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. 2020 Mar 4;112(1):168–179. doi: 10.1093/ajcn/nqaa034

TABLE 5.

HRs (95% CIs) for a doubling of nutritional variable in relation to the incidence of CVD, cancer, or diabetes, both in a WHI Measurement Precision subcohort (n = 5488) using “biomarker” intake and in a complementary larger WHI cohort (n = 76,691) using calibrated FFQ (plus dietary supplements for β-carotene and α-tocopherol) intake1

α-Carotene β-Carotene Lutein + zeaxanthin α-Tocopherol
Intake measure Outcome (cases) HR 95% CI LogHR SE HR 95% CI LogHR SE HR 95% CI LogHR SE HR 95% CI LogHR SE
CVD
 Biomarker CHD (154) 0.97 0.86, 1.09 0.063 1.00 0.76, 1.33 0.145 0.93 0.74, 1.16 0.115 0.97 0.27, 2.31 0.063
 Calibrated2 CHD (2711) 0.95 0.89, 1.02 0.034 0.91 0.85, 0.99 0.040 0.95 0.86, 1.05 0.049 0.94 0.87, 1.01 0.037
 Calibrated3 CHD (2711) 0.93 0.84, 1.02 0.051 0.90 0.82, 0.99 0.046 0.95 0.85, 1.05 0.055 0.95 0.89, 1.01 0.032
 Biomarker CABG/PCI (172) 0.86 0.77, 0.96 0.055 0.77 0.60, 0.98 0.125 0.88 0.81, 1.33 0.103 1.16 1.04, 1.29 0.056
 Calibrated2 CABG/PCI (2933) 0.99 0.93, 1.06 0.033 0.94 0.87, 1.01 0.039 1.01 0.92, 1.10 0.047 0.97 0.90, 1.04 0.036
 Calibrated3 CABG/PCI (2933) 0.99 0.90, 1.09 0.050 0.93 0.85, 1.02 0.045 1.01 0.92, 1.12 0.052 0.97 0.91, 1.03 0.031
 Biomarker Stroke (124) 0.96 0.83, 1.10 0.071 0.96 0.72, 1.27 0.144 0.77 0.60, 0.99 0.130 0.94 0.80, 1.10 0.081
 Calibrated2 Stroke (2274) 0.93 0.86, 1.00 0.038 1.01 0.92, 1.10 0.045 0.96 0.87, 1.07 0.053 1.00 0.92, 1.08 0.041
 Calibrated3 Stroke (2274) 0.90 0.80, 1.00 0.058 1.01 0.91, 1.11 0.052 0.96 0.85, 1.07 0.059 1.00 0.93, 1.07 0.035
 Biomarker Total CVD (370) 0.92 0.85, 1.00 0.040 0.89 0.76, 1.06 0.088 0.83 0.72, 0.95 0.073 1.07 0.99, 1.16 0.042
 Calibrated2 Total CVD (6545) 0.95 0.91, 0.99 0.022 0.96 0.91, 1.01 0.026 0.98 0.92, 1.04 0.032 0.97 0.93, 1.02 0.024
 Calibrated3 Total CVD (6545) 0.93 0.87, 0.99 0.033 0.91 0.85, 0.98 0.030 0.98 0.92, 1.05 0.035 0.97 0.94, 1.01 0.021
Cancer
 Biomarker Breast (176) 0.86 0.75, 0.99 0.071 0.65 0.49, 0.86 0.146 0.89 0.71, 1.12 0.116 1.00 0.81, 1.13 0.062
 Calibrated2 Breast (3908) 0.95 0.90, 1.01 0.029 0.98 0.91, 1.05 0.035 0.98 0.90, 1.07 0.045 0.96 0.90, 1.03 0.034
 Calibrated3 Breast (3908) 0.94 0.86, 1.02 0.044 0.97 0.90, 1.05 0.039 0.99 0.90, 1.08 0.045 0.97 0.92, 1.03 0.029
 Biomarker Total invasive (473) 0.95 0.87, 1.03 0.041 0.88 0.74, 1.05 0.089 1.04 0.91, 1.19 0.070 1.05 0.97, 1.13 0.039
 Calibrated2 Total invasive (9557) 0.95 0.92, 0.99 0.019 1.01 0.97, 1.06 0.023 0.99 0.94, 1.05 0.029 1.00 0.96, 1.05 0.022
 Calibrated3 Total invasive (9557) 0.93 0.88, 0.99 0.028 1.01 0.96, 1.06 0.025 0.99 0.94, 1.05 0.029 1.00 0.97, 1.04 0.018
Diabetes mellitus
 Biomarker Treated (644) 0.91 0.85, 0.97 0.033 0.76 0.67, 0.87 0.067 0.85 0.75, 0.97 0.063 1.04 0.97, 1.12 0.036
 Calibrated2 Treated (8504) 0.98 0.94, 1.02 0.019 1.01 0.97, 1.06 0.022 1.02 0.77, 1.08 0.029 1.04 0.99, 1.09 0.025
 Calibrated3 Treated (8504) 0.97 0.91, 1.02 0.050 1.02 0.97, 1.07 0.026 1.02 0.96, 1.09 0.031 1.03 0.99, 1.07 0.021
1

Biomarker intake in this Measurement Precision cohort of 5488 women, for whom concentrations of the micronutrients considered here and total cholesterol were routinely measured in blood collected at baseline, using the regression model on the right side of Table 2. FFQs were measured at 1 y postenrollment in the Dietary Modification clinical trial comparison group, and at enrollment in the Observational Study. Following exclusion of participants with prevalent disease at baseline or having missing covariate data, there were 3780, 3686, and 3693 participants included in CVD, cancer, and diabetes analyses, respectively. Follow-up from enrollment in 1993–1998 to 30 September 2010 for CVD incidence, and to 31 December 2013 for cancer diabetes and mortality outcomes. HRs were calculated using Cox regression with detailed baseline stratification of hazard rates, and with modeled regression variables composed of calibrated log-intake and potential confounding factors. CIs are calculated using a sandwich procedure that acknowledges random error in regression equation coefficients. Participants having a history of CVD, invasive cancer, or diabetes, or having missing covariates used to control confounding were excluded from respective CVD, cancer, and diabetes analyses. CABG/PCI, coronary artery bypass graft or percutaneous coronary intervention; CHD, coronary heart disease; CVD, cardiovascular disease; NPAAS, Nutrition and Physical Activity Assessment Study; SE, estimated SE (for estimated logHR); WHI, Women's Health Initiative.

2

Calibrated intake calculated using calibration equations developed in the NPAAS Nutritional Biomarker Study (n = 436) using the regression model on the right side of Table 2, and based on FFQ (plus supplement intake for β-carotene and α-tocopherol) intake assessments and participant covariates. Following exclusion of participants with prevalent disease at baseline or having missing covariate data, there were 73,188, 68,234, and 73,707 participants included in CVD, cancer, and diabetes analyses, respectively.

3

Calibrated intake calculated using calibration equations developed in the WHI Measurement Precision subcohort (n = 5488), using the regression model on the right side of Table 2, and based on FFQ (plus supplements) intake estimates and participant covariates. Following exclusion of participants with prevalent disease at baseline or having missing covariate data, there were 73,188, 68,234, and 73,707 participants included in CVD, cancer, and diabetes analyses, respectively.