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For the WHI FFQ: My Pyramid Equivalents Database 2.0 (MPED 2.0) Healthy Eating Index-2005 (HEI-2005) Guidelines for computing diet indices for AHEI-2010, aMed, DASH, HEI-2010 Addition of the MyPyramid Equivalents Database 2.0 (MPED 2.0) Variables to the WHI FFQ for construction of the HEI-2005 The Nutrition Assessment Shared Resource (NASR) of the Fred Hutchinson Cancer Research Center has added the MyPyramid Equivalents 2.0 to the nutrient database for the WHI FFQ as additional “nutrients”. Appending MyPyramid Equivalents to the WHI FFQ Nutrient Database The MyPyramid Equivalents Database 2.0 (MPED) includes 32 per 100 grams equivalent measures (see Table) for 7,752 different foods. For more information on the dataset see MyPyramid Equivalents Database, 2.0 for USDA Survey Foods, 2003-2004: Documentation and User Guide. It is currently available on the USDA website as of August 2016 (http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/mped/mped2_doc.pdf ). Each food has a food code and a modification code that together uniquely define the food in the dataset. The listing below summarizes NASR coding rules that were used in the matching process when direct matches were not available. Issue No MPED food available for many spices and seasonings. No MPED food available for several dry ingredients (e.g. corn flour, pudding mix). MPED foods often have information about whether and what type of fat was added in cooking. Coding Rule If spice/seasoning has minimal nutritional value, code as “missing”. Match these foods at the “recipe” level rather than at the component-level. MPED provides information about specific cooking method, but no cooking method is noted for the NDSR component (e.g. the NDSR component “steak – beef, chuck, no visible fat eaten” does not include information about how the steak was cooked). Where available, choose “no fat added” or “NS as to cooking method” for the MPED food. The NDSR component-level data has fat as a separate component so use the MPED food with “no fat added” where this is an option. The fat in the line item is matched separately. Table: MPED 2.0 Variables Field Name G_TOTAL G_WHL G_NWHL Description. Total number of ounce equivalents from the grains group Number of ounce equivalents of whole grains from the grains group Number of ounce equivalents of non-whole grains (refined grains) from the grains group WHI MPEDs and Dietary Indices Guidances (September 2016) page 1 Field Name V_TOTAL V_DRKGR V_ORANGE V_POTATO V_STARCY V_TOMATO V_OTHER F_TOTAL F_CITMLB F_OTHER D_TOTAL D_MILK D_YOGURT D_CHEESE M_MPF M_MEAT M_ORGAN M_FRANK M_POULT M_FISH_HI M_FISH_LO M_EGG Description. Total number of cup equivalents from the vegetables group. Includes cup equivalents from: V_DRKGR, V_ORANGE, V_POTATO, V_STARCY, V_TOMATO, and V_OTHER NOTE: V_TOTAL does not include cup equivalents from dry beans and peas (variable LEGUMES). Dry beans and peas can count toward equivalents from either the vegetables or meat and beans group (but not double counted in both) according to USDA's MyPyramid Food Guidance System Number of cup equivalents of dark-green vegetables Number of cup equivalents of orange vegetables Number of cup equivalents of white potatoes Number of cup equivalents of other starchy vegetables, excluding dry beans and peas (LEGUMES) and white potatoes (V_POTATO) Number of cup equivalents of tomatoes Number of cup equivalents of other vegetables, not dark-green (V_DRKGR), orange (V_ORANGE), white potatoes (V_POTATO), other starchy vegetables (V_STARCHY), tomatoes (V_TOMATO), or dry beans or peas (LEGUMES) Total number of cup equivalents