risk. Methods A prospective analysis among 67,250 women in the Nurses...
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Background: Red and processed meat consumption has been consistently associated with increased risk of colorectal cancer (CRC), but the association for fish intake is unclear. Evidence using objective dietary assessment approaches to evaluate these associations is sparse. Objectives: We aim to investigate the plasma metabolite profiles related t...
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Background: Insulin resistance and hyperinsulinemia play important roles in the progression of multiple chronic disease and conditions. Diet modulates insulin response; however, evidence is limited regarding whether diet with higher insulinemic potential is associated with invasive breast cancer risk.Objectives: We prospectively evaluated the assoc...
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Background: PTEN loss and/or PIK3CA mutation are hypothesized to predict more aggressive tumor behavior and worse outcomes in women with breast cancer. However, the results of previous studies with small sample size have been conflicting. Methods: We followed pre- and postmenopausal women with invasive breast cancer from the Nurses’ Health Study (d...
Article
Few biomarker-based validation studies have examined error in online self-report dietary assessment instruments, and food records (FRs) have been considered less than food frequency questionnaires (FFQs) and 24-hour recalls (24HRs). We investigated measurement error in online and paper-based FFQs, online 24HRs, and paper-based FRs in three samples...
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Background: The roles of vitamin D, omega-3 fatty acids, and home exercise on fall prevention among generally healthy and active older adults are unclear. Objectives: We tested the effects of daily supplemental vitamin D, daily supplemental marine omega-3s fatty acids, and a simple home exercise program (SHEP), alone or in combination, on the in...
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Background: Evidence on the comprehensive role of lifestyle in frailty risk is scarce. To assess the association between a lifestyle-based Healthy Heart Score (HHS), which estimates the 20-year risk of cardiovascular disease (CVD), and risk of frailty among older women. Methods: Prospective cohort study in 121,700 nurses from the USA participati...
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Diet is one of the modifiable risk factors for cognitive decline. However, human studies on total energy intake and cognitive function have remained limited and studies on fat intake and cognitive decline have been inconclusive. We aimed to examine prospectively the associations between long-term intakes of total energy and fat with subsequent subj...
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Background Olive oil consumption has been shown to lower cardiovascular disease risk, but its associations with total and cause-specific mortality are unclear. Objectives The purpose of this study was to evaluate whether olive oil intake is associated with total and cause-specific mortality in 2 prospective cohorts of U.S. men and women. Methods...
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Background Intake of conventionally grown fruits and vegetables (FVs) is an important route of exposure to pesticide residues in the general population. However, whether health risk stemming from exposure to pesticides through diet could offset benefits of consuming FVs is unclear. Objective We assessed the association of FV intake, classified acc...
Article
Among 683 participants of the Women’s Lifestyle Validation Study (2010-2012), we evaluated the performance of a self-administered physical activity questionnaire (PAQ) and web-based 24-hour recalls (ACT24) using multiple comparison methods. Two PAQs, four ACT24s, two 7-day accelerometer measurements, one doubly-labeled water (DLW)-physical activity...
Article
STUDY QUESTION Are menstrual cycle characteristics throughout the reproductive lifespan associated with cancer risk? SUMMARY ANSWER Irregular and long menstrual cycles throughout the reproductive lifespan were associated with increased risk of total invasive cancer, especially obesity-related cancers. WHAT IS KNOWN ALREADY Long and irregular mens...
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Background Some previous studies suggested that high supplemental vitamin C intake may be associated with an increased risk of breast cancer, although evidence is inconsistent. Objective Our objective was to study the association between vitamin C intake and breast cancer risk using regularly updated assessments of intake over a long follow-up. M...
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Objective: Insulin response is related to overall health. Diet modulates insulin response. We investigated whether insulinemic potential of diet is associated with risk of all-cause and cause-specific mortality. Research design and methods: We prospectively followed 63,464 women from the Nurses' Health Study (1986-2016) and 42,880 men from the H...
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Objective To assess the association between diet cost and quality by place of residence. Design We analyzed cross-sectional data of the National Health and Nutrition Survey-2012. Diet cost was estimated by linking dietary data, obtained from a 7-day Food Frequency Questionnaire, with municipality food prices, which were derived from a national exp...
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Background The relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method. Methods We included individual-participant data from six prospective cohorts of generally...
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Background Diet quality scores (DQSs) are frequently used to study diet–disease relations but the validity of these scores derived from FFQs has rarely been evaluated. Objectives To evaluate the validity and reproducibility of 6 commonly used DQSs derived from the FFQ, including the Alternate Healthy Eating Index–2010, Dietary Approaches to Stop H...
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Background Red meat is a nutrient-dense source of protein fundamental for older adults; however, red meat is also high in detrimental components, including saturated fat. It is unclear whether habitual red meat consumption is associated with risk of frailty. This study aimed to examine the prospective association between the consumption of total, u...
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Background Conventionally grown fruits and vegetables (FVs) are the main source of general population exposure to pesticide residues. Objective To evaluate the relation of intake of high- and low-pesticide-residue FVs with cancer risk. Methods We followed 150,830 women (Nurses’ Health Study, 1998–2016, and Nurses’ Health Study II, 1999–2017) and...
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Background & Aims In patients with celiac disease, gluten triggers an immune reaction that damages small intestinal villi and may increase long-term risk of gastrointestinal cancer. However, the health impacts of gluten in the general population are understudied. We aimed to examine the association between gluten intake and risk of digestive system...