from the fruits group Number of cup equivalents of citrus fruits, melons, berries, and their juices Number of cup equivalents of fruits and juices, which are not citrus fruits, melons, berries, or their juices Total number of cup equivalents from the milk group Number of cup equivalents of milk Number of cup equivalents of yogurt Number of cup equivalents of cheese. Includes natural and processed cheese Ounces of cooked lean meat from beef, pork, veal, lamb, and game (M_MEAT); organ meats (M_ORGAN); frankfurters, sausages, and luncheon meat (M_FRANK); poultry (M_POULT); and fish and shellfish (M_FISH_HI and M_FISH_LO) Ounces of cooked lean meat from beef, pork, veal, lamb, and game, excludes lean meat organ meats (M_ORGAN) and frankfurters, sausages, and luncheon meat (M_FRANK) Ounces of cooked lean meat from all types of organ meats, including that from beef, pork, veal, lamb, game, poultry, and fish Ounces of cooked lean meat from frankfurters, sausages, and luncheon meats Ounces of cooked lean meat from chicken, turkey, and other poultry. Excludes poultry organ meats and poultry present in frankfurters, sausages, and luncheon meats Ounces of cooked lean meat from fish, shellfish, and other seafood that are high in the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) Ounces of cooked lean meat from fish, shellfish, and other seafood that are low in the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) Number of ounce equivalents, where one egg is one ounce equivalent of cooked lean meat. Includes eggs and egg substitutes WHI MPEDs and Dietary Indices Guidances (September 2016) page 2 Field Name M_SOY M_NUTSD LEGUMES DISCFAT_OIL DISCFAT_SOL ADD_SUG A_BEV Description. Number of ounce equivalents from soybean products where one cup of soy milk, 1/4 cup of cubed tofu, 1/4 cup of soy nuts, and one ounce of meat analog are one ounce equivalent of cooked lean meat each Number of ounce equivalents of cooked lean meat from nuts and seeds, where ½ ounce of nuts and seeds is one ounce equivalent of cooked lean meat Number of cup equivalents of cooked dry beans and peas [In MPED 2.0, legumes are placed under vegetables and expressed in terms of cup equivalents. They can also be counted meat alternate. See Chapter 1 for guidelines and conversion factors for analyzing legumes as meat alternate.] Grams of discretionary oil from the foods in each of the five major MyPyramid food groups and oils Grams of discretionary solid fat from the foods in each of the five major MyPyramid food groups Teaspoon equivalents of added sugars, where one teaspoon is the quantity of sweetener that contains the same amount of total nutrient sugar as one teaspoon of table sugar. [Added sugars are defined as white sugar, brown sugar, raw sugar, corn syrup, corn syrup solids, high fructose corn syrup, malt syrup, maple syrup, pancake syrup, fructose sweetener, liquid fructose, honey, molasses, dextrose, and dextrin that are eaten separately or as ingredients from processed or prepared foods.] Total drinks of alcohol, where one drink is defined as 12 fluid ounces of beer, five fluid ounces of wine, and 1-1/2 fluid ounces of 80-proof distilled spirits Additional Equivalent Variables Three “non-juice” fruit variables were added to the WHI nutrient database to facilitate calculations for the Healthy Eating Index-2005. These variables are listed below. Field Name F_NJ_TOTAL F_NJ_CITMLB F_NJ_OTHER Description Total number of cup equivalents from the non-juice fruits group Number of cup equivalents of non-juice citrus fruits, melons, and berries Number of cup equivalents of non-juice fruits, which are not citrus fruits, melons, or berries The MPEDs components have been added to the WHI FFQ “nutrient” variables. See variable list at end of this documentation. Healthy Eating Index-2005 (HEI-2005) The Healthy Eating Index-2005 (HEI-2005) is a measure of diet quality that assesses conformance to Federal dietary guidance. The original HEI was created by the U.S. Department of Agriculture (USDA) in 1995. Release of new Dietary Guidelines for Americans in 2005 motivated a revision of the HEI to the HEI-2005. The food group standards are based on the recommendations found in MyPyramid (see Britten et al., Journal of Nutrition Education and Behavior 38(6S) S78-S92). The HEI-2005 construct elements are presented in the USDA Center for Nutrition Policy and Promotion (CNPP) Fact Sheet No. 1 December 2006: Healthy Eating Index-2005 (healthyeatingindex2005factsheet.pdf) WHI MPEDs and Dietary Indices Guidances (September 2016) page 3 The HEI 2005 components and total score have been computed as WHI FFQ “nutrient” variables, and thus guidances for constructing this index are not provided. See the data dictionary on the WHI website: https://www.whi.org/researchers/data/WhiDataDict/f60_mpeds_hei_inv.pdf Additional Dietary Quality Indices A number of additional dietary quality indices may be computed from the MPEDs and FFQ nutrients. Examples include are the Alternate Healthy Eating Index 2010 (AHEI 2010) (1), alternative Mediterranean diet (aMed) (2-4), Dietary Approaches to Stop Hypertension (DASH) (2, 5, 6), and the HEI-2010 (7-9). The following pages provide guidance for which WHI FFQ variables to select when constructing indices for the AHEI-2010, aMed, DASH and HEI-2010. For scoring guidelines, refer to the publications footnoted below each the guidelines for each index on the following pages. WHI MPEDs and Dietary Indices Guidances (September 2016) page 4 MPEDs or FFQ Component Dark-green WHI Variable Name V_DRKGR V_ORANGE V_STARCY Fruit (servings/day) Orange Other starchy vegetables Tomatoes Other vegetables Total fruits Whole grains (g/d) Sugar-sweetened beverages and fruit juice, servings/day Whole-grains Obtain from WHI FFQ items and food groups G_WHL OJ FFQ Item #12: Orange or grapefruit juice, med serv/day. AHEI 2010 a Vegetables (servings/day) V_TOMATO V_OTHER F_NJ_TOTAL KOOLAID Item FFQ Item #13: Tang/Kool-Aid/HiC/other fruit drinks, med serv/day. Notes Use F_NJ_TOTAL from WHI MPEDs variables. This is the whole fruit (NJ = non-juice) variable. Orange juice and grapefruit juice; Tang, Kool-Aid, Hi-C, and other fruit drinks; Other fruit juices such as apple, grape; Regular soft drinks (not diet) Use caution when including 100% fruit juices as the nutrition science community is not all in agreement that 100% fruit juices should be considered with sugar-sweetened beverages. FRTJUICE FFQ Item #14: Other fruit juices, med serv/day. POP FFQ Item #116: Regular soft drinks (not diet), med serv/day Nuts and legumes, servings/day Red/processed meat, servings/day Soybean products (tofu, meat analogs) Nuts and seeds Legumes Meat M_SOY Frankfurters, Sausage, Processed Luncheon Meats M_FRANK M_NUTSD LEGUMES M_MEAT WHI MPEDs and Dietary Indices Guidances (September 2016) page 5 trans Fat (% of energy/day) Obtain from WHI FFQ computed nutrients F60TF181 Dietary Trans Fatty Acid, 181T (g). Dietary Trans Fatty Acid, 182T (g). F60PF205 Dietary PFA 20:5, EPA (g).F60PF226 Dietary PFA 22:6, dha (g). Sum 18:1T and 18:2T. Man-made trans fa are typically 18:1 and 18:2. Multiply g fa by 9 for kcalories; divide kcalories by total kcalories. Long-chain (n-3) fats (EPA + DHA), mg/d Obtain from WHI FFQ computed nutrients PUFA (% energy) Obtain from WHI FFQ computed nutrients F60PFA Dietary