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Background: Higher circulating carotenoids are associated with lower breast cancer risk. The underlying biology remains under-explored. Methods: We profiled 293 pre-diagnostic plasma metabolites in a nested case-control study (n=887 cases) within the Nurses' Health Studies. Associations between circulating carotenoids and metabolites were identi...
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Background The prevalence of type 2 diabetes has increased substantially in India over the past 3 decades. Undiagnosed diabetes presents a public health challenge, especially in rural areas, where access to laboratory testing for diagnosis may not be readily available. Objectives The present work explores the use of several machine learning and st...
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Background We have developed a diet quality metric intended for global use. To assess its utility in high-income settings, an evaluation of its ability to predict chronic disease is needed. Objectives We aimed to prospectively examine the ability of the Global Diet Quality Score (GDQS) to predict the risk of type 2 diabetes in the United States, e...
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Background Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. Objectives...
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Background Evidence on concurrent changes in overall diet quality and weight and waist circumference in women of reproductive age from low- and middle-income countries is limited. Objectives We examined the associations of changes in the Global Diet Quality Score (GDQS) and each GDQS food group with concurrent weight and waist circumference change...
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Background In India, there is a need to monitor population-level trends in changes in diet quality in relation to both undernutrition and noncommunicable diseases. Objectives We conducted a study to validate a novel diet quality score in southern India. Methods We included data from 3041 nonpregnant women of reproductive age (15–49 years) from 2...
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Background We have developed a simple and globally applicable tool, the Global Diet Quality Score (GDQS), to measure diet quality. Objectives To test the utility of the GDQS, we examined the associations of the GDQS with weight change and risk of obesity in US women. Methods Health, lifestyle, and diet information were collected from women (n = 6...
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Background The global diet quality score (GDQS) is a simple, standardized metric appropriate for population-based measurement of diet quality globally. Objectives We aimed to operationalize data collection by modifying the quantity of consumption cutoffs originally developed for the GDQS food groups and to statistically evaluate the performance of...
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Background The double burdens of under- and overnutrition are changing the health of individuals and the economic and disease burdens in China. Poor diet plays an important role; however, a valid and easily operationalized metric that could capture the full range of characteristics of the diet that are relevant to both under- and overnutrition is l...
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Background Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. Objectives We evaluated comparative performance of a novel food-based Global Diet Quality Score (G...
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Background Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. Objectives To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. Methods We scored the...
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Background: Breast cancer (BC) incidence and mortality are lower in Poland than in the United States (US). However, Polish-born migrant women to US approach the higher BC mortality rates of US women. We evaluated the association between consumption of cabbage/sauerkraut foods and BC risk in Polish-born migrants to US. Methods: We conducted a cas...
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Background: The associations between nut consumption and cancer risk have not been extensively investigated. Objectives: We aimed to examine the associations between nut consumption, especially specific types of nuts (peanut, tree nut, walnut, and tree nut other than walnut), and cancer risk. Methods: Nut consumption was assessed by FFQ at bas...
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Background Evidence regarding the role of diet quality, especially its change, in subjective cognitive decline (SCD) is scarce. Objectives To examine associations of long-term diet qualities, including Alternate Mediterranean Diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and Alternate Healthy Eating Index 2010 (AHEI-2010) with SCD i...
Preprint
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Background: To compare the prevalence of healthy aging among adults age 70 and older from 5 European countries recruited for the DO-HEALTH clinical trial. Participants were selected for absence of prior major health events. Methods: Cross-sectional analysis of DO-HEALTH baseline data. All 2,157 participants (mean age 74.9, SD 4.4; 61.7% women) were...
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The glycaemic index (GI) is a food metric that ranks the acute impact of available (digestible) carbohydrates on blood glucose. At present, few countries regulate the inclusion of GI on food labels even though the information may assist consumers to manage blood glucose levels. Australia and New Zealand regulate GI claims as nutrition content claim...
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Food systems are at the center of a brewing storm consisting of a rapidly changing climate, rising hunger and malnutrition and significant social inequities. At the same time, there are vast opportunities to ensure that food systems produce healthy and safe food in equitable ways that promote environmental sustainability, especially if the world ca...
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According to a commonly held view, the obesity pandemic is caused by overconsumption of modern, highly palatable, energy-dense processed foods, exacerbated by a sedentary lifestyle. However, obesity rates remain at historic highs, despite a persistent focus on eating less and moving more, as guided by the energy balance model (EBM). This public hea...
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Objective Poor metabolic health and unhealthy lifestyle factors have been associated with risk and severity of COVID-19, but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its interaction with socioeconomic deprivation. Design We used data from 592 571 participants of the s...
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Background & Aims Unrestrained eating behavior has been thought to be a proxy for diet frequency, timing, and caloric intake. We investigated the association of unrestrained eating with mortality risk in the Nurses’ Health Study prospectively. Methods During follow-up (1994-2016), 21953 deaths were documented among 63999 eligible participants in a...
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The Mediterranean diet (MedDiet), one of the most studied and well-known dietary patterns worldwide, has been associated with a wide range of benefits for health. In the present narrative review, we aimed to provide a comprehensive overview of the current knowledge on the relation of the MedDiet to important health outcomes, considering both observ...