Total PFA (g). Multiply g fa by 9 for kcalories; divide kcalories by total kcalories. Sodium (mg/d) Obtain from WHI FFQ computed nutrients F60SODUM Dietary Sodium (mg). Note that WHI FFQ does not collect data on salt added during cooking or at the table. Thus, the WHI FFQ is an incomplete assessment of sodium. If the AHEI-2010 score is a primary exposure, compute calibrated estimates of sodium intake3. To compute the calibrated estimates, data will need to be obtained from the WHI website under the studies, W8 WHI Nutritional Biomarkers (NBS) and AS218 Nutrition and Physical Activity Assessment Study (NPAAS) – available to lead authors of WHI approved paper proposals. Alcohol (drinks/day) Alcoholic beverages A_BEV Sum 20:5 and 22:6. Divide total by 1000 to convert from grams to mg. a Chiuve SE, Fung TT, Rimm EB, Hu FB, et al. Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease. The Journal of nutrition. June 1, 2012 2012;142(6):1009-1018. WHI MPEDs and Dietary Indices Guidances (September 2016) page 6 Alternative Mediterranean (aMed) a, b, c Fruit Vegetables, excluding potatoes Nuts Legumes MPEDs or FFQ Component WHI Variable Name Notes Total fruits F_ TOTAL Includes whole fruits and fruit juices Dark-green V_DRKGR = Sum (V_DRKGR + V_ORANGE + V_TOMATO + V_OTHER) Orange Tomatoes Other vegetables Nuts and seeds Legumes and soy V_ORANGE V_TOMATO V_OTHER M_NUTSD LEGUMES M_SOY = Sum (LEGUMES + M_SOY) To convert dry beans and peas from vegetable cup equivalents to meat and beans group ounce equivalents, multiply the number of LEGUMES cup equivalents by 4 (LEGUMES x 4) Whole grains Fish Ratio of monounsaturated fat to saturated fat Red/processed meat, servings/day Whole-grains Fish, both high and low n-3 fatty acids Obtain from WHI FFQ computed nutrients G_WHL M_FISH_HI M_FISH_LO = Sum (M_FISH_HI + M_FISH_LO) F60MFA F60SFA F60MFA/F60SFA Dietary Total MFA (g)/Dietary Total SFA (g) Meat M_MEAT = Sum (M_MEAT + M_FRANK) Frankfurters, Sausage, Processed Luncheon Meats Cooked lean meat from all types of organ meats, including that from beef, pork, veal, lamb, game, poultry, and fish Alcoholic beverages M_FRANK Or, =Sum ((M_MEAT + M_FRANK) + M_ORGAN) Alcohol (drinks/day) (M_ORGAN) Investigator discretion to include – organ meats include those from red and non-red meat sources A_BEV A_BEV amounts per serving are equivalent to the 5-15 g alcohol that assigns 1 point to the aMed score. Or, F60ALC Or, can use FFQ F60ALC (for grams) a aMed excludes potatoes and splits fruit/nuts into two groups compared to the originally published Mediterranean diet scale by Trichopoulou et al. 2003 (Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean Diet and Survival in a Greek Population. New England Journal of Medicine. 2003;348(26):2599-2608.) WHI MPEDs and Dietary Indices Guidances (September 2016) page 7 b Levitan EB, Lewis CE, Tinker LF, Eaton CB, Ahmed A, Manson JE, Snetselaar LG, Martin LW, Trevisan M, Howard BV, Shikany JM. Mediterranean and DASH Diet Scores and Mortality in Women With Heart Failure: The Women's Health Initiative. Circulation. Heart failure. Nov 1 2013;6(6):1116-1123. c Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women. Circulation. 2009-03-03 00:00:00 2009;119(8):1093-1100. WHI MPEDs and Dietary Indices Guidances (September 2016) page 8 Dietary Approaches to Stop Hypertension (DASH) a, b, c Fruit Vegetables, excluding potatoes Nuts and Legumes MPEDs or FFQ Component WHI Variable Name Notes Total fruits F_ TOTAL Includes whole fruits and fruit juices Dark-green V_DRKGR = Sum (V_DRKGR + V_ORANGE + V_TOMATO + V_OTHER) Orange Tomatoes Other vegetables Nuts and seeds, Legumes, Soy V_ORANGE V_TOMATO V_OTHER M_NUTSD LEGUMES M_SOY Low-fat dairy Whole grains Sodium Whole-grains Obtain from WHI FFQ computed nutrients Sweetened beverages Obtain from FFQ Items and Food Groups: KOOLAID, POP Meat Red/processed meat, servings/day Use SAS code provided G_WHL F60SODUM KOOLAID POP M_MEAT = Sum (M_NUTSD + LEGUMES + M_SOY) If converting dry beans and peas from vegetable cup equivalents to meat and beans group ounce equivalents, multiply the number of LEGUMES cup equivalents by 4 (LEGUMES x 4) See SAS Code for computing DASH dairy (September 2016) If the DASH score is a primary exposure, compute calibrated estimates of sodium intake3. To compute the calibrated estimates, data will need to be obtained from the WHI website under the studies, W8 WHI Nutritional Biomarkers (NBS) and AS218 Nutrition and Physical Activity Assessment Study (NPAAS) – available to lead authors of WHI approved paper proposals. = Sum (KOOLAID + POP) = Sum (M_MEAT + M_FRANK) Or, =Sum (M_MEAT + M_FRANK + M_ORGAN Frankfurters, Sausage, Processed Luncheon Meats All types of organ meats M_FRANK (M_ORGAN) Investigator discretion to include – organ meats include those from red and non-red meat sources, including that from beef, pork, veal, lamb, game, poultry, and fish a Levitan EB, Lewis CE, Tinker LF, Eaton CB, Ahmed A, Manson JE, Snetselaar LG, Martin LW, Trevisan M, Howard BV, Shikany JM. Mediterranean and DASH Diet Scores and Mortality in Women with Heart Failure: The Women's Health Initiative. Circulation. Heart failure. Nov 1 2013;6(6):1116-1123. WHI MPEDs and Dietary Indices Guidances (September 2016) page 9 b Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a dash-style diet and risk of coronary heart disease and stroke in women. Archives of internal medicine. 2008;168(7):713-720. c Huang Y, Van Horn L, Tinker LF, Neuhouser ML, Carbone L, Mossavar-Rahmani Y, Thomas F, Prentice RL. Measurement error corrected sodium and potassium intake estimation using 24-hour urinary excretion. Hypertension. Feb 2014;63(2):238-244. WHI MPEDs and Dietary Indices Guidances (September 2016) page 10 Total Fruit MPEDs or FFQ Component Total fruit WHI Variable Name F_TOTAL Whole Fruit Non-juice fruit F_NJ_TOTAL Total Vegetables Total Vegetable V_TOTAL Greens and Beans Dark-green V_DRKGR HEI 2010 a, b, c LEGUMES Whole grains Dairy Whole-grains All dairy G_WHL D_TOTAL Total Protein Foods All meats, poultry, fish (and beans and peas if total protein standard not met) M_MPF (and if Total Protein Foods standard is not met: +LEGUMES) M_FISH_HI + M_FISH_LO + M_NUTSD + M_SOYESM +LEGUMES that are counted as Total Protein Foods (F60PFA Dietary Total PFA (g) + F60MFA Dietary Total MFA (g))/F60SFA Dietary Total SFA ≥ 2.5 Seafood and Plant Proteins Fatty Acids Refined Grains (PUFAs + MUFAs)/SFAs ≥ 2.5 Notes Includes 100% fruit juice Use F_NJ_TOTAL from WHI MPEDs variables. This is the whole fruit (NJ = non-juice) variable. Includes all forms except juice Includes any beans and peas not counted as Total Protein Foods. Includes any beans and peas not counted as Total Protein Foods. Includes all milk products, such as fluid milk, yogurt, and cheese, and fortified soy beverages. Beans and peas [LEGUMES] are included here (and not with vegetables) when the Total Protein Foods standard is otherwise not met. Beans and peas are included here (and not with vegetables) when the Total Protein Foods standard is otherwise not met. Includes seafood, nuts, seeds, soy products (other than beverages) as well as beans and peas counted as Total Protein Foods. Ratio of poly- and monounsaturated fatty acids (PUFAs and MUFAs) to saturated fatty acids (SFAs) G_NWHL WHI MPEDs and Dietary Indices Guidances (September 2016) page 11 Sodium (mg/d) Empty Calories Obtain from WHI FFQ computed nutrients F60SODUM Dietary Sodium (mg). HEI12 Note that WHI FFQ does not collect data on salt added during cooking or at the table. Thus, the WHI FFQ is an incomplete assessment of sodium. If the HEI-2010 score is a primary exposure, compute calibrated estimates of sodium intake3. To compute the calibrated estimates, data will need to be obtained from the WHI website under the studies, W8 WHI Nutritional Biomarkers (NBS) and AS218 Nutrition and Physical Activity Assessment Study (NPAAS) – available to lead authors of WHI approved paper proposals. Calories from solid fats, alcohol, and added sugars; threshold for counting alcohol is > 13 grams/1,000 kcal or 28 g/day. The HEI12, computed for the HEI-2005, is an approximation as there is no qualifier for amount of alcohol consumed. a Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Update of the Healthy Eating Index: HEI-2010. Journal of the Academy of Nutrition and Dietetics. Apr 2013;113(4):569-580. b Guenther PM, Kirkpatrick SI, Reedy J, Krebs-Smith SM, Buckman DW, Dodd KW, Casavale KO, Carroll RJ. The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans. The Journal of nutrition. Mar 2014;144(3):399-407. c Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HAB, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Healthy Eating Index (HEI-2010). 2013; https://www.whi.org/researchers/data/Documents/WHI%20MPEDS%20and%20HEI%20Dataset_contents.pdf . Accessed August 19. 2016, 2016. WHI MPEDs and Dietary Indices Guidances (September 2016) page 12 References Cited 1. 2. 3. 4. 5. 6. 7. 8. 9. Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, Stampfer MJ, Willett WC. Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease. The Journal of nutrition 2012;142(6):1009-1018. doi: 10.3945/jn.111.157222. Levitan EB, Lewis CE, Tinker LF, Eaton CB, Ahmed A, Manson JE, Snetselaar LG, Martin LW, Trevisan M, Howard BV, Shikany JM. Mediterranean and DASH Diet Scores and Mortality in Women With Heart Failure: The Women's Health Initiative. Circulation Heart failure 2013;6(6):1116-1123. doi: 10.1161/circheartfailure.113.000495. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women. Circulation 2009;119(8):1093-1100. doi: 10.1161/circulationaha.108.816736. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. The New England journal of medicine 2003;348(26):2599-2608. doi: 10.1056/NEJMoa025039. Huang Y, Van Horn L, Tinker LF, Neuhouser ML, Carbone L, Mossavar-Rahmani Y, Thomas F, Prentice RL. Measurement error corrected sodium and potassium intake estimation using 24-hour urinary excretion. Hypertension 2014;63(2):238-244. doi: 10.1161/hypertensionaha.113.02218. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a dash-style diet and risk of coronary heart disease and stroke in women. Archives of internal medicine 2008;168(7):713-720. doi: 10.1001/archinte.168.7.713. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Update of the Healthy Eating Index: HEI-2010. Journal of the Academy of Nutrition and Dietetics 2013;113(4):569-580. doi: 10.1016/j.jand.2012.12.016. Guenther PM, Kirkpatrick SI, Reedy J, Krebs-Smith SM, Buckman DW, Dodd KW, Casavale KO, Carroll RJ. The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans. The Journal of nutrition 2014;144(3):399-407. doi: 10.3945/jn.113.183079. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HAB, Kuczynski KJ, Kahle LL, KrebsSmith SM. Internet: https://www.whi.org/researchers/data/Documents/WHI%20MPEDS%20and%20HEI%20Dataset_conte nts.pdf (accessed August 19. 2016 2016). WHI MPEDs and Dietary Indices Guidances (September 2016) page